Type 1 diabetes

The immune system destroys the cells that make insulin. Nothing to do with lifestyle, and insulin is not optional.

What it is

Type 1 diabetes is an autoimmune condition. The immune system destroys the beta cells in the pancreas that make insulin, and without insulin the body cannot use glucose for fuel.

It is not caused by diet, weight or anything anybody did. Around 400,000 people in the UK have it, including roughly 29,000 children.

Insulin is life-sustaining, not a treatment that can be paused. Missing it leads to diabetic ketoacidosis, which is a medical emergency and kills people.

Technology has changed this condition enormously in ten years: continuous glucose monitoring and hybrid closed-loop systems now do part of the thinking that people previously did by hand, dozens of times a day.

Signs you might notice

At onset, the classic four: passing urine frequently, extreme thirst, weight loss, and tiredness. Often over weeks.

In children, bedwetting after being dry, thrush, and blurred vision.

Diabetic ketoacidosis: vomiting, abdominal pain, deep rapid breathing, breath smelling of pear drops, drowsiness. That is a 999 call.

Hypoglycaemia: shaking, sweating, confusion, irritability, and eventually unconsciousness.

How it can affect day-to-day life

The invisible work is relentless. Carbohydrate counting, dose adjustment, exercise planning, illness rules, and the mental load of never being off duty. Diabetes distress and burnout are real, common, and rarely asked about.

Hypo anxiety, particularly at night, shapes decisions and drives people to run their glucose higher than is good for them.

In care settings, the biggest risks are missed insulin, insulin given without food, and staff not recognising a hypo. All three are documented causes of serious harm.

Supporting someone well

Never omit insulin, including when somebody is unwell and not eating. Sick day rules exist precisely for that situation, and stopping insulin is what causes ketoacidosis.

Treat a hypo fast: 15 to 20g of fast-acting carbohydrate, wait 15 minutes, retest, then follow with longer-acting carbohydrate. Never leave somebody alone during one.

Know where the glucagon is and who can give it.

Ask about technology. CGM and closed-loop systems are available on the NHS to far more people than currently use them, and asking is often what unlocks them.

Ask about structured education such as DAFNE.

Ask about diabetes distress, not just about the numbers.

Fiducia Guardian holds insulin regimes, hypo plans and the care team in one record, which is what a school, a respite service and a family need to be doing the same thing.

Where to get help

A specialist diabetes team, not a GP alone, should manage type 1.

Diabetes UK run a helpline on 0345 123 2399 and JDRF focus on type 1 specifically.

Ketoacidosis symptoms need 999. Ketones with high glucose need urgent advice the same day.