What type 1 diabetes is, and what the job actually is

This page answers two questions: what type 1 diabetes actually is, and what living with it asks of someone every day. Both are widely misunderstood — including, often, by the people closest to the person who has it.

An autoimmune condition

In type 1 diabetes, the immune system has destroyed the cells in the pancreas that make insulin. It is the same category of thing as coeliac disease or thyroid disease — which is why those conditions often turn up alongside it.

Nobody caused it

Not sugar. Not diet. Not parenting. Not anything anyone did or failed to do.

It is not type 2

Type 1 and type 2 have a different cause, a different treatment and different risks. Almost everything the public believes about diabetes is about type 2, and most of it does not transfer.

That confusion has a real cost. Roughly three in four people with type 1 report experiencing stigma — most often being seen as having a character flaw — and nearly all of that comes from being confused with type 2. This explains a lot of what people with type 1 experience socially. It can land hard with families who realize they have been contributing to it without knowing; the point is not blame, it is noticing.

Insulin is not optional

There is no diet, supplement or amount of exercise that replaces insulin in type 1. Anyone selling otherwise is selling something dangerous.

The job: replacing a feedback loop, by hand, forever

A working pancreas measures blood sugar and adjusts insulin continuously, hundreds of times an hour, with no conscious effort at all.

Replacing that means:

• estimating what is in your food,
• predicting what your body is about to do,
• injecting a decision that cannot be taken back,
• and then living with the result for the next four hours.

Several times a day. Every day. With no days off.

That point about a decision that cannot be taken back is what separates insulin from most other medication. Once the dose is in, it works whether or not the meal arrives, whether or not the afternoon goes as planned.

Everything else on this site is detail. This is the actual work, and it is far harder than it looks from outside. For family members, this is the part that conveys the scale of it.

Where to go next

If you read only one more thing today, make it the two emergencies — how to recognize and treat a low, and when ketoacidosis means going to hospital. After that, the three daily levers explain what moves blood sugar up and down from hour to hour.