Is T1 diabetes preventable?

Ian DP said:

You are right, I am sure they will start rising at some point. They could indeed have been slowly destroyed my whole life, indeed I think that is highly likely.... Which also strengthens my argument that had I been able to have kept my BG at a lower level prior to diagnosis, my diagnosis would have been deferred.

Phoenix has pointed out that LADA onset is different to T1 onset. You are probably right, T1 onset can not be prevented, but I still think mine (LADA) could. Since LADA is early T1, I had mistakenly thought the two on sets were the same.

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I think u r right that it could be deferred, but it wouldn't stop it.
LADA is T1 that develops more slowly. I wouldn't try to reason whether u could have stopped it, u couldn't, u will just drive urself mad. There's no way diet could have stopped the antibodies killing the beta cells

Ian, I've edited the link and it seems to work.
I think that the onset of T1 and LADA are different but that the outcome ketosis prone and an absence of sufficient insulin to function properly are the same.
Personally, I had three years that I know I had diabetes before I developed DKA and needed insulin.
I don't think that there is any evidence that a lower carb or indeed lower calorie diet saved people with autoimmune diabetes prior to the introduction of insulin. It may have sometimes prolonged life but not a very good life The statistics and pictures of children with T1 before insulin make grim reading. Older people lasted longer but of course most of those, as today, would have had T2. Basically if you had acute onset then you didn't have many years left. Most people who we now know have LADA would have had acute onset (ie DKA) because they wouldn't have been diagnosed until a later stage

It's another question entirely and not to do with T1/LADA but I also don't think that the global epidemic of diabetes has happened because of carbohydrates; The staple food of many of the countries concerned was until recently mainly plant and starch dominated Think about Asia.
Have a look at the Island of Nauru
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I guess onset conditions are something that varies for different people. I wouldn't have said I felt ill when I was diagnosed, but I had slowed down, lost weight and gone off foods. I was also much more emotionally volatile. I didn't feel ill per se, but my bs was astonishingly high and I would have been very much in DKA.

Ian DP said:

Any idea of your BG levels before diagnosis.... A month before? A year before? 5 years before?

It would be interesting to know someone's BG reading before diagnosis.

I have no idea of mine, but guess they were probably rising for some years beforehand

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Of course not! I was diagnosed at 13 after over a year of progression that can be traced back to a flu virus. A month before my diagnosis, I imagine I was not far off the levels I was at when I was diagnosed. My urine strip turned black when I used it, which was off the scale on the Urine testers.

Ian, I can't give you any figures but I can tell you I lost a lot of weight etc and was convinced I had diabetes. I 'confirmed' it with a urine test that went the darkest possible colour (I 'filched' one from the hospital loo when my daughter was in labour!)
Not going into detail but I didn't go to a doctor, I did mostly try to do what someone diagnosed with T2 would be told ie I (mostly) ate a healthy diet (low GI ), I exercised.
This was three years before I went to a doctor following more weight loss accompanied by a total lack of energy ( I knitted 3 jumpers in about a month, I didn't knit before and haven't since!.
To get over the inactivity, I forced myself to try a mountain bike ride, ended up gasping for breath .My husband thought I was having a heart attack,. Got back to the car breathing became normal again. I found a GP , tried to explain. To his credi, he sent this very skinny, mad Englishwoman who seemed to think she had T2 for a fasting blood test. Had it next morning, results faxed to the doctor and I ended up in hospital for 10 days!
Looking back, I think that after my first bout of weight loss there were sufficient beta cells to cope whilst I ate and exercised normally. They were though still being lost, slowly. Eventually the critical point came again and by this time far too little insulin was being produced. ( c peptide was very low) and I hadn't enough insulin to keep fasting levels at anything like normal. (mid 20s at diagnosis) My Hba1c though wasn't sky high, it was in the 7s.
The gradual loss of cells was 'normal' for LADA . It seems to take longer in older people than younger (though there are case labelled LADY of LADC (latent autoimmune diabetes in the young/children) . As it is caused by an autoimmnune reaction it's going to happen whatever you eat.
Your lower carb diet may mean that you can avoid insulin for a while (until you have insufficient to deal with basal needs) but that is a personal choice Normal peoples glucose , is not by any means static, it moves up after meals and their body releases insulin to deal with it. If you can't eat a few berries at breakfast then you don't have sufficient insulin function to cope with normal requirement..
. People have very good outcomes when they use insulin sensibly to control their glucose to reasonably good levels (the DCCT trials didn't find anything like the same benefit for reducing HbA1c levels below 6.5% as they did for reducing levels below 8%)

phoenix said:

. People have very good outcomes when they use insulin sensibly to control their glucose to reasonably good levels (the DCCT trials didn't find anything like the same benefit for reducing HbA1c levels below 6.5% as they did for reducing levels below 8%)

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That's an interesting stat. Given my Libre reckons I'm currently running at about 5.8%, I have upwards leeway.

If only it was preventable.............

This is the DCCT complication graph The risk never gets to zero though.

It might be something else that causes some individuals to have a higher risk. The people in the Joslin medallist trial with no complications have an average HbA1c of over 7% (and some have HbA1cs on file going back to when they were first introduced). The fifty year survivors who have some complications don't have that different an average HbA1c. I'll look it up and add a link to the post later.


edit:
you can read the whole paper here. These people are of course the survivors and to be clear, though they are increasing in number hugely, not everyone was a survivor (though it also has to be remembered that when diagnosed, they didn't have the tools we have today)
http://care.diabetesjournals.org/content/34/4/968.full.pdf
No significant relationship was found between glycemic control and any complication in the Medalist cohort.

.Behavioral skills leading to improved control of blood glucose, blood pressure, and cholesterol are clearly crucial in preventing complications in diabetic patients in general. Indeed, the mean Medalist HbA1c of 7.3% indicates good glycemic control in many subjects, and it is possible that Medalists without complications had better control during early diabetes than those who developed complications.
However, the existence of additional unique protective factors in some Medalists is supported by the fact that glycemic control was not related to complications in this cohort despite a wide range of HbA1c (5–14%).

I really believe that one day LADA will be shown to be a completely different condition than Type 1.

Everything about my condition was slow onset. Obviously I don't know how long I had diabetes prior to diagnosis, but the weight loss and illness didn't happen until about 9 months to a year after diagnosis. My fasting levels were excellent for a long time without insulin or medication, but I couldn't eat a thing without spiking high. Still can't. Five years on, I still produce some of my own insulin and still use relatively small amounts of injected. Tiny, tiny amounts of carb raise my BG into double figures - only 6g needed to correct a minor hypo - and it actually overcorrects it (e.g. a 6g sweet will take 3.1mmol to 8mmol and above). My BG changes slowly - no rapid drops usually - unless I do something to prompt it to change (e.g. eat a sweet). I have good tolerance of low BG levels but very poor tolerance of high BG levels. My body corrects low BGs very well. Very little I read about Type 1 seems to match what I experience.

I believe that if I had low-carbed before diagnosis I might have slowed-down the onset considerably, but we shall never know. I believe that had my original diagnosis been correct (rather than Type 2 to be controlled on diet and exercise) I might have slowed-down the onset considerably, but again we shall never know. I just wish the medical profession would care more about studying and understanding these 'anomolies' rather than brushing things off with 'everybody's different' type statements. Then we might actually learn something about LADA.

Smidge

With Type 1 there was a great Finish study looking at vitamin D supplementation in newborns and they found a massive 88% reduction in frequency of Type 1 diabetes in those that had received supplementation of 2,000 IUs of vitamin D3.

The idea as I understood it was that births in winter would mean that the infants would be vitamin D deficient so the body compensated by overstimulating the normal immune response; this meant that the infants' chances of surviving were normalised but the consequence was that their immune system remained in a chronically activated state until exposed to normal vitamin D levels. If they weren't then that dramatically increased the risk of Type 1 diabetes.

Any Type 1 diabetics should not bet against the house and supplement their children with vitamin D for at least the first 12 months of their lives.

http://www.ncbi.nlm.nih.gov/pubmed/11705562

Best

Dillinger

@Dillinger
I wonder when they stopped advocating vit D supplementation and if it made any difference to the number of diagnoses
My children both had drops which the 'baby clinic' provided. When I was a child it was supplemented as a spoonful of malt with cod liver oil (.just like Roo in Winnie the Poo)
They are doing an up to 15 year prospective study looking into what might be the triggers in childhood onset T1. I think I would have a spread bet, if that's the right term, at there being more than one significant trigger .
https://teddy.epi.usf.edu/TEDDY/index.htm

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I remember the drops that we used to have on breakfast cereal as a wee nipper. Oh, but I'm T1

phoenix said:

@Dillinger
I wonder when they stopped advocating vit D supplementation and if it made any difference to the number of diagnoses
My children both had drops which the 'baby clinic' provided. When I was a child it was supplemented as a spoonful of malt with cod liver oil (.just like Roo in Winnie the Poo)
They are doing an up to 15 year prospective study looking into what might be the triggers in childhood onset T1. I think I would have a spread bet, if that's the right term, at there being more than one significant trigger .
https://teddy.epi.usf.edu/TEDDY/index.htm

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True; I'm sure it's not the sole factor but it seems to make sense as an explanation.

The other thing is that perhaps being Finland most people were vitamin d deficient all the time so the effect was heightened; and if the test happened in the sunny south of France perhaps the effect would be lower.

Annoyingly, I can't find the article/study that suggested the mechanism I describe above. As I understood it after the Finish study was carried out they reduced the vitamin d levels for supplementation and guess what? They reduction in Type 1 diabetes disappeared.

There seems to be quite a few studies that essentially say; dosage at this small level has no effect therefore vitamin d has no effect...

Best

Dillinger

tim2000s said:

I remember the drops that we used to have on breakfast cereal as a wee nipper. Oh, but I'm T1

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You're just lucky I guess...