Severe form of diabetes on the rise

The number of people being diagnosed with the most serious form of diabetes, Type 1, has risen significantly in the past few years in a trend that has experts baffled.

Unlike Type 2 diabetes, which often occurs in adulthood and insulin-resistance is sometimes triggered by obesity, Type 1 diabetes typically occurs in childhood and is a genetic-based immune disorder. Although Type 2 diabetes can largely be managed by diet and exercise, Type 1 requires a lifetime regimen of insulin injections and is harder to manage.

Cases in Memorial Health System rose from 31 in 2006 to 42 in 2007, said Leigh MacHaffie, Memorial Hospital for Children’s diabetes case manager. Memorial, with a children’s Pediatric Intensive Care Unit, receives most of southern Colorado’s serious cases.

Lynn Page, branch manager for the Juvenile Diabetes Research Foundation, said that four years ago the region had about two to three cases per month reported through its outreach program. Today that number is six to seven per month.

Diagnoses of Type 1 diabetes have doubled since the mid-’80s and are increasing by 3 percent to 5 percent a year internationally, according to a publication by Juvenile Diabetes Research Foundation International. Colorado, Page said, has the second-highest number of new Type 1 diabetes cases in the country.

The rising rates have medical experts scratching their heads.

“Long story short, we don’t know why it’s going up like it is,” Page said.

Type 1 diabetes is the second-most common chronic childhood illness after asthma, MacHaffie said.

Researchers have found that people are genetically predisposed to get Type 1 diabetes, just as some people have genetics making them susceptible to certain cancers. They also know that something in the environment ignites this genetic cocktail to turn the body against its insulin-producing cells in the pancreas.

Those environmental factors, though, remain a mystery. People have been diagnosed with Type 1 diabetes after a bout of flu, pneumonia or even stress. It is thought something has changed in the modern-day environment that’s driving the rise, but that change has eluded doctors.

The Barbara Davis Center for Childhood Diabetes at Aurora’s Anschutz Medical Campus has been researching the interplay between genetics and environment in hundreds of children predisposed to diabetes. It recently found a key antibody that might someday be used in diabetes therapy.

The center points to two prominent guesses about a cause. In one, researchers say a viral infection may trigger diabetes. In the other, “the hygiene hypothesis,” society’s sanitary practices have retrained our immune systems to attack themselves in the form of autoimmune diseases.

Memorial’s children’s hospital has seen surges of cases in the fall, during the holidays and again in the spring.

The Juvenile Diabetes Research Foundation is not devoting resources to the question, but instead concentrating on how to combat the problem, Page said.

“We don’t want to spend the research dollars to find out why,” she said. “We want to find a cure and minimize the complications while we look for one.”

MacHaffie, in her role at Memorial, is a family nurse practitioner and certified diabetes educator who helps newly diagnosed diabetics and establishes their insulin regimen. She has seen it diagnosed in months-old babies and people well into adulthood. Whatever the age, she said it’s “devastating” to families.

When insulin shots and diet are meticulously managed, people can live reasonably normal, healthy lives.

That often isn’t the case. Teenagers grow frustrated and rebel. Parents don’t understand the gravity of a poorly managed diet for their young children. The uninsured face $200 to $300 a month in costs for medical materials such as test strips and insulin.

The consequences of unregulated blood sugar can lead to blindness, amputation, stroke, coma and a host of other complications.

MacHaffie pointed to a former patient, a 28-year-old woman, who had recently gone to hospice with complications from Type 1 diabetes. She died Tuesday.