Research & Education

Type 1 Diabetes & Early Mortality

A study published recently in The Lancet added a new layer of information to what was already, unfortunately, known about those with type 1 diabetes: not only do they have greater mortality and cardiovascular disease incidence than healthy individuals, but the earlier they’re diagnosed, the larger the risk. In other words, the longer they live with type 1 diabetes, the shorter they live, or the sooner they develop cardiovascular disease.

The study, conducted in the Swedish population, found that women diagnosed with type 1 diabetes (T1D) before they were 10 years old die an average of nearly 18 years earlier than women without diabetes. Men don’t fare much better: with a T1D diagnosis before 10 years of age, they die 14 years sooner than nondiabetic men. People diagnosed a little later in life—age 26-30 years—have a lifespan 10 years shorter than nondiabetics.

Regarding risk for CVD, compared to healthy individuals, risk among those who develop T1D before 10 years of age was nearly a whopping 30 times higher. Risk for those diagnosed at age 26-30 years was 6 times higher. The most striking finding among findings all of which were striking, was that women who developed T1D before the age of ten years had risk of experiencing a heart attack 90 times higher than for controls without diabetes.

Individuals with T1D suffer the same long-term complications as those with type 2 diabetes, especially if their blood glucose is poorly managed. Beyond the retinopathy, nephropathy, neuropathy, and other microvascular damage stemming from chronic hyperglycemia, ever-increasing doses of insulin mean that those with T1D may experience problems resulting from medication-induced hyperinsulinemia, which are the same as those from exposure to excessive amounts of the body’s own endogenous insulin, such as hypertension and weight gain. This is the infamous “double diabetes,” wherein individuals with T1D—who produce no insulin—actually suffer the consequences of chronic hyperinsulinemia due to large doses of exogenous insulin.

It makes sense that people diagnosed with T1D at a younger age would have greater risk for adverse health outcomes: the longer they’re exposed to hyperglycemia and/or hyperinsulinemia, the more time those things have to exert their effects on the cardiovascular system, not to mention the kidneys, nervous system, and brain. (Research from the Joslin Diabetes Center revealed that long-term type 1 diabetics have a slight decline in cognitive function compared to healthy individuals. Chronically high blood glucose—in fact, even glucose that’s only slightly high—seems to be a risk factor for dementia over the long term.) 

Fortunately, a growing body of research—plus thousands of individuals taking matters into their own hands—indicates that it is entirely possible for type 1 diabetics to achieve normal blood sugars. We recently covered a survey showing type 1 diabetics maintaining exceptionally good glycemic control via a low-carbohydrate diet, often with glucose measurements and HbA1c percentages even non-diabetics find it difficult to achieve. 

Richard Bernstein, MD, author of Dr. Bernstein’s Diabetes Solution: The Complete Guide to Achieving Normal Blood Sugars, and himself an octogenarian type 1 diabetic, said it best: “We are not doomed to share the fate of others after years of painful diabetic complications. With the ability to control our blood sugars comes the ability to prevent the consequences of high blood sugars.” (Source.)

Araz Rawshani, one of the authors of the Swedish study, would likely agree. Rawshani said:

“We know with certainty that if we maintain good blood sugar control in these patients, we can lower the risk of cardiovascular damage. This makes it important to carefully consider both evidence-based medications and modern technological aids for blood sugar measurements and insulin administration in patients diagnosed with type 1 diabetes at an early age. At the same time the study must also be viewed in the light of the tremendous progress that has been made in the past few decades. Management of type 1 diabetes is nowadays highly sophisticated, with modern tools for glucose monitoring, delivery of insulin and management of cardiovascular risk factors.”

Perhaps the best of these “modern tools” and “modern technological aids” is a continuous glucose monitor (CGM). These devices deliver clear feedback as to which foods and lifestyle factors affect glucose the most, giving people actionable information with regard to changes they can make to get on the path to normal blood sugars. They no longer have to guess, fly blind, and hope for the best.

If maintaining glucose within a healthy range can prevent the complications of long-term hyperglycemia, and controlling blood glucose more effectively via diet means lower doses of exogenous insulin are required, then type 1 diabetics—regardless of age at diagnosis—may be able to take a more active role in their health destiny, and quite possibly their lifespan.

Aside from Dr. Bernstein, other physicians with T1D are using low carb/ketogenic diets to manage their diabetes: Carrie Diulus, MD, and Keith Runyan, MD are just two of them.

By Amy Berger, MS, CNS


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