It is World Diabetes Day today. As many of you know, diabetes is close to my heart as my youngest daughter was diagnosed with type 1 when she was just two years old – and this started me down the track of becoming a nutritionist.

For many, the diagnosis can be traumatic, if the body has started using fats and proteins for energy (as it can no longer use sugar properly) and has created high levels of ketones as a result, as these can make the blood dangerously acidic. Many of my friends’ children were taken into intensive care at diagnosis because of this, battling for their lives.

To avoid this, you need to be diagnosed early, and started on insulin treatment.

Symptoms and diagnosis

Knowing the 4Ts – tired, thirsty, toilet, thinner – can help you recognise if someone you know might have diabetes. These signs – drinking and weeing more, fatigue and losing weight – are also applicable to type 2 diabetes.

If you are ever worried that you could have diabetes, then don’t wait – ask the doctors to do a finger-prick blood test or a urine test to see what your sugar levels are. These are really cheap tests to do – and it is so much better to ‘make a fuss’ when it’s nothing – than end up in hospital with acidosis (which would cost loads more to the NHS in the long run – and to your health and mental wellbeing…)

Remember as well that just because you are older, doesn’t mean that you definitely have type 2. The autoimmune attack that leads to type 1 diabetes can happen to anyone, at any age. If you have autoimmunity in your family, or have recently had a virus or a stressful experience that could have triggered the immune reaction, or if you don’t feel that you have the normal risk factors for type 2 diabetes – do ask the question, could this be type 1? Without the proper diagnosis you might not be given insulin, and you may continue to get worse.

There are also other types of diabetes – you may have variants of some genes involved in regulating the amount of sugar in your blood, for example – and these too are often missed at diagnosis.

Immune system involvement

As type 1 diabetes is an autoimmune condition, having it can increase the risk that you develop other autoimmune conditions. To my mind this means that there is an argument for looking into ways to calm down the over-active immune system – in order to reduce that risk.

Interestingly, I saw a talk years ago where a Professor of Immunology at King’s College spoke about Joslin medal winners (those are people who have lived with diabetes for 25 or 50 years). Some of these donated their bodies to medical science upon their death – and when scientists examined their pancreases (or is it pancrei??) they found there were some functioning insulin producing beta-cells still there – but they also saw immune cells within the pancreas, which were likely destroying these cells.

This suggests that the body continues to be capable of producing beta-cells, but it is, at the same time, continually getting rid of them again. If then, we could stop the immune system in its tracks, re-educate it, people with type 1 diabetes could again start to produce their own insulin. This is what Professor Peakman was looking into – a desensitisation approach, much like is done with giving minuscule doses of peanut to allergy sufferers.

We are still way off this in terms of actual therapies, but it gives me hope that making changes to diet and lifestyle that support better regulatory responses within the immune system has a point. And sometimes you just need to cling to that hope.

I am not so naïve as to believe that with a few diet and lifestyle interventions, people with type 1 would be able to live without insulin. However, beta cells also help the alpha cells of the pancreas work properly. The alpha cells produce a hormone called glucagon which is released if blood sugars are dropping too low – leading to glucose being released from the liver to raise blood sugars again. Without the beta cells the alpha cells can make this glucagon, but don’t release it so easily – so not only are you battling high blood sugars as you have no insulin production, you are more at risk of low sugars – hypoglycaemia – which can have fatal consequences. If you could just retain enough beta-cells that your alpha-cells could work better… I’d take that as a win.

There is a time and a place for this however. Getting your head around living with type 1 and taking on the role of your own pancreas is a full time job, especially at the start. If you are further down the line, and have got a handle on managing your condition, nutritional therapy can help you to identify some of the underlying factors that could be contributing to dysfunctional immune system regulation in your individual case.

If you would like to look into this ever, I am more than happy to be on your team.

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