presentation of type 1

• Patient Care & Health Information
• Diseases & Conditions
• Type 1 diabetes

What is type 1 diabetes? A Mayo Clinic expert explains

Learn more about type 1 diabetes from endocrinologist Yogish Kudva, M.B.B.S.

I'm Dr. Yogish C. Kudva an endocrinologist at Mayo Clinic. In this video, we'll cover the basics of type 1 diabetes. What is it? Who gets it? The symptoms, diagnosis, and treatment. Whether you're looking for answers for yourself or someone you love. We are here to give you the best information available. Type 1 diabetes is a chronic condition that affects the insulin making cells of the pancreas. It's estimated that about 1.25 million Americans live with it. People with type 1 diabetes don't make enough insulin. An important hormone produced by the pancreas. Insulin allows your cells to store sugar or glucose and fat and produce energy. Unfortunately, there is no known cure. But treatment can prevent complications and also improve everyday life for patients with type 1 diabetes. Lots of people with type 1 diabetes live a full life. And the more we learn and develop treatment for the disorder, the better the outcome.

We don't know what exactly causes type 1 diabetes. We believe that it is an auto-immune disorder where the body mistakenly destroys insulin producing cells in the pancreas. Typically, the pancreas secretes insulin into the bloodstream. The insulin circulates, letting sugar enter your cells. This sugar or glucose, is the main source of energy for cells in the brain, muscle cells, and other tissues. However, once most insulin producing cells are destroyed, the pancreas can't produce enough insulin, meaning the glucose can't enter the cells, resulting in an excess of blood sugar floating in the bloodstream. This can cause life-threatening complications. And this condition is called diabetic ketoacidosis. Although we don't know what causes it, we do know certain factors can contribute to the onset of type 1 diabetes. Family history. Anyone with a parent or sibling with type 1 diabetes has a slightly increased risk of developing it. Genetics. The presence of certain genes can also indicate an increased risk. Geography. Type 1 diabetes becomes more common as you travel away from the equator. Age, although it can occur at any age there are two noticeable peaks. The first occurs in children between four and seven years of age and the second is between 10 and 14 years old.

Signs and symptoms of type 1 diabetes can appear rather suddenly, especially in children. They may include increased thirst, frequent urination, bed wetting in children who previously didn't wet the bed. Extreme hunger, unintended weight loss, fatigue and weakness, blurred vision, irritability, and other mood changes. If you or your child are experiencing any of these symptoms, you should talk to your doctor.

The best way to determine if you have type 1 diabetes is a blood test. There are different methods such as an A1C test, a random blood sugar test, or a fasting blood sugar test. They are all effective and your doctor can help determine what's appropriate for you. If you are diagnosed with diabetes, your doctor may order additional tests to check for antibodies that are common in type 1 diabetes in the test called C-peptide, which measures the amount of insulin produced when checked simultaneously with a fasting glucose. These tests can help distinguish between type 1 and type 2 diabetes when a diagnosis is uncertain.

If you have been diagnosed with type 1 diabetes, you may be wondering what treatment looks like. It could mean taking insulin, counting carbohydrates, fat protein, and monitoring your glucose frequently, eating healthy foods, and exercising regularly to maintain a healthy weight. Generally, those with type 1 diabetes will need lifelong insulin therapy. There are many different types of insulin and more are being developed that are more efficient. And what you may take may change. Again, your doctor will help you navigate what's right for you. A significant advance in treatment from the last several years has been the development and availability of continuous glucose monitoring and insulin pumps that automatically adjust insulin working with the continuous glucose monitor. This type of treatment is the best treatment at this time for type 1 diabetes. This is an exciting time for patients and for physicians that are keen to develop, prescribe such therapies. Surgery is another option. A successful pancreas transplant can erase the need for additional insulin. However, transplants aren't always available, not successful and the procedure can pose serious risks. Sometimes it may outweigh the dangers of diabetes itself. So transplants are often reserved for those with very difficult to manage conditions. A successful transplant can bring life transforming results. However, surgery is always a serious endeavor and requires ample research and concentration from you, your family, and your medical team.

The fact that we don't know what causes type 1 diabetes can be alarming. The fact that we don't have a cure for it even more so. But with the right doctor, medical team and treatment, type 1 diabetes can be managed. So those who live with it can get on living. If you would like to learn even more about type 1 diabetes, watch our other related videos or visit mayoclinic.org. We wish you well.

Type 1 diabetes, once known as juvenile diabetes or insulin-dependent diabetes, is a chronic condition. In this condition, the pancreas makes little or no insulin. Insulin is a hormone the body uses to allow sugar (glucose) to enter cells to produce energy.

Different factors, such as genetics and some viruses, may cause type 1 diabetes. Although type 1 diabetes usually appears during childhood or adolescence, it can develop in adults.

Even after a lot of research, type 1 diabetes has no cure. Treatment is directed toward managing the amount of sugar in the blood using insulin, diet and lifestyle to prevent complications.

Products & Services

• A Book: The Essential Diabetes Book

Type 1 diabetes symptoms can appear suddenly and may include:

• Feeling more thirsty than usual
• Urinating a lot
• Bed-wetting in children who have never wet the bed during the night
• Feeling very hungry
• Losing weight without trying
• Feeling irritable or having other mood changes
• Feeling tired and weak
• Having blurry vision

When to see a doctor

Talk to your health care provider if you notice any of the above symptoms in you or your child.

The exact cause of type 1 diabetes is unknown. Usually, the body's own immune system — which normally fights harmful bacteria and viruses — destroys the insulin-producing (islet) cells in the pancreas. Other possible causes include:

• Exposure to viruses and other environmental factors

The role of insulin

Once a large number of islet cells are destroyed, the body will produce little or no insulin. Insulin is a hormone that comes from a gland behind and below the stomach (pancreas).

• The pancreas puts insulin into the bloodstream.
• Insulin travels through the body, allowing sugar to enter the cells.
• Insulin lowers the amount of sugar in the bloodstream.
• As the blood sugar level drops, the pancreas puts less insulin into the bloodstream.

The role of glucose

Glucose — a sugar — is a main source of energy for the cells that make up muscles and other tissues.

• Glucose comes from two major sources: food and the liver.
• Sugar is absorbed into the bloodstream, where it enters cells with the help of insulin.
• The liver stores glucose in the form of glycogen.
• When glucose levels are low, such as when you haven't eaten in a while, the liver breaks down the stored glycogen into glucose. This keeps glucose levels within a typical range.

In type 1 diabetes, there's no insulin to let glucose into the cells. Because of this, sugar builds up in the bloodstream. This can cause life-threatening complications.

Risk factors

Some factors that can raise your risk for type 1 diabetes include:

• Family history. Anyone with a parent or sibling with type 1 diabetes has a slightly higher risk of developing the condition.
• Genetics. Having certain genes increases the risk of developing type 1 diabetes.
• Geography. The number of people who have type 1 diabetes tends to be higher as you travel away from the equator.
• Age. Type 1 diabetes can appear at any age, but it appears at two noticeable peaks. The first peak occurs in children between 4 and 7 years old. The second is in children between 10 and 14 years old.

Complications

Over time, type 1 diabetes complications can affect major organs in the body. These organs include the heart, blood vessels, nerves, eyes and kidneys. Having a normal blood sugar level can lower the risk of many complications.

Diabetes complications can lead to disabilities or even threaten your life.

• Heart and blood vessel disease. Diabetes increases the risk of some problems with the heart and blood vessels. These include coronary artery disease with chest pain (angina), heart attack, stroke, narrowing of the arteries (atherosclerosis) and high blood pressure.

Nerve damage (neuropathy). Too much sugar in the blood can injure the walls of the tiny blood vessels (capillaries) that feed the nerves. This is especially true in the legs. This can cause tingling, numbness, burning or pain. This usually begins at the tips of the toes or fingers and spreads upward. Poorly controlled blood sugar could cause you to lose all sense of feeling in the affected limbs over time.

Damage to the nerves that affect the digestive system can cause problems with nausea, vomiting, diarrhea or constipation. For men, erectile dysfunction may be an issue.

• Kidney damage (nephropathy). The kidneys have millions of tiny blood vessels that keep waste from entering the blood. Diabetes can damage this system. Severe damage can lead to kidney failure or end-stage kidney disease that can't be reversed. End-stage kidney disease needs to be treated with mechanical filtering of the kidneys (dialysis) or a kidney transplant.
• Eye damage. Diabetes can damage the blood vessels in the retina (part of the eye that senses light) (diabetic retinopathy). This could cause blindness. Diabetes also increases the risk of other serious vision conditions, such as cataracts and glaucoma.
• Foot damage. Nerve damage in the feet or poor blood flow to the feet increases the risk of some foot complications. Left untreated, cuts and blisters can become serious infections. These infections may need to be treated with toe, foot or leg removal (amputation).
• Skin and mouth conditions. Diabetes may leave you more prone to infections of the skin and mouth. These include bacterial and fungal infections. Gum disease and dry mouth also are more likely.
• Pregnancy complications. High blood sugar levels can be dangerous for both the parent and the baby. The risk of miscarriage, stillbirth and birth defects increases when diabetes isn't well-controlled. For the parent, diabetes increases the risk of diabetic ketoacidosis, diabetic eye problems (retinopathy), pregnancy-induced high blood pressure and preeclampsia.

There's no known way to prevent type 1 diabetes. But researchers are working on preventing the disease or further damage of the islet cells in people who are newly diagnosed.

Ask your provider if you might be eligible for one of these clinical trials. It is important to carefully weigh the risks and benefits of any treatment available in a trial.

• Summary of revisions: Standards of medical care in diabetes — 2022. Diabetes Care. 2022; doi:10.2337/dc22-Srev.
• Papadakis MA, et al., eds. Diabetes mellitus. In: Current Medical Diagnosis & Treatment 2022. 61st ed. McGraw Hill; 2022. https://accessmedicine.mhmedical.com. Accessed May 4, 2022.
• What is diabetes? National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/diabetes/overview/what-is-diabetes. Accessed May 4, 2022.
• Levitsky LL, et al. Epidemiology, presentation, and diagnosis of type 1 diabetes mellitus in children and adolescents. https://www.uptodate.com/contents/search. Accessed May 4, 2022.
• Diabetes mellitus (DM). Merck Manual Professional Version. https://www.merckmanuals.com/professional/endocrine-and-metabolic-disorders/diabetes-mellitus-and-disorders-of-carbohydrate-metabolism/diabetes-mellitus-dm. Accessed May 4, 2022.
• AskMayoExpert. Type 1 diabetes mellitus. Mayo Clinic; 2021.
• Robertson RP. Pancreas and islet transplantation in diabetes mellitus. https://www.uptodate.com/contents/search. Accessed May 4, 2022.
• Levitsky LL, et al. Management of type 1 diabetes mellitus in children during illness, procedures, school, or travel. https://www.uptodate.com/contents/search. Accessed May 4, 2022.
• Hyperglycemia (high blood glucose). American Diabetes Association. https://www.diabetes.org/healthy-living/medication-treatments/blood-glucose-testing-and-control/hyperglycemia. Accessed May 4, 2022.
• Diabetes and DKA (ketoacidosis). American Diabetes Association. https://www.diabetes.org/diabetes/dka-ketoacidosis-ketones. Accessed May 4, 2022.
• Insulin resistance & prediabetes. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/diabetes/overview/what-is-diabetes/prediabetes-insulin-resistance. Accessed May 4, 2022.
• Blood sugar and insulin at work. American Diabetes Association. https://www.diabetes.org/tools-support/diabetes-prevention/high-blood-sugar. Accessed May 4, 2022.
• Inzucchi SE, et al. Glycemic control and vascular complications in type 1 diabetes. https://www.uptodate.com/contents/search. Accessed May 4, 2022.
• Diabetes and oral health. American Diabetes Association. https://www.diabetes.org/diabetes/keeping-your-mouth-healthy. Accessed May 4, 2022.
• Drug treatment of diabetes mellitus. Merck Manual Professional Version. https://www.merckmanuals.com/professional/endocrine-and-metabolic-disorders/diabetes-mellitus-and-disorders-of-carbohydrate-metabolism/drug-treatment-of-diabetes-mellitus. Accessed May 4, 2022.
• Weinstock DK, et al. Management of blood glucose in adults with type 1 diabetes mellitus. https://www.uptodate.com/contents/search. Accessed May 7, 2022.
• FDA proves first automated insulin delivery device for type 1 diabetes. U.S. Food and Drug Administration. https://www.fda.gov/news-events/press-announcements/fda-approves-first-automated-insulin-delivery-device-type-1-diabetes. Accessed May 4, 2022.
• Boughton CK, et al. Advances in artificial pancreas systems. Science Translational Medicine. 2019; doi:10.1126/scitranslmed.aaw4949.
• Hypoglycemia (low blood sugar). American Diabetes Association. https://www.diabetes.org/healthy-living/medication-treatments/blood-glucose-testing-and-control/hypoglycemia. Accessed May 4, 2022.
• Diabetes in the workplace and the ADA. U.S. Equal Opportunity Employment Commission. https://www.eeoc.gov/laws/guidance/diabetes-workplace-and-ada. Accessed May 4, 2022.
• Cardiovascular disease and risk management: Standards of medical care in diabetes — 2022. Diabetes Care. 2022; doi:10.2337/dc22-S010.
• Diabetes technology. Standards of Medical Care in Diabetes — 2022. 2022; doi:10.2337/dc22-S007.
• FDA authorizes a second artificial pancreas system. JDRF. https://www.jdrf.org/blog/2019/12/13/jdrf-reports-fda-authorizes-second-artificial-pancreas-system/. Accessed May 4, 2022.
• Classification and diagnosis of diabetes: Standards of medical care in diabetes — 2022. Diabetes Care. 2022; doi:10.2337/dc22-S002.
• Retinopathy, neuropathy, and foot care: Standards of medical care in diabetes — 2022. Diabetes Care. 2022; doi:10.2337/dc22-S012.
• Glycemic targets: Standards of medical care in diabetes — 2022. Diabetes Care. 2022; doi:10.2337/dc22-S012.
• Pharmacologic approaches to glycemic treatment: Standards of medical care in diabetes — 2022. Diabetes Care. 2022; doi:10.2337/dc22-S009.
• Facilitating behavior change and well-being to improve health outcomes: Standards of medical care in diabetes — 2022. Diabetes Care. 2022; doi:10.2337/dc22-S005.
• Centers for Disease Control and Prevention. Use of hepatitis B vaccination for adults with diabetes mellitus: Recommendations of the Advisory Committee on Immunization Practices (ACIP). Morbidity and Mortality Weekly Report. 2011;60:1709.
• Management of diabetes in pregnancy: Standards of medical care in diabetes — 2022. Diabetes Care. 2022; doi:10.2337/dc22-S015.
• Older adults: Standards of medical care in diabetes — 2022. Diabetes Care. 2022; doi:10.2337/dc22-S013.
• FDA approves first-of-its-kind automated insulin delivery and monitoring system for use in young pediatric patients. U.S. Food and Drug Administration. https://www.fda.gov/news-events/press-announcements/fda-approves-first-its-kind-automated-insulin-delivery-and-monitoring-system-use-young-pediatric#:~:text=Today, the U.S. Food and,by individuals aged 2 to. Accessed May 8, 2022.
• What you need to know: Getting a COVID-19 vaccine. American Diabetes Association. https://www.diabetes.org/coronavirus-covid-19/vaccination-guide. Accessed June 1, 2022.

News from Mayo Clinic

• Driven by family, fueled by hope: Mayo Clinic researcher fights against Type 1 diabetes Aug. 06, 2023, 11:00 a.m. CDT
• Symptoms & causes
• Diagnosis & treatment
• Doctors & departments

Mayo Clinic does not endorse companies or products. Advertising revenue supports our not-for-profit mission.

• Opportunities

Mayo Clinic Press

Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press .

• Mayo Clinic on Incontinence - Mayo Clinic Press Mayo Clinic on Incontinence
• The Essential Diabetes Book - Mayo Clinic Press The Essential Diabetes Book
• Mayo Clinic on Hearing and Balance - Mayo Clinic Press Mayo Clinic on Hearing and Balance
• FREE Mayo Clinic Diet Assessment - Mayo Clinic Press FREE Mayo Clinic Diet Assessment
• Mayo Clinic Health Letter - FREE book - Mayo Clinic Press Mayo Clinic Health Letter - FREE book

Your gift holds great power – donate today!

Make your tax-deductible gift and be a part of the cutting-edge research and care that's changing medicine.

Learn how UpToDate can help you.

Select the option that best describes you

• Medical Professional
• Resident, Fellow, or Student
• Hospital or Institution
• Group Practice
• Patient or Caregiver
• Find in topic

RELATED TOPICS

Contributor Disclosures

Please read the Disclaimer at the end of this page.

TYPE 1 DIABETES OVERVIEW

Type 1 diabetes mellitus is a chronic medical condition that occurs when the pancreas, an organ in the abdomen, produces very little or no insulin ( figure 1 ). Insulin is a hormone that helps the body to use glucose for energy. Glucose is a sugar that comes, in large part, from foods we eat. Insulin allows glucose to enter cells in the body where it is needed and stores excess glucose for later use. It has other important actions as well. Without insulin, blood glucose (sugar) levels become too high, and over time, this will harm the body.

Type 1 diabetes requires regular blood sugar monitoring and treatment with insulin. Treatment, lifestyle adjustments, and self-care can control blood sugar levels and minimize the risk of disease-related complications.

Type 1 diabetes often begins in childhood or young adulthood, but it can develop at any age. In the United States, Canada, and Europe, type 1 diabetes accounts for 5 to 10 percent of all cases of diabetes.

Other topics that discuss type 1 diabetes are available:

● (See "Patient education: Type 1 diabetes: Insulin treatment (Beyond the Basics)" .)

● (See "Patient education: Glucose monitoring in diabetes (Beyond the Basics)" .)

● (See "Patient education: Type 1 diabetes and diet (Beyond the Basics)" .)

● (See "Patient education: Hypoglycemia (low blood glucose) in people with diabetes (Beyond the Basics)" .)

● (See "Patient education: Care during pregnancy for patients with type 1 or 2 diabetes (Beyond the Basics)" .)

DIABETES CARE DURING THE COVID-19 PANDEMIC

COVID-19 stands for "coronavirus disease 2019." It is an infection caused by a virus called SARS-CoV-2. The virus first appeared in late 2019 and has since spread throughout the world.

People with certain underlying health conditions, including diabetes, are at increased risk of severe illness if they get COVID-19. COVID-19 infection can also lead to severe complications of diabetes, including diabetic ketoacidosis (DKA). Getting vaccinated is the best way to lower the risk of severe illness.

THE IMPACT OF TYPE 1 DIABETES

Being diagnosed with type 1 diabetes can be a frightening and overwhelming experience, and it is common to have questions about why it developed, what it means for long-term health, and how it will affect everyday life.

For most people, the first few months after being diagnosed are filled with emotional highs and lows. You and your family can use this time to learn as much as possible so that diabetes-related care (eg, blood glucose [sugar] testing, continuous glucose monitoring, medical appointments, daily insulin, nutrition, foot care) becomes a part of your routine. (See "Patient education: Glucose monitoring in diabetes (Beyond the Basics)" and "Patient education: Preventing complications from diabetes (Beyond the Basics)" .)

In addition, you should talk with members of your diabetes health care team about resources that are available for medical as well as psychological support. This might include group classes; meetings with a nutritionist, social worker, or nurse educator; and other educational resources, such as books, websites, or magazines. Several of these resources are listed below. (See 'Where to get more information' below.)

Despite the risks associated with type 1 diabetes, most people can lead active lives and continue to enjoy the foods and activities they enjoyed before being diagnosed with diabetes. Diabetes does not mean an end to special occasion foods like birthday cake. With a little advanced planning, most people with diabetes can enjoy exercise in almost any form.

TYPE 1 DIABETES CAUSES

Type 1 diabetes usually develops when the immune system destroys the insulin-producing cells (called the beta cells) in the pancreas. This is called an autoimmune response. The cause of this abnormal immune response is being studied.

This process occurs over many months or years, and there may be no symptoms of diabetes. High blood sugar and its associated symptoms (frequent urination, thirst) do not usually occur until more than 90 percent of the cells that make insulin have been destroyed.

Type 1 diabetes can develop in people with a family history of type 1 diabetes, but it also develops in people with no family history of diabetes. In either case, people who develop diabetes have one or more genes that make them susceptible to the disease. Environmental factors and exposure to certain viruses might trigger the autoimmune response.

Close relatives (children, siblings) of a person with type 1 diabetes have an increased risk of developing type 1 diabetes, compared with a person with no family history (5 to 6 percent versus 0.4 percent, respectively). Genetic testing can help to determine if a family member is at risk of developing diabetes. However, these tests are currently only available to people who participate in a clinical research trial.

Family members at greatest risk for developing type 1 diabetes have high levels of substances called "pancreatic autoantibodies" circulating in their blood, which can indicate that the body has started to destroy its own insulin-producing cells. These blood tests are not routinely obtained, but they are measured in research programs. One such program available across the United States is called TrialNet (www.trialnet.org/our-research/risk-screening).

TYPE 1 DIABETES DIAGNOSIS

The diagnosis of diabetes is based on your symptoms and blood tests.

Symptoms  —  Most people with type 1 diabetes have symptoms of high blood sugar levels (hyperglycemia) at the time of diagnosis. These include:

● Excessive thirst

● Feeling tired

● Needing to urinate frequently

● Blurred vision

● Feeling hungry

● Unintentional weight loss

● Frequent yeast infections or urinary tract infections

● Slowly healing wounds

Less commonly, there are symptoms of a serious problem called diabetic ketoacidosis (DKA). People with DKA have symptoms of high blood sugar (see above), as well as nausea and vomiting, belly pain, breathing rapidly, feeling sluggish, having trouble paying attention, and sometimes coma. DKA is a medical emergency and must be treated promptly.

Blood tests  —  Simple, inexpensive blood tests are used to diagnose diabetes. Having a higher than normal blood sugar, as well as the symptoms described above, usually means that you have diabetes.

Type 1 versus type 2 diabetes  —  In youth, it is usually easy for a health care provider to tell if you have type 1 or type 2 diabetes. In this situation, your health care team will treat you as if you have type 1 while awaiting the results of further blood tests. However, with adult-onset type 1 diabetes, there are many situations where it is not clear if the person has type 1 or 2 diabetes. In this situation, additional blood testing may be ordered.

TYPE 1 DIABETES TREATMENT

Treatment of diabetes requires a team approach, including you and your family and health care providers (doctor, nurse, diabetes educator, dietitian), and sometimes other clinicians (mental health professionals, podiatrist, etc). The treatment of type 1 diabetes is discussed separately. (See "Patient education: Type 1 diabetes: Insulin treatment (Beyond the Basics)" .)

COMPLICATIONS OF TYPE 1 DIABETES

Keeping your blood sugar near normal can reduce your risk of long-term complications, such as eye and kidney diseases and problems with the nerves in different parts of your body. This means that you will need to check your blood sugar several times per day or use a continuous glucose monitoring device, give insulin shots or use an insulin pump, monitor what you eat, and see your diabetes care team on a regular basis. You should also have your eyes checked by an eye care professional and practice good foot care (see "Patient education: Foot care for people with diabetes (Beyond the Basics)" ). Your diabetes care provider will check your kidney function regularly.

People with type 1 diabetes are at increased risk of cardiovascular disease, which can cause heart attack, chest pain, stroke, and even death. (See "Patient education: Preventing complications from diabetes (Beyond the Basics)" .)

However, you can substantially lower your risk of cardiovascular disease by:

● Not smoking (see "Patient education: Quitting smoking (Beyond the Basics)" )

● Managing high blood pressure and high cholesterol with diet, exercise, and medications (see "Patient education: High cholesterol and lipids (Beyond the Basics)" and "Patient education: High blood pressure treatment in adults (Beyond the Basics)" )

● Keeping your glycated hemoglobin (A1C) at 7 percent or lower

● Taking a low-dose aspirin every day (for adults with cardiovascular disease and sometimes those who are at increased risk of cardiovascular disease)

PREGNANCY AND TYPE 1 DIABETES

Women with type 1 diabetes are usually able to become pregnant and have a healthy baby. However, it is important to carefully control blood sugar levels before and during pregnancy to minimize the risk of complications. A full discussion of this topic is available separately. (See "Patient education: Care during pregnancy for patients with type 1 or 2 diabetes (Beyond the Basics)" .)

WHERE TO GET MORE INFORMATION

Your health care provider is the best source of information for questions and concerns related to your medical problem.

This article will be updated as needed on our website ( www.uptodate.com/patients ). Related topics for patients, as well as selected articles written for health care professionals, are also available. Some of the most relevant are listed below.

Patient level information  —  UpToDate offers two types of patient education materials.

The Basics  —  The Basics patient education pieces answer the four or five key questions a patient might have about a given condition. These articles are best for patients who want a general overview and who prefer short, easy-to-read materials.

Patient education: Type 1 diabetes (The Basics) Patient education: Hemoglobin A1C tests (The Basics) Patient education: Preparing for pregnancy when you have diabetes (The Basics) Patient education: Diabetic ketoacidosis (The Basics) Patient education: Latent autoimmune diabetes in adults (The Basics) Patient education: Diabetes and infections (The Basics) Patient education: Foot care for people with diabetes (The Basics) Patient education: Diabetic foot ulcer (The Basics) Patient education: Checking your blood sugar at home (The Basics) Patient education: Keeping track of your blood sugar (The Basics) Patient education: Blood glucose tests (The Basics) Patient education: Kidney disease caused by diabetes (The Basics) Patient education: Friedreich ataxia (The Basics)

Beyond the Basics  —  Beyond the Basics patient education pieces are longer, more sophisticated, and more detailed. These articles are best for patients who want in-depth information and are comfortable with some medical jargon.

Patient education: Type 1 diabetes: Insulin treatment (Beyond the Basics) Patient education: Glucose monitoring in diabetes (Beyond the Basics) Patient education: Type 1 diabetes and diet (Beyond the Basics) Patient education: Hypoglycemia (low blood glucose) in people with diabetes (Beyond the Basics) Patient education: Care during pregnancy for patients with type 1 or 2 diabetes (Beyond the Basics) Patient education: Preventing complications from diabetes (Beyond the Basics) Patient education: Quitting smoking (Beyond the Basics) Patient education: High cholesterol and lipids (Beyond the Basics) Patient education: High blood pressure treatment in adults (Beyond the Basics)

Professional level information  —  Professional level articles are designed to keep doctors and other health professionals up-to-date on the latest medical findings. These articles are thorough, long, and complex, and they contain multiple references to the research on which they are based. Professional level articles are best for people who are comfortable with a lot of medical terminology and who want to read the same materials their doctors are reading.

Amylin analogs for the treatment of diabetes mellitus Glucose monitoring in the ambulatory management of nonpregnant adults with diabetes mellitus Classification of diabetes mellitus and genetic diabetic syndromes Clinical presentation, diagnosis, and initial evaluation of diabetes mellitus in adults Exercise guidance in adults with diabetes mellitus Measurements of chronic glycemia in diabetes mellitus General principles of insulin therapy in diabetes mellitus Glycemic management and vascular complications in type 1 diabetes mellitus Pregestational (preexisting) diabetes mellitus: Antenatal glycemic control Pancreatic beta cell function Management of blood glucose in adults with type 1 diabetes mellitus Hypoglycemia in adults with diabetes mellitus Moderately increased albuminuria (microalbuminuria) in type 1 diabetes mellitus Nutritional considerations in type 1 diabetes mellitus Diabetic kidney disease: Pathogenesis and epidemiology Overview of general medical care in nonpregnant adults with diabetes mellitus Pancreas and islet transplantation in diabetes mellitus

The following organizations also provide reliable health information.

● National Library of Medicine

( www.nlm.nih.gov/medlineplus/healthtopics.html )

● National Institute of Diabetes and Digestive and Kidney Diseases

( www.niddk.nih.gov )

● American Diabetes Association (ADA)

(800)-DIABETES (800-342-2383)

( www.diabetes.org )

● The Endocrine Society

( www.endo-society.org )

● Hormone Health Network

( www.hormone.org/diseases-and-conditions/diabetes , available in English and Spanish)

● Juvenile Diabetes Research Foundation

( www.jdrf.org )

● Glu, an online community of the T1D Exchange

( www.myglu.org/ )

● US Centers for Disease Control and Prevention

( www.cdc.gov/diabetes/basics/type1.html , available in English and Spanish)

● Type 1 Diabetes TrialNet: Pathway to Prevention

( www.trialnet.org/our-research/risk-screening )

Understanding Type 1 Diabetes

Type 1 diabetes is an autoimmune disease. Testing, coupled with education about diabetes symptoms and close follow-up, has been shown to enable earlier diagnosis and to prevent diabetes ketoacidosis.

What is type 1 diabetes?

When you have type 1 diabetes, your immune system mistakenly treats the beta cells in your pancreas that create insulin as foreign invaders and destroys them. When enough beta cells are destroyed, your pancreas can’t make insulin or makes so little of it that you need to take insulin to live. 

Insulin is a hormone that helps blood glucose (blood sugar) enter your body’s cells so that it can be used as energy. If you have diabetes, blood glucose can’t enter your cells so it builds up in your bloodstream. This causes high blood glucose ( hyperglycemia ). Over time, high blood glucose harms your body and can lead to diabetes-related complications if not treated.

Most of the time, type 1 diabetes is diagnosed in young people, but it can develop in anyone at any age. Scientists and researchers today aren’t sure how to prevent type 1 diabetes or what triggers it.

If you have type 1 diabetes, you can live a long, healthy life by having a strong support system and managing it with your diabetes care team . The treatment plan you develop with your diabetes care team will include insulin, physical activity, and an eating plan to reach your health goals.

Type 1 Diabetes Symptoms

If you or your child have the following symptoms of diabetes, let your health care provider know. Symptoms include:

• Urinating often
• Feeling very thirsty
• Feeling very hungry—even though you are eating
• Extreme fatigue
• Blurry vision
• Cuts/bruises that are slow to heal
• Weight loss—even though you are eating more

It’s important to know when you first develop type 1 diabetes, you may not have any symptoms at all.

Children with Type 1 Diabetes

Adults with Type 1 Diabetes

Learning Your Risk for Type 1 Diabetes

Why Learning Your Risk Helps

Children with type 1 diabetes will usually have the symptoms listed above. If your child is potty-trained without issues at night starts having accidents and wetting the bed again, diabetes might be the reason.

Even though it’s easy to diagnose a child with diabetes by checking their blood glucose at the doctor’s office or emergency room, the tricky part is recognizing the symptoms and knowing to take your child to get checked. If you’re a parent, it’s important to know that young children, including infants, can develop type 1 diabetes.

Sometimes children can be in diabetic ketoacidosis (DKA) when they are diagnosed with diabetes. When there is a lack of insulin in the body, high levels of an acid called ketones can build up. DKA is a medical emergency that usually requires hospitalization and immediate care with insulin and IV fluids.

When an adult develops type 1 diabetes, they are often mistakenly told they have type 2 diabetes. This may be from lack of awareness that type 1 diabetes can start at any age and in people of every race, shape, weight, and size. People with type 1 diabetes who also have the classic risk factors for type 2 diabetes—such as overweight/obesity, not being physically active, having high blood pressure, or are over age 35—are often misdiagnosed. It can also be tricky because some adults with new-onset type 1 diabetes are not sick at first. Their health care provider may find an elevated blood glucose level at a routine visit and starts them on diet, exercise, and an oral medication.

Early detection and treatment of diabetes can decrease the risk of developing complications both at the time of diagnosis and in the future. By knowing and recognizing the symptoms above, you can learn if you have type 1 diabetes early and avoid complications, like diabetic ketoacidosis (DKA) . 

Did you know?

• Type 1 diabetes doesn’t develop only in children
• There have been recent advances in type 1 diabetes screening and treatment

If you have a family history of type 1 diabetes, your health care provider may suggest screening for type 1 diabetes. They will order a blood test to measure your islet autoantibodies. The test results can go one of two ways:

• Negative: Your health care provider will retest you in the future.
• Positive: Even if you get a positive result, this doesn’t mean you have type 1 diabetes. Your health care provider will refer you to counseling about the risk of developing diabetes, diabetes symptoms, and DKA prevention. Additional testing as needed may be done to determine the course of your treatment.  

Even if you may not want to know if you, your children, or other family members are at risk for developing type 1 diabetes, there are benefits to knowing.

First, you can learn more about the early warning signs of type 1 diabetes so you and your health care team can detect diabetes early—before DKA or severe illness develops. Because DKA can be life-threatening and early symptoms can be vague, knowing what to watch out for can help detect and treat DKA early or prevent it altogether.

Second, there are emerging treatments and clinical trials that seek to delay the onset of type 1 diabetes in those who are at high risk. If you are at high risk for developing type 1 diabetes, it will be important to speak with an endocrinologist to learn whether these opportunities may be available and right for you.

Calling All Professionals

ADA convened leading experts, including endocrinologists, researchers, primary care professionals, certified diabetes care and education specialists, and mental health professionals, to understand opportunities and barriers to type 1 diabetes screening and awareness. The outcome of this roundtable is a report that outlines the discussion and potential opportunities for future direction. The report does not necessarily reflect official guidelines or recommendations from the American Diabetes Association or other participating organizations.

The Honeymoon Phase

Some people with type 1 diabetes have a "honeymoon" period, a brief period of time where your body is producing enough insulin to lower blood glucose levels. The honeymoon phase usually happens after you start taking insulin and you may not need as much to manage your blood glucose. Work with your diabetes care team for treatment and care to avoid complications like hypoglycemia . A honeymoon period can last as little as a week or even up to a year. It’s important to know that the absence of symptoms doesn't mean the diabetes is gone. The pancreas will eventually be unable to make enough insulin, and, if untreated, the symptoms will return.

Is it Possible You Don't Have Type 2 Diabetes? 

If you or someone you know is diagnosed with type 2 diabetes but isn’t able to manage it with the typical treatments for type 2 diabetes, it may be worth a visit to an endocrinologist to verify what type of diabetes you have. Generally, this requires antibody tests and possibly the measurement of a C-peptide level. It is important to be sure that your diagnosis is correct because that will determine your treatment plan, allowing you manage your diabetes and prevent its complications.

Resources for Type 1 Diabetes

Browse these resources for type 1 diabetes.

Resources for Living with Type 1 Diabetes

Whether you’ve lived with diabetes for a long time, are newly diagnosed, or a caregiver, we have the resources to help you learn about how to navigate life with type 1.

Having diabetes doesn’t mean giving up all your favorite foods, it’s about modifying what you love to fit your new lifestyle and help you manage diabetes.  

Physical Activity

Staying physically active will help you manage your diabetes, improve your mood, and lower your risk for complications.

Diabetes Food Hub®

Access thousands of free diabetes-friendly recipes for all meals, occasions, and dietary restrictions—plus nutrition articles that answer common questions people have about eating with diabetes.

Safe at School®

This program helps to ensure children with diabets receive the care they need at school.

Healthy Living e-newsletter

Sign up to receive diabetes-friendly recipes, articles, and more resources delivered directly to your email inbox every month.

Mental Health Resource

Screening for diabetes has a significant emotional and mental health toll. These resources can help you offer support to people you treat and their families.

Diagnosis and Classification of Type 1 Diabetes

Read our Standards of Care in Diabetes—2024 recommendations on type 1 diabetes screening and diagnosis. 

Prevention or Delay of Diabetes

Read Standards of Care in Diabetes recommendations on interventions to delay type 1 diabetes.  

Infographics

These documents provide at-a-glance guidance for type 1 diabetes screening based on the Standards of Care in Diabetes .

Latest Innovations and Treatments in Type 1 Diabetes

Earn free CE credit in the Institute of Learning.

School Nurse Resources

School nurses play an important role for students with type 1 diabetes and their caregivers. Training resources are available.

Information specialists at the Center for Information are your personal guides to information on diabetes, donation inquiries, as well as American Diabetes Association programs and events.

1-800-diabetes ( 1-800-342-2383 )  , supported in part by:.

Sanofi supports phase 3 of ADA’s Therapeutic Inertia program. The main goal of phase 3 is to promote the measurable adoption of evidence-based practices, strategies, programs and tools that address key barriers associated with therapeutic inertia in diabetes care, leading to improved, timely treatment modification and improved overall glycemic control in adult patients with type 2 diabetes. Sanofi also supported the American Diabetes Association’s 100 Years of Insulin, a year-long campaign that focused on awareness, education and promoting activities that build community.

View website

Donate Today and Change Lives!

Type 1 Diabetes

Overview of causes, symptoms, and daily management.

The basics of everyday diabetes care for newly diagnosed people.

Your guide to insulin types and how they work.

Insulin pens, pumps, and 2 other methods for taking insulin.

Causes, symptoms, and types of low blood sugar.

What you need to know to treat mild or severe low blood sugar.

What to watch for and how to be prepared for this serious condition.

Help for young adults learning to manage their diabetes care.

Plan ahead with your child’s health care team and school for a safe, healthy year.

How to stay healthy and help prevent health problems.

• Diabetes Basics
• Living With Diabetes
• Diabetes Self-Management Education and Support
• Prevent Complications

To receive updates about diabetes topics, enter your email address:

• Diabetes Home
• State, Local, and National Partner Diabetes Programs
• National Diabetes Prevention Program
• Native Diabetes Wellness Program
• Chronic Kidney Disease
• Vision Health Initiative
• Heart Disease and Stroke
• Overweight & Obesity

Exit Notification / Disclaimer Policy

• The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website.
• Linking to a non-federal website does not constitute an endorsement by CDC or any of its employees of the sponsors or the information and products presented on the website.
• You will be subject to the destination website's privacy policy when you follow the link.
• CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website.

Ohio State nav bar

The Ohio State University

• BuckeyeLink
• Find People
• Search Ohio State

Pathophysiology and Clinical Presentation

Pathophysiology:

Type 1 Diabetes Mellitus is a syndrome characterized by hyperglycemia and insulin deficiency resulting from the loss of beta cells in pancreatic islets (Mapes & Faulds, 2014). Nonimmune (type 1B diabetes), occurs secondary to other diseases and is much less common than autoimmune (type 1A). The destruction of beta cells in Type 1A diabetes results from the interaction of both genetic and environmental factors. Although the genetic susceptibility is not well understood, type 1 diabetes is most strongly associated with major histocompatibility complex (MHC), specifically histocompatibility leukocyte antigen (HLA) class II alleles (HLA-DQ and HLA-DR) (McCance & Heuther, 2014). Type 1 diabetes is less hereditary than type 2 but 7-13% of patients also have a first degree relative with type 1 diabetes (Mapes & Faulds, 2014). Environmental factors include viral infections (especially enteroviruses), exposure to infectious microorganisms (such as  Helicobacter pylori ), exposure to cow’s milk proteins and a lack of vitamin D (McCance & Heuther, 2014).

The destruction of insulin-producing beta cells in the pancreas starts with the formation of autoantigens. These autoantigens are ingested by antigen-presenting cells which activate T helper 1 (Th1) and T helper 2 (Th2) lmphocytes. Activated Th1 lymphocytes secrete interluekin-2 (IL-2) and interferon. IL-2 activates autoantigen-specific T cytotoxic lymphocytes which destroy islet cells through the secretion of toxic perforins and granzymes. Interferon activates macrophages and stimulates the release of inflammatory cytokines (including IL-1 and tumor necrosis factor [TNF]) which further destroy beta cells (McCance & Heuther, 2014). Activated Th2 lymphocytes produce  IL-4 which stimulates B lymphocytes to proliferate and produce islet cell autoantibodies (ICAs) and  anti-glutamic acid decarboxylase (antiGAD65) antibodies. AntiGAD65 is an enzyme that helps control the release of insulin from beta cells and can be used to determine the cause of diabetes (McCance & Heuther, 2014). Insulin autoantibodies [IAAs]) and zinc transporter 8 (Znt8) protein are also associated with type 1 diabetes mellitus. Despite it’s complicated pathophysiology, it is important to understand the destruction of beta cells in type 1 diabetes because it leads to a lack of insulin and amylin. Without insulin or amylin the body cannot promote glucose disappearance or limit glucose appearance from the bloodstream, respectively, resulting in hyperglycemia (Mapes & Faulds, 2014).

Clinical Presentation:

Type 1 diabetes does not present clinically until 80-90% of the beta cells have been destroyed (McCance & Heuther, 2014). Because insulin stimulates glucose uptake into tissues, stores glycose as glycogen, inhibits glucagon secretion and inhibits glucose production from the liver, the destruction of insulin-producing beta cells causes hyperglycemia (Mapes & Faulds, 2014). Type 1 diabetics may present with abrupt onset of diabetic ketoacidosis, polyuria, polyphagia, polydipsia, or rapid weight loss with marked hyperglycemia (Mapes & Faulds, 2014).  To diagnose diabetes, patients must have an A1C level greater than 6.5% percent on two separate tests; the presence of ketones in the urine and/or autoantibodies in the blood can distinguish type 1 from type 2 diabetes (Mayo Clinic, 2014).

2 thoughts on “ Pathophysiology and Clinical Presentation ”

none for now

Leave a Reply Cancel reply

Your email address will not be published. Required fields are marked *

Save my name, email, and website in this browser for the next time I comment.

• Next Article

Introduction

Understanding adult-onset type 1 diabetes, article information, adult-onset type 1 diabetes: current understanding and challenges.

• Split-Screen
• Article contents
• Figures & tables
• Supplementary Data
• Peer Review
• Open the PDF for in another window
• Cite Icon Cite
• Get Permissions

R. David Leslie , Carmella Evans-Molina , Jacquelyn Freund-Brown , Raffaella Buzzetti , Dana Dabelea , Kathleen M. Gillespie , Robin Goland , Angus G. Jones , Mark Kacher , Lawrence S. Phillips , Olov Rolandsson , Jana L. Wardian , Jessica L. Dunne; Adult-Onset Type 1 Diabetes: Current Understanding and Challenges. Diabetes Care 1 November 2021; 44 (11): 2449–2456. https://doi.org/10.2337/dc21-0770

Download citation file:

• Ris (Zotero)
• Reference Manager

Recent epidemiological data have shown that more than half of all new cases of type 1 diabetes occur in adults. Key genetic, immune, and metabolic differences exist between adult- and childhood-onset type 1 diabetes, many of which are not well understood. A substantial risk of misclassification of diabetes type can result. Notably, some adults with type 1 diabetes may not require insulin at diagnosis, their clinical disease can masquerade as type 2 diabetes, and the consequent misclassification may result in inappropriate treatment. In response to this important issue, JDRF convened a workshop of international experts in November 2019. Here, we summarize the current understanding and unanswered questions in the field based on those discussions, highlighting epidemiology and immunogenetic and metabolic characteristics of adult-onset type 1 diabetes as well as disease-associated comorbidities and psychosocial challenges. In adult-onset, as compared with childhood-onset, type 1 diabetes, HLA-associated risk is lower, with more protective genotypes and lower genetic risk scores; multiple diabetes-associated autoantibodies are decreased, though GADA remains dominant. Before diagnosis, those with autoantibodies progress more slowly, and at diagnosis, serum C-peptide is higher in adults than children, with ketoacidosis being less frequent. Tools to distinguish types of diabetes are discussed, including body phenotype, clinical course, family history, autoantibodies, comorbidities, and C-peptide. By providing this perspective, we aim to improve the management of adults presenting with type 1 diabetes.

Clinically, it has been relatively easy to distinguish the acute, potentially lethal, childhood-onset diabetes from the less aggressive condition that affects adults. However, experience has taught us that not all children with diabetes are insulin dependent and not all adults are non–insulin dependent. Immune, genetic, and metabolic analysis of these two, apparently distinct, forms of diabetes revealed inconsistencies, such that insulin-dependent and immune-mediated diabetes was redefined as type 1 diabetes, while most other forms were relabeled as type 2 diabetes. Recent data suggest a further shift in our thinking, with the recognition that more than half of all new cases of type 1 diabetes occur in adults. However, many adults may not require insulin at diagnosis of type 1 diabetes and have a more gradual onset of hyperglycemia, often leading to misclassification and inappropriate care. Indeed, misdiagnosis occurs in nearly 40% of adults with new type 1 diabetes, with the risk of error increasing with age ( 1 , 2 ). To consider this important issue, JDRF convened a workshop of international experts in November 2019 in New York, NY. In this Perspective, based on that workshop, we outline the evidence for a new viewpoint, suggesting future directions of research and ways to alter disease management to help adults living with type 1 diabetes.

Incidence of Type 1 Diabetes Among Adults Worldwide

Adult-onset type 1 diabetes is more common than childhood-onset type 1 diabetes, as shown from epidemiological data from both high-risk areas such as Northern Europe and low-risk areas such as China ( 3 – 8 ). In southeastern Sweden, the disease incidence among individuals aged 0–19 years is similar to that among individuals 40–100 years of age (37.8 per 100,000 persons per year and 34.0/100,000/year, respectively) ( 3 ). Given that the comparable incidence spans only two decades in children, it follows that adult-onset type 1 diabetes is more prevalent. Similarly, analysis of U.S. data from commercially insured individuals demonstrated an overall lower incidence in individuals 20–64 years of age (18.6/100,000/year) than in youth aged 0–19 years (34.3/100,000/year), but the total number of new cases in adults over a 14-year period was 19,174 compared with 13,302 in youth ( 4 ). Despite the incidence of childhood-onset type 1 diabetes in China being among the lowest in the world, prevalence data show similar trends across the life span. From 2010–2013, the incidence was 1.93/100,000 among individuals aged 0–14 years and 1.28/100,000 among those 15–29 years of age versus 0.69/100,000 among older adults ( 5 ). In aggregate, adults comprised 65.3% of all clinically defined newly diagnosed type 1 diabetes cases in China, which is similar to estimates using genetically stratified data from the population-based UK Biobank using a childhood-onset polygenic genetic risk score (GRS) ( 6 ). It is important to note that the proportion would likely be higher if autoimmune cases not requiring insulin initially were classified as type 1 diabetes. For example, in a clinic-based European study, the proportion of adults with diabetes not initially requiring insulin yet with type 1 diabetes–associated autoantibodies was even higher than those started on insulin at diagnosis with a defined type 1 diabetes diagnosis ( 9 ). Moreover, in an adult population-based study in China, the fraction (8.6%) with diabetes not requiring insulin yet with type 1 diabetes–associated autoantibodies was similar to that in Europe, implying that there could be over 6 million Chinese with adult-onset type 1 diabetes ( 10 ). While there is a wide range in the incidence of type 1 diabetes across different ethnic groups, even using differing methods of case identification ( 7 ), these data support the notion that, worldwide, over half of all new-onset type 1 diabetes cases occur in adults.

Natural History Studies of Type 1 Diabetes

Our understanding of the natural history of type 1 diabetes has been informed by a number of longitudinal and cross-sectional studies. At one end of the spectrum are prospective birth cohort studies, such as the BABYDIAB study in Germany and The Environmental Determinants of Diabetes in the Young (TEDDY) study, which includes sites in Germany, Finland, Sweden, and the U.S. While these studies now have the potential to explore the pathogenesis of islet autoimmunity by being extended into adulthood, they have primarily focused on events occurring in childhood ( 11 ). Clinical centers in North America, Europe, and Australia collaborate within Type 1 Diabetes TrialNet, a study that identifies autoantibody-positive adults and children in a cross-sectional manner to examine the pathogenesis of type 1 diabetes and to perform clinical trials on those at high risk in order to preserve β-cell function ( 12 ). At the other end of the spectrum, the European Prospective Investigation into Cancer and Nutrition (EPIC)-InterAct study is a case-cohort study nested in the U.K. prospective adult population-based EPIC study ( 13 ), while the clinical, immunogenetic, and metabolic characteristics of autoimmune adult-onset type 1 diabetes have been extensively studied in large American, European, and Chinese studies, including UK Prospective Diabetes Study (UKPDS), Action LADA, Scandia, Non Insulin Requiring Autoimmune Diabetes (NIRAD), and LADA China ( 9 , 14 – 19 ). Based on these cross-sectional and prospective studies, considerable data have been generated to define differences within type 1 diabetes according to the age at onset. Here, we highlight key aspects of age-related genetic, immune, and metabolic heterogeneity in type 1 diabetes. Of note, the term latent autoimmune diabetes in adults (LADA) has been used to describe adults with slowly progressive autoimmunity, sometimes exhibiting features overlapping with those of type 2 diabetes ( 9 , 14 , 18 ). At the outset of the workshop and for the purposes of this Perspective, LADA was not considered a unique entity; rather, we considered the classification of type 1 diabetes to include all individuals with evidence of autoimmunity, regardless of the trajectory of disease development (i.e., rapid or slowly progressive) or other associated demographic and/or clinical features (e.g., obesity).

Age-Related Genetic Heterogeneity

Type 1 diabetes shows heterogeneity across a broad range of clinical, genetic, immune, histological, and metabolic features ( 20 ). Childhood-onset type 1 diabetes is most often attributed to susceptibility alleles in human leukocyte antigen (HLA), which contribute ∼50% of the disease heritability. Whereas ethnic differences exist, notably for specific HLA genotypes, several broad principles apply. Compared with childhood-onset disease, adult-onset type 1 diabetes cases show lower type 1 diabetes concordance rates in twins ( 21 ), less high-risk HLA heterozygosity ( 19 ), lower HLA class I ( 14 ), more protective genotypes ( 14 , 15 ), and lower GRS ( 6 , 22 ), which are calculated by summing the odds ratios (OR) for disease-risk alleles.

Diabetes-Associated Immune Changes

Adult-onset type 1 diabetes, like childhood-onset type 1 diabetes, is associated with the presence of serum autoantibodies against β-cell antigens. Serum glutamic acid decarboxylase (GADA) autoantibodies may be useful as a predictor of type 1 diabetes in adults, as adult-onset cases most often present with GADA positivity ( 9 , 10 , 15 , 17 , 18 , 20 , 22 ) and possess an HLA-DR3 genotype ( 9 , 14 , 15 , 20 , 21 , 23 ). In one prospective study of a general population, the hazard risk of incident diabetes in those with a high type 1 diabetes GRS and GADA positivity was 3.23 compared with all other individuals, suggesting that 1.8% of incident diabetes in adults was attributable to that combination of risk factors ( 13 ). In adult-onset type 1 diabetes, multiple diabetes-associated autoantibodies tend to be less prevalent with increasing age at diagnosis ( 1 , 8 ), yet GADA remains the dominant autoantibody irrespective of the need for insulin treatment at diagnosis and irrespective of ethnicity ( 9 , 17 , 18 , 24 , 25 ), even despite a paucity of HLA DR3, as in Japan and China ( 17 , 18 ). In contrast, childhood-onset type 1 diabetes cases often have insulin autoantibodies and an HLA-DR4 genotype, higher identical twin disease concordance, more HLA heterozygosity, and higher GRS ( 20 ). Taken together, these data indicate that type 1 diabetes is heterogeneous across the spectrum of diagnoses, suggesting that pathogenesis and optimal therapy are also diverse.

Data from the TrialNet Pathway to Prevention cohort demonstrated lower risk of progression to type 1 diabetes in adults than children, even when both show multiple autoantibodies on a single occasion and are monitored over 10 years ( 12 ). One recent analysis found that the 5-year rate of progression to diabetes in multiple autoantibody–positive adults was only ∼15%, with a number of them remaining diabetes-free for decades ( 26 ). A combined cohort study, known as the Slow or Nonprogressive Autoimmunity to the Islets of Langerhans (SNAIL) study, is following such “slow progressors” with multiple autoantibodies who have yet to progress to stage 3 type 1 diabetes (i.e., clinical diagnosis) over at least a 10-year period ( 27 ). Many of these slow progressors lose disease-associated autoantibodies over time, adding complexity to cross-sectional classification ( 28 ). Based on estimates from natural history studies, slow progressors, even if identified when young, cannot account for all autoimmune adult-onset diabetes, indicating that autoantibodies must develop at all ages ( 11 ). However, little is known about those who initially develop autoimmunity as adults, mostly due to the lack of longitudinal studies focusing on this population.

People with type 1 diabetes, in contrast to the majority of those with type 2 diabetes, have altered adaptive immunity (i.e., islet autoantibodies and T-cell activation), while innate immune changes, including cytokine changes, are common to both ( 29 ). Increased T-cell activation by islet proteins has also been found in a proportion of adults with initially non-insulin-requiring diabetes, even when they lack diabetes autoantibodies ( 30 ). However, there is a paucity of immune studies on adult-onset type 1 diabetes and few histologic studies. An analysis of tissues from the Network for Pancreatic Organ Donors with Diabetes (nPOD) showed no relationship between age at diabetes onset and the frequency of islet insulitis ( 31 ). The composition of islet insulitis differs in very young children compared with older individuals, with the former having an increased frequency of B cells in islet infiltrates ( 32 ). However, relating pancreatic histological changes to changes in peripheral blood remains a challenge.

Adults with new-onset type 1 diabetes are at increased risk of other autoimmune conditions. About 30% of individuals with adult-onset type 1 diabetes have thyroid autoimmunity ( 27 , 29 ). In addition, adults with type 1 diabetes who possess high-titer GADA and/or multiple islet autoantibodies are at increased risk of progression to hypothyroidism ( 24 , 33 ). In a large population-based Chinese study, the prevalence of adult-onset type 1 diabetes was 6% among initially non-insulin-requiring diabetes cases, and 16.3% of them had thyroid autoimmunity (OR 2.4) ( 10 ). Of note, those with islet antigen 2 autoantibodies had a high risk of tissue transglutaminase autoantibodies, a marker for celiac disease (OR 19.1) ( 10 ). Thus, in the clinical setting, there should be a high index of suspicion for other autoimmune conditions in individuals with adult-onset type diabetes, and associated autoimmunity should be screened where clinically indicated.

Metabolic Characteristics of Adult-Onset Type 1 Diabetes

Age-related differences in type 1 diabetes extend to metabolic parameters. C-peptide at diagnosis is higher in adults than children, driven in part by higher BMI ( 34 ). Analysis of U.K., TrialNet, and Chinese cohorts has identified two distinct phases of C-peptide decline in stage 3 disease: an initial exponential fall followed by a period of relative stability. Along with initial differences at the time of clinical diagnosis, the rate of decline over 2–4 years was inversely related to age at onset ( 10 , 34 – 36 ). Furthermore, the U.S. T1D Exchange Study found that glycemic control was better in adults with type 1 diabetes than in children and adolescents with type 1 diabetes ( 37 ). The American Diabetes Association (ADA) targets for glycemia are higher in children, so that in this same cohort, 17% of children, compared with 21% of adults, achieved the ADA hemoglobin A 1c (HbA 1c ) goal of <7.5% and <7.0%, respectively ( 37 ). Other factors confound this relationship between age at diagnosis and metabolic control. First, individuals with adult-onset type 1 diabetes are more likely to have residual insulin-producing β-cells and persistent measurable C-peptide in disease of long duration, the latter of which has been linked to improved glycemic control ( 38 , 39 ). Second, individuals with adult-onset type 1 diabetes, initially not on insulin therapy, tend to have worse metabolic control than people with type 2 diabetes, even when receiving insulin treatment ( 9 , 40 ). The sole exception is the LADA China study, where worse control was noted only among those with a high GAD titer ( 18 ). Metabolic differences between adults and children extend beyond C-peptide. Adults with autoantibody positivity who progressed to type 1 diabetes were less likely than very young children to exhibit elevated proinsulin/C-peptide ratios prior to stage 3 disease onset ( 41 ). In addition, in individuals with disease of long duration, those diagnosed at an older age had evidence of improved proinsulin processing and nutrient-induced proinsulin secretory capacity ( 42 ).

Diagnosis and Management of Adult-Onset Type 1 Diabetes

Correctly identifying diabetes etiology and type is difficult, and misclassification may occur in up to 40% of adults presenting with type 1 diabetes ( 1 , 2 ). Reasons underlying misclassification are multiple and include 1 ) lack of awareness that the onset of type 1 diabetes is not limited to children; 2 ) the overwhelming majority of people developing diabetes as older adults have type 2 diabetes, contributing to a confirmation bias ( 2 ); 3 ) typical clinical criteria, such as BMI and metabolic syndrome, can be poor discriminators, especially as rates of obesity in the overall population increase ( 9 , 43 ); 4 ) clinical characteristics of adult-onset type 1 diabetes can masquerade as type 2 diabetes, given their slow metabolic progression and risk of metabolic syndrome (which occurs in about 40%), so that the distinction between types of diabetes may be blurred ( 43 – 45 ); and 5 ) lack of awareness of and accessibility to biomarkers that may serve as tools to distinguish type 1 diabetes and type 2 diabetes.

Tools to distinguish type 1 and type 2 diabetes are under active development. For example, classification models integrating up to five prespecified predictor variables, including clinical features (age of diagnosis and BMI) and clinical biomarkers (autoantibodies and GRS) in a White European population, had high accuracy to identify adults with recently diagnosed diabetes with rapid insulin requirement despite using GRS derived from childhood-onset type 1 diabetes. While GRS have the potential to assist diagnosis of type 1 diabetes in uncertain cases, they are not yet widely available in clinical practice. Moreover, it is important to note that while the model was optimized with the inclusion of all five variables, the addition of GRS had only a modest effect on overall model performance ( 22 ).

Classification can be aided by the measurement of autoantibodies and C-peptide. Recommended autoantibodies to assay at the time of diagnosis include those to insulin (insulin autoantibody), glutamate decarboxylase isoform 65 (GAD65A), insulinoma antigen 2, and zinc transporter isoform 8 (Znt8A), with GAD65A being the most prevalent autoantibody among adults. High levels or the presence of more than one antibody increases the likelihood of type 1 diabetes. However, it is important to realize that islet autoantibodies are a continuous marker that can also occur in the population without diabetes. As with many other tests, an abnormal test is usually based on a threshold signal from control populations without diabetes, usually the 97.5th or the 99th centile. Therefore, false-positive results with these assays can occur and can be reduced by using higher-specificity assays or thresholds and targeting testing toward those with clinical features suggestive of type 1 diabetes ( 46 ). Finally, since antibody levels can wane over time in established type 1 diabetes, the absence of autoantibodies does not rule out the possibility of a diagnosis of type 1 diabetes.

Measurement of C-peptide, paired with a blood glucose in the same sample, provides an estimate of endogenous insulin production and has the most utility in disease of long duration when levels fall below 300 pmol/L ( 39 , 47 ). However, C-peptide levels are typically higher at presentation and may be difficult to distinguish from levels in type 2 diabetes, which are usually >600 pmol/L. Thus, thresholds of C-peptide that clearly delineate type 1 diabetes from type 2 diabetes at diagnosis cannot be categorically defined, and C-peptide must be interpreted within the context of other clinical and laboratory features. Measurement of a random nonfasting C-peptide is superior to fasting C-peptide in identifying type 1 diabetes ( 48 ) and is well correlated with stimulated C-peptide levels measured during a mixed-meal tolerance test, which is considered the gold standard assessment of insulin secretory function in established type 1 diabetes ( 49 ). A recent analysis found that concomitant blood glucose ≥144 mg/dL (8 mmol/L) increased the specificity of random C-peptide in predicting a stimulated C-peptide level <600pmol/L, suggesting this is a reasonable threshold of blood glucose to employ for C-peptide interpretation ( 49 ).

C-peptide also can be used to guide therapy ( 50 ). Individuals with a random C-peptide level ≤300 pmol/L should be managed mainly with insulin. For those with random C-peptide levels >300 pmol/L, insulin could be combined with other diabetes therapies, although evidence about safety and efficacy is limited. It is generally agreed that sulfonylureas should be avoided because of the potential to hasten β-cell failure ( 50 ). There is concern for increased risk of diabetic ketoacidosis (DKA) with sodium–glucose cotransporter 1 (SGLT1) and SGLT2 inhibitors when these agents are used in type 1 diabetes, especially in nonobese individuals who may need only low dosages of insulin ( 51 ). All other agents could be considered for therapy in those not requiring insulin initially. In individuals with random C-peptide levels exceeding 600 pmol/L, management can be much as recommended for type 2 diabetes, with the caveats outlined above ( 50 ). An important consideration is that loss of β-cell function may be rapid in autoimmune diabetes. As such, individuals treated without insulin should be closely monitored.

In the absence of prospectively validated decision support tools that have been tested in multiethnic populations, we suggest, as an approach to aid the practicing physician, assessment of age, autoimmunity, body habitus/BMI, background, control, and comorbidities, using the acronym AABBCC ( Table 2 ). This approach includes the clinical consideration of autoimmunity and other clinical features suggestive of type 1 diabetes, including age at diagnosis, low BMI, an unexplained or rapid worsening of clinical course manifesting as a lack of response or rising HbA 1c with type 2 diabetes medications, and a rapid requirement for insulin therapy, especially within 3 years of diagnosis. It should be emphasized that among these features, age at diagnosis (<40 years), low BMI (<25 kg/m 2 ), and rapid need for insulin therapy are the most discriminatory ( 43 ). We recommend measurement of islet antibodies and C-peptide be considered in all older people with clinical features that suggest type 1 diabetes, with islet autoantibodies being the initial test of choice in short-duration disease (<3 years) and C-peptide the test of choice at longer durations.

Diabetes-Associated Comorbidities and Complications

The U.S. SEARCH for Diabetes in Youth study reported that nearly 30% of youth with newly diagnosed type 1 diabetes age <20 years presented with DKA ( 52 ). The frequency of DKA among adults at diagnosis with type 1 diabetes is unknown but is believed to be lower given that they often have higher C-peptide levels at diagnosis and a slower decline in β-cell function over time, even in those requiring insulin initially ( 34 ). Among childhood-onset type 1 diabetes, most episodes of DKA beyond diagnosis are associated with insulin omission, pump failure, or treatment error ( 53 ). However, for adults with type 1 diabetes, the primary risk factors are noncompliance and infections ( 54 ), the former sometimes due to the cost of insulin ( 55 ). Thus, there is a need to further understand DKA in adults, not least because it is associated with long-term worsening glycemic control ( 56 ).

Hypoglycemia

Fear of hypoglycemia remains a major problem in the clinical management of adults with type 1 diabetes ( 57 ), influencing quality of life and glycemic control. The effect of diabetes duration or age at diagnosis on hypoglycemia risk is not consistent among different studies. However, α-cell responses to hypoglycemia and hypoglycemia risk are both lower in individuals with higher C-peptide levels ( 38 ). Because residual C-peptide is more likely to be observed in those with a later age of onset, hypoglycemia risk may be different between those with childhood- and adult-onset diabetes. While insulin pumps and continuous glucose monitors are associated with improved glycemic control and reduced hypoglycemia ( 37 ), adults may show reluctance or inertia in adopting newer technologies. In the T1D Exchange study population, 63% of adults used an insulin pump while only 30% used a continuous glucose monitor, and use of these technologies tended to be lower in adults than in children ( 37 ). Factors that dictate use of these technologies are multiple and may include reduced access to or acceptance of wearable technology, challenges with insurance coverage, especially in the context of past misclassification, and/or inadequate education about hypoglycemia risk ( 58 ). A better understanding of potential barriers to technology use in adult-onset type 1 diabetes is needed. Furthermore, little is known about changes in hypoglycemia risk across the life span of individuals with adult-onset disease, representing an important gap in knowledge.

Microvascular and Macrovascular Disease Complications

Despite the prevalence of adult-onset type 1 diabetes, there is a paucity of data on the burden of microvascular complications in this population. Current knowledge is largely based on small, cross-sectional studies. In aggregate, these studies suggest that the prevalence of nephropathy and retinopathy are lower in adult-onset type 1 than in type 2 diabetes, but this conclusion is potentially confounded by diabetes duration. For example, the prevalence of nephropathy and retinopathy was lower in Chinese individuals with adult-onset type 1 diabetes than in those with type 2, but only in those with a disease duration <5 years, while in the Botnia Study, retinopathy risk in adult-onset type 1 diabetes increased, as expected, with disease duration ( 59 ). Two substantial prospective studies recently reported that those adults with diabetes enrolled in the UKPDS who were also GADA positive (i.e., presumably with type 1 diabetes) compared with those who were GADA negative (with type 2 diabetes) showed a higher prevalence of retinopathy and lower prevalence of cardiovascular events ( 60 , 61 ). These results are consistent with people with adult-onset type 1 diabetes compared with those with type 2 diabetes, showing a general tendency to higher HbA 1c levels ( 40 , 44 , 60 , 61 ) as well as reduced traditional cardiovascular risk factors, including reduced adiposity (BMI and waist circumference), metabolic (lipid levels), and vascular (blood pressure) profiles ( 9 , 24 , 62 ). Nevertheless, all-cause mortality and cardiovascular mortality rates in such individuals with adult-onset type 1 diabetes ( 59 ) are still higher than those among individuals without diabetes. In addition, there are discrepancies across studies, likely related to differences in populations under study (i.e., age, race/ethnicity, and diabetes duration), lack of consistent case definitions (i.e., adult-onset type 1 diabetes or LADA cases), and different outcomes, as well as small sample sizes with insufficient events on which to base strong recommendations.

Psychosocial Challenges

Negative stressors, including pressure to achieve target HbA 1c levels, lifestyle considerations, and fear of complications, are factors leading to the increased frequency of mood disorders, attempted suicide, and psychiatric care in adults with diabetes ( 63 ). In individuals who have experienced misclassification, additional stress derives from conflicting messages about the nature of their diabetes. Among adults with type 1 diabetes, those with high psychological coping skills (e.g., self-efficacy, self-esteem, and optimism) and adaptive skills may buffer the negative effect of stress and should be cultivated ( 64 ). Relationship challenges, including sexual intimacy, starting a family, caring for children, and relational stress, are major stressors for adults with type 1 diabetes ( 65 ). In addition, there is the looming threat of complications, including blindness and amputations ( 65 ). Adults with type 1 diabetes describe a sense of powerlessness, fear of hypoglycemia, and the challenges of both self-management and appropriate food management ( 66 ). A common misunderstanding is that while they face the same life choices associated with type 2 diabetes (e.g., weight loss, exercise, and limiting intake of simple sugars), adults with type 1 diabetes may require different management skills ( 67 ). Moreover, there is a strong association in adults with type 1 diabetes between chronic, stressful life events and fluctuating HbA 1c , possibly due to indirect mechanisms, including adherence to diabetes management ( 68 ). Whether these risks differ between those diagnosed as children or as adults is unclear and requires additional study.

In this Perspective, we have summarized the current understanding of adult-onset type 1 diabetes while identifying many knowledge gaps ( Table 1 ). Epidemiological data from diverse ethnic groups show that adult-onset type 1 diabetes is often more prevalent than childhood-onset type 1 diabetes. However, our understanding of type 1 diabetes presenting in adults is limited. This striking shortfall in knowledge ( Table 1 ) results in frequent misclassification, which may negatively impact disease management. Here, we outline a roadmap for addressing these deficiencies ( Fig. 1 ). A cornerstone of this roadmap is a renewed emphasis on the careful consideration of the underlying etiology of diabetes in every adult presenting with diabetes.

Proposed roadmap to better understand, diagnose, and care for adults with type 1 diabetes (T1D). Created in BioRender ( BioRender.com ).

Knowledge gaps

In the absence of data-driven classification tools capable of estimating individual-level risk, we offer a simple set of questions, incorporating what we have termed the AABBCCs of diabetes classification and management ( Table 2 ). In parallel, we invite the research community to join together in addressing key gaps in knowledge through studies aimed at defining the genetic, immunologic, and metabolic phenotype of adult-onset type 1 diabetes with the goal of using this knowledge to develop improved approaches for disease management and prevention ( Fig. 1 ).

AABBCC approach to diabetes classification

Acknowledgments. Sharon Saydah, Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, attended the workshop and participated in subsequent discussions of the manuscript. Elizabeth Seaquist, Division of Diabetes, Endocrinology, and Metabolism at the University of Minnesota, participated in the workshop. The authors acknowledge Marilyn L. Wales for her assistance with formatting the manuscript.

Funding and Duality of Interest. This manuscript is the result of a one-day meeting held at JDRF headquarters in New York, NY. Financial support for the workshop was provided by JDRF and Janssen Research and Development, LLC. Financial support from Janssen Research and Development, LLC, for the workshop was in an unrestricted grant to JDRF. JDRF provided participants with transportation, lodging, and meals to attend the workshop. No additional support was provided for the writing of the manuscript. R.D.L. is supported by a grant from the European Union (contract no. QLGi-CT-2002-01886). C.E.-M. is supported by National Institute for Health Research grants R01 DK093954, R21DK11 9800, U01DK127786, R01DK127308, and P30DK 097512; VA Merit Award I01BX001733; JDRF grant 2-SRA-2019-834-S-B; and gifts from the Sigma Beta Sorority, the Ball Brothers Foundation, and the George and Frances Ball Foundation. R.B. is supported in part by the Italian Ministry of University and Research (project code 20175L9H7H). A.G.J. is funded by a National Institute for Health Research (NIHR) Clinician Scientist fellowship (CS-2015-15-018). L.S.P. is supported in part by U.S. Department of Veterans Affairs (VA) awards CSP #2008, I01 CX001899, I01 CX001737, and Health Services Research & Development IIR 07-138; National Institute for Health Research awards R21 DK099716, R18 DK066204, R03 AI133172, R21 AI156161, U01 DK091958, U01 DK098246, and UL1 TR002378; and Cystic Fibrosis Foundation award PHILLI12A0.

R.D.L. received unrestricted educational grants from Novo Nordisk, Sanofi, MSD, and AstraZeneca. C.E.-M. has participated in advisory boards for Dompé Pharmaceuticals, Provention Bio, MaiCell Technologies, and ISLA Technologies. C.E.M. is the recipient of in-kind research support from Nimbus Pharmaceuticals and Bristol Myers Squibb and an investigator-initiated research grant from Eli Lilly and Company. J.F.-B. and J.L.D. were employed by JDRF during the workshop and early stages of writing. J.F.-B. is currently an employee of Provention Bio, and J.L.D. is currently an employee of Janssen Research and Development, LLC. R.B. participated in advisory boards for Sanofi and Eli Lilly and received honoraria for speaker bureaus from Sanofi, Eli Lilly, AstraZeneca, Novo Nordisk, and Abbott. L.S.P. has served on scientific advisory boards for Janssen and has or had research support from Merck, Pfizer, Eli Lilly, Novo Nordisk, Sanofi, PhaseBio, Roche, AbbVie, Vascular Pharmaceuticals, Janssen, GlaxoSmithKline, and the Cystic Fibrosis Foundation. L.S.P. is also a cofounder and officer and board member and stockholder for a company, Diasyst, Inc., that markets software aimed to help improve diabetes management. No other potential conflicts of interest relevant to this article were reported.

The sponsors had no role in the design and conduct of the study, collection, management, analysis, and interpretation of the data, and preparation, review, or approval of the manuscript. This work is not intended to reflect the official opinion of the VA or the U.S. Government.

Author Contributions. R.D.L., C.E.M., J.F.-B., and J.L.D. conceived of the article and wrote and edited the manuscript. All other authors were involved in the writing and editing of the manuscript. R.D.L. and C.E.-M. are guarantors of this work and, as such, had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Email alerts

• Online ISSN 1935-5548
• Print ISSN 0149-5992
• Diabetes Care
• Clinical Diabetes
• Diabetes Spectrum
• Standards of Medical Care in Diabetes
• Scientific Sessions Abstracts
• BMJ Open Diabetes Research & Care
• ShopDiabetes.org
• ADA Professional Books

Clinical Compendia

• Clinical Compendia Home
• Latest News
• DiabetesPro SmartBrief
• Special Collections
• DiabetesPro®
• Diabetes Food Hub™
• Insulin Affordability
• Know Diabetes By Heart™
• About the ADA
• Journal Policies
• For Reviewers
• Advertising in ADA Journals
• Reprints and Permission for Reuse
• Copyright Notice/Public Access Policy
• ADA Professional Membership
• ADA Member Directory
• Diabetes.org
• X (Twitter)
• Cookie Policy
• Accessibility
• Terms & Conditions
• Get Adobe Acrobat Reader
• © Copyright American Diabetes Association

This Feature Is Available To Subscribers Only

Sign In or Create an Account

• UBC Directories
• UBC Quick Links
• The University of British Columbia
• a place of mind
• Learn Pediatrics
• Diabetes: Approach to First Presentation

 Click for pdf: Diabetes

General presentation

Diabetes mellitus (DM) is an important endocrine disorder that presents commonly in children and adolescents. There are two types of diabetes mellitus: type 1 and type 2. Type 1 DM is one of the most common chronic diseases in children and is characterized by insulin deficiency as a result of autoimmune destruction of pancreatic beta islet cells; whereas type 2 DM is the presence of high blood glucose with insulin resistance and relative insulin deficiency. Diabetes mellitus is a chronic condition that requires long-term follow-up and adequate patient (and parent) education to maintain good glycemic control to prevent long-term complications.

Epidemiology

Approximately 2/3 of all new diabetes diagnoses in patients less than 19 years of age in the United States are type 1 DM. Over 300,000 Canadians have type 1 DM, with a 3-5% increase each year; especially in children aged 5-9. Typically, the age of onset has a bimodal distribution, with the first peak in children 4-6 years old, and the second peak in children 10-14 years old (early puberty). Unlike other autoimmune diseases, the overall incidence appears to be equal in both genders. There is a higher risk of developing this condition in children with close relatives who have type 1 DM.

The incidence of type 2 DM has increased 10 fold in the last decade. There is an estimated 3600/100,000 cases of type 2 DM in Canadian adolescents and 1100/100,000 cases in Canadian children. This value may be as high as 1% in Canadian aboriginal youths and children. There is a strong association between increasing rates of obesity in the pediatric population and the development of type 2 DM.

Basic Physiology

In type 1 DM, there is autoimmune-mediated destruction of insulin-producing pancreatic beta cells that results in insulin deficiency. It is a progressive condition that occurs in genetically susceptible individuals. The autoimmune destruction can be triggered by various environmental agents. Some proposed environmental factors include pregnancy-related and perinatal influences, viruses, cow’s milk and cereals. There is a long latency period (where the patient is asymptomatic and euglycemic) between the onset of beta cell destruction and clinical presentation of diabetes mellitus. A large number of functional beta cells must be lost before clinical symptoms like hyperglycemia occurs.

Genetic polymorphisms in six genes have been shown to be associated with type 1 DM. Major Histocompatibility Complex genes and elsewhere in the genome all contribute to the risk, but only the HLA alleles seem to have a large effect.

The natural history has four stages:

• Preclinical autoimmune destruction of pancreatic beta cells
• Onset of clinical symptoms
• Transient remission
• Established diabetes with acute and chronic complications

Type 2 DM is a complex, multifactorial disease characterized by both relative insulin deficiency and insulin resistance with various environmental and behavioural risk factors. Increased hepatic glucose production, insulin resistance and progressive loss of glucose-stimulated insulin release all contribute to the development of hyperglycemia. In Type 2 DM, pancreatic beta cells retain the ability to produce insulin, but levels are not adequate to counteract the developing insulin resistance. The current theory is that insulin resistance develops first, followed and complicated by gradual destruction of beta cells. Insulin resistance worsens with obesity and physical inactivity; and improves with weight loss and increased physical exercise.

Puberty also plays a role in the development of type 2 DM in adolescents. During this period, insulin sensitivity is approximately 30% lower than that of preadolescents or adults, which results in hyperinsulinemia as a compensatory mechanism. In adolescents with both genetic predisposition and negative environmental contributors, this period of relative insulin resistance may result in a decompensated state (inadequate insulin secretion and glucose intolerance). The resulting hyperglycemic state may cause worsening abnormalities of insulin secretion and action, starting a vicious cycle that progress beyond the adolescent years.

Clinical Presentation

Childhood type 1 DM can present in the following ways:

Classic new onset:

Hyperglycemia without acidosis

Symptoms include:

• Can present as nocturia, bedwetting, daytime incontinence in a previously continent child
• Polydipsia – due to increased serum osmolality and hypovolemia
• Impaired glucose utilization in skeletal muscle and increased fat and muscle breakdown

Diabetic ketoacidosis

Similar symptoms but are usually more severe

• Clinical: polydipsia, polyuria, dehydration, hypotension, ketosis, etc.
• Metabolic: hyperglycemia, glycosuria, metabolic acidosis, ketonemia, etc.

Reported frequency varies between 15-67%

• Young children (<6) from low socioeconomic backgrounds are more likely to present with diabetic ketoacidosis

Silent Presentation

Diagnosis before onset of clinical symptoms

Typically occurs in children with a family member with type 1 DM (close monitoring)

Childhood type 2 DM can present in the following ways:

• Hyperglycemia, ketonuria, acidosis
• Frequency varies between 5-25%

Hyperosmolar hyperglycemic state

• Marked hyperglycemia (>33.3 mmol/L) and severe dehydration but no ketonuria
• Less common in adolescents

Symptomatic

• Due to hyperglycemia and include: polyuria, polydipsia, and nocturia
• Recent weight loss is less frequent
• Adolescent girls: vaginal discharge due to candida infection may be initial presentation

Asymptomatic

• Identified based on screening (for type 2 DM or urinalysis as part of a regular physical exam)

Questions to ask

Historical Investigation

Presenting condition:

• Have you been very thirsty? Do you drink a lot?
• Have you been urinating more than usual?
• Has the child had any bedwetting episodes?
• Has there been any recent weight loss?
• Have you been feeling tired lately?
• Have you noticed an increased appetite lately?
• Has the child had more frequent minor skin infections?

Predisposing factors:

• Have you had any viral infections recently?
• What kinds of exercise do you participate in on a regular basis? How frequent do you exercise? How long do you exercise each time?
• How many hours a day do you spend watching TV, using the computer, and play video games?
•  What do you normally eat? What is the portion size? How many meals do you have per day? Do you normally eat out or home cooked meals? Do you eat as a family? Do you eat at the table or in front of the tv?

Family history:

• Are there any family members with insulin-dependent diabetes mellitus?
• Are there any family members with autoimmune conditions?
• Does your mother or father have diabetes?
• Are there any other family members with diabetes? (grandparents, aunts, uncles, brothers, sisters, etc.)

Physical Examination

Do a complete physical exam with particular attention to the following:

• Assess hydration status
• Assess circulation: HR, BP, capillary refill
• Temperature: coexisting infection
• Use growth chart to check for weight loss
• Neck examination: look for thyroid abnormalities
• Respiratory: respiratory rate (hyperventilation – DKA), auscultation (respiratory infection), ketones on breath (DKA)
• Measure body weight and height, calculate BMI
• Measure lying and standing BP
• Inspect skin for acanthosisnigricans
• Examine feet to look for decreased sensation and circulation (pulses)
• Measure visual acuity

Differential diagnosis

• DM types 1 and 2
• Diabetes insipidus
• Urinary tract infection
• Malabsorption (e.g. Celiac disease)
• Secondary diabetes
• Maturity-onset diabetes of the young

Procedures for investigation

Diagnostic Criteria

• Fasting plasma glucose >7 mmol/L (no caloric intake for at least 8 hours)
• Symptoms of hyperglycemia, random venous plasma glucose >11.1 mmol/L
• Abnormal oral glucose tolerance test – plasma glucose >11.1 mmol/L measured 2 hours after a glucose load of 1.75 g/kg (max 75g)
• Glycated hemoglobin (A1C) ≥ 6.5%

Other Investigations

• Urinalysis for glucosuria and ketonuria
• Urinalysis for microalbuminemia
• Alemzadeh R, Wyatt DT. Section 6 – Diabetes mellitus in children. In: Kliegman: Nelson Textbook of Pediatrics. 18 th ed. Saunders, Pennsylvania. 2007
• Eisenbarth GS, McCulloch DK. Pathogenesis of type 1 diabetes mellitus. In: UpToDate, Basow, DS (Ed), UpToDate, Waltham, MA, 2011
• Laffel L, Svoren B. Epidemiology, presentation, and diagnosis of type 2 diabetes mellitus in children and adolescents. In: UpToDate, Basow, DS (Ed), UpToDate, Waltham, MA, 2011
• Levinson P, Nelson BA, Scherger JE. Diabetes mellitus type 1 in children. [Online]. 2007. Availabe from: FirstConsult, MDConsult. [cited 2011 Jan 15]
• Levitsky LL, Misra M. Epidemiology, presentation, and diagnosis of type 1 diabetes mellitus in children and adolescents. In: UpToDate, Basow, DS (Ed), UpToDate, Waltham, MA, 2011
• McCulloch DK, Robertson RP. Pathogenesis of type 2 diabetes mellitus. In: UpToDate, Basow, DS (Ed), UpToDate, Waltham, MA, 2011
• Panagiotopoulos C. Type 2 diabetes in children and adolescents. BCMJ. 2004;46(9): 461-466
• Scherger JE, McIntire SDC, Escobar O, Heinzman DM. Diabetes mellitus type 2 in children. [Online]. 2007. Availabe from: FirstConsult, MDConsult. [cited 2011 Jan 15]

Acknowledgements

Written by: Ying Yao

Edited by: Dianna Louie

Last updated on November 10, 2011 @5:01 pm

Feedback: How useful was the above information?

Post comment click here to cancel reply..

You must be logged in to post a comment.

• Approach to the Child with a fever and rash
• Approach to Bradycardia
• Basics of cardiac pharmacology
• Approach to cardiac history taking
• Congestive heart failure in children
• Approach to Pediatric Hypertension
• Approach to Cyanotic Congenital Heart Disease in the Newborn
• Approach to Syncope: Is it Cardiac or Not?
• Approach to Pediatric Tachycardia
• Approach to Pediatric Chest Pain
• Approach to Cardiac Murmurs
• Normal Cardiac Physiology – Transition From Fetal to Neonatal
• Basic Physiology and Approach to Heart Sounds
• Approach to Pediatric ECGs
• Care of a Child with Turner Syndrome
• Approach to the Underweight Child
• Normal sexual maturity rating
• Hypothyroidism
• Approach to the Short Child
• Approach to Vomiting
• Suspected Foreign Body Ingestion
• Approach to a Mediastinal Mass
• Toxic Ingestion
• Nutritional Deficiencies
• Pharmacology of Common Agents Used in Gastrointestinal Conditions
• Approach to Pediatric Abdominal Pain
• Pediatric Gastrointestinal History Taking
• Approach to diarrhea
• Approach to a picky eater
• Constipation
• Hepatomegaly
• Splenomegaly
• Approach to Abdominal Mass
• Failure to Thrive
• Approach to Skin Lesions
• Common Paediatric Skin Conditions & Birthmarks
• Approach to the child with mental health concerns
• Child with a sore ear (Otalgia)
• To vaccinate or not to vaccinate
• Approach to a the Child with a Fever and Rash
• Approach to a Routine Adolescent Interview
• Sore Throat in Children – Clinical Considerations and Evaluation
• Approach to Strabismus
• Approach to Adolescent Substance Use
• Approach to the Child Who is Dry
• Conjunctivitis: Approach to the Child with a Red Eye
• Acne In Teens
• Pediatric Neck Mass
• Fetal Alcohol Spectrum Disorder
• To Circumcise or Not to Circumcise
• Approach to inborn errors of metabolism
• Infants of Diabetic Mothers
• Fever in the Newborn Period
• Neonatal Thrombocytopenia
• Consequences of Prematurity
• Respiratory Distress in the Newborn
• Approach to Neonatal Cyanosis
• Approach to the Child with IUGR/SGA
• Neonatal Jaundice
• Breastfeeding Problems
• Diaper Rash: Clinical Considerations and Evaluation
• The Pediatric Neurological History
• Evaluation of Pediatric Development (Normal)
• Closed Head Injury in Pediatrics
• Approach to the Ataxic Child
• Approach to the Child with a Seizure
• Basics to the Approach of Developmental Delay
• Lumbar Puncture in Pediatrics
• The Basics of Cerebral Palsy
• Approach to a Child with a Headache
• Febrile Seizures
• Approach to the Comatose Child
• Basics of Spina Bifida
• Principles of Pharmacotherapy in Neurology
• Easy Bleeding
• Non-Neonatal Jaundice
• Approach to Lymphadenopathy
• Tumor Lysis Syndrome
• Febrile Neutropenia
• Pediatric Neutropenia
• Blood Transfusion Reactions
• Approach to Sickle Cell Disease
• Iron-deficiency and Health Consequences in Children
• Easy Clotting
• Approach to Thrombocytopenia
• Approach to Pediatric Leukemias and Lymphomas
• Approach to Thalassemia
• Approach to Non-Accidental Injuries
• Common Pediatric Bone Diseases-Approach to Pathological Fractures
• Infant with an Abnormal Hip Exam
• Knock Kneed Children
• Elbow Injuries
• Approach to the Child with a Limp
• Pediatric Fractures
• Clearing the C - Spine
• Approach to a Child With a Cough
• Approach to Pediatric Hemoptysis
• Approach to Pediatric Dyspnea
• Introduction
• Systemic Exam
• Kidneys and Bladder
• Male Infants
• Female Infants
• Acute Assessment
• General exam
• Peripheral palpation
• Precordium palpation
• Auscultation
• General Inspection
• Genito-Urinary
• Musculoskeletal
• Neurological
• Mental Status Exam
• Cranial Nerve Exam
• Sensory Exam
• Cerebellar Exam
• Other Resources
• Physical Exam Setup
• Screening MSK Exam
• Focused MSK Exams

Emergency Procedures  |  Accessibility  |  Contact UBC  |  © Copyright The University of British Columbia

We use essential cookies to make Venngage work. By clicking “Accept All Cookies”, you agree to the storing of cookies on your device to enhance site navigation, analyze site usage, and assist in our marketing efforts.

Manage Cookies

Cookies and similar technologies collect certain information about how you’re using our website. Some of them are essential, and without them you wouldn’t be able to use Venngage. But others are optional, and you get to choose whether we use them or not.

Strictly Necessary Cookies

These cookies are always on, as they’re essential for making Venngage work, and making it safe. Without these cookies, services you’ve asked for can’t be provided.

Show cookie providers

• Google Login

Functionality Cookies

These cookies help us provide enhanced functionality and personalisation, and remember your settings. They may be set by us or by third party providers.

Performance Cookies

These cookies help us analyze how many people are using Venngage, where they come from and how they're using it. If you opt out of these cookies, we can’t get feedback to make Venngage better for you and all our users.

• Google Analytics

Targeting Cookies

These cookies are set by our advertising partners to track your activity and show you relevant Venngage ads on other sites as you browse the internet.

• Google Tag Manager
• Infographics
• Daily Infographics
• Popular Templates
• Accessibility
• Graphic Design
• Graphs and Charts
• Data Visualization
• Human Resources
• Beginner Guides

Blog Beginner Guides 8 Types of Presentations You Should Know [+Examples & Tips]

8 Types of Presentations You Should Know [+Examples & Tips]

Written by: Krystle Wong Aug 11, 2023

From persuasive pitches that influence opinions to instructional demonstrations that teach skills, the different types of presentations serve a unique purpose, tailored to specific objectives and audiences.

Presentations that are tailored to its objectives and audiences are more engaging and memorable. They capture attention, maintain interest and leave a lasting impression. 

Don’t worry if you’re no designer —  Whether you need data-driven visuals, persuasive graphics or engaging design elements, Venngage can empower you to craft presentations that stand out and effectively convey your message.

Venngage’s intuitive drag-and-drop interface, extensive presentation template library and customizable design options make it a valuable tool for creating slides that align with your specific goals and target audience. 

Click to jump ahead:

8 Different types of presentations every presenter must know

How do i choose the right type of presentation for my topic or audience, types of presentation faq, 5 steps to create a presentation with venngage .

When it comes to presentations, versatility is the name of the game. Having a variety of presentation styles up your sleeve can make a world of difference in keeping your audience engaged. Here are 8 essential presentation types that every presenter should be well-acquainted with:

1. Informative presentation

Ever sat through a presentation that left you feeling enlightened? That’s the power of an informative presentation. 

This presentation style is all about sharing knowledge and shedding light on a particular topic. Whether you’re diving into the depths of quantum physics or explaining the intricacies of the latest social media trends, informative presentations aim to increase the audience’s understanding.

When delivering an informative presentation, simplify complex topics with clear visuals and relatable examples. Organize your content logically, starting with the basics and gradually delving deeper and always remember to keep jargon to a minimum and encourage questions for clarity.

Academic presentations and research presentations are great examples of informative presentations. An effective academic presentation involves having clear structure, credible evidence, engaging delivery and supporting visuals. Provide context to emphasize the topic’s significance, practice to perfect timing, and be ready to address anticipated questions. 

2. Persuasive presentation

If you’ve ever been swayed by a passionate speaker armed with compelling arguments, you’ve experienced a persuasive presentation . 

This type of presentation is like a verbal tug-of-war, aiming to convince the audience to see things from a specific perspective. Expect to encounter solid evidence, logical reasoning and a dash of emotional appeal.

With persuasive presentations, it’s important to know your audience inside out and tailor your message to their interests and concerns. Craft a compelling narrative with a strong opening, a solid argument and a memorable closing. Additionally, use visuals strategically to enhance your points.

Examples of persuasive presentations include presentations for environmental conservations, policy change, social issues and more. Here are some engaging presentation templates you can use to get started with: 

3. Demonstration or how-to presentation

A Demonstration or How-To Presentation is a type of presentation where the speaker showcases a process, technique, or procedure step by step, providing the audience with clear instructions on how to replicate the demonstrated action. 

A demonstrative presentation is particularly useful when teaching practical skills or showing how something is done in a hands-on manner.

These presentations are commonly used in various settings, including educational workshops, training sessions, cooking classes, DIY tutorials, technology demonstrations and more. Designing creative slides for your how-to presentations can heighten engagement and foster better information retention. 

Speakers can also consider breaking down the process into manageable steps, using visual aids, props and sometimes even live demonstrations to illustrate each step. The key is to provide clear and concise instructions, engage the audience with interactive elements and address any questions that may arise during the presentation.

4. Training or instructional presentation

Training presentations are geared towards imparting practical skills, procedures or concepts — think of this as the more focused cousin of the demonstration presentation. 

Whether you’re teaching a group of new employees the ins and outs of a software or enlightening budding chefs on the art of soufflé-making, training presentations are all about turning novices into experts.

To maximize the impact of your training or instructional presentation, break down complex concepts into digestible segments. Consider using real-life examples to illustrate each point and create a connection. 

You can also create an interactive presentation by incorporating elements like quizzes or group activities to reinforce understanding.

5. Sales presentation

Sales presentations are one of the many types of business presentations and the bread and butter of businesses looking to woo potential clients or customers. With a sprinkle of charm and a dash of persuasion, these presentations showcase products, services or ideas with one end goal in mind: sealing the deal.

A successful sales presentation often has key characteristics such as a clear value proposition, strong storytelling, confidence and a compelling call to action. Hence, when presenting to your clients or stakeholders, focus on benefits rather than just features. 

Anticipate and address potential objections before they arise and use storytelling to showcase how your offering solves a specific problem for your audience. Utilizing visual aids is also a great way to make your points stand out and stay memorable.

A sales presentation can be used to promote service offerings, product launches or even consultancy proposals that outline the expertise and industry experience of a business. Here are some template examples you can use for your next sales presentation:

6. Pitch presentation

Pitch presentations are your ticket to garnering the interest and support of potential investors, partners or stakeholders. Think of your pitch deck as your chance to paint a vivid picture of your business idea or proposal and secure the resources you need to bring it to life. 

Business presentations aside, individuals can also create a portfolio presentation to showcase their skills, experience and achievements to potential clients, employers or investors. 

Craft a concise and compelling narrative. Clearly define the problem your idea solves and how it stands out in the market. Anticipate questions and practice your answers. Project confidence and passion for your idea.

7. Motivational or inspirational presentation

Feeling the need for a morale boost? That’s where motivational presentations step in. These talks are designed to uplift and inspire, often featuring personal anecdotes, heartwarming stories and a generous serving of encouragement.

Form a connection with your audience by sharing personal stories that resonate with your message. Use a storytelling style with relatable anecdotes and powerful metaphors to create an emotional connection. Keep the energy high and wrap up your inspirational presentations with a clear call to action.

Inspirational talks and leadership presentations aside, a motivational or inspirational presentation can also be a simple presentation aimed at boosting confidence, a motivational speech focused on embracing change and more.

8. Status or progress report presentation

Projects and businesses are like living organisms, constantly evolving and changing. Status or progress report presentations keep everyone in the loop by providing updates on achievements, challenges and future plans. It’s like a GPS for your team, ensuring everyone stays on track.

Be transparent about achievements, challenges and future plans. Utilize infographics, charts and diagrams to present your data visually and simplify information. By visually representing data, it becomes easier to identify trends, make predictions and strategize based on evidence.

Now that you’ve learned about the different types of presentation methods and how to use them, you’re on the right track to creating a good presentation that can boost your confidence and enhance your presentation skills . 

Selecting the most suitable presentation style is akin to choosing the right outfit for an occasion – it greatly influences how your message is perceived. Here’s a more detailed guide to help you make that crucial decision:

1. Define your objectives

Begin by clarifying your presentation’s goals. Are you aiming to educate, persuade, motivate, train or perhaps sell a concept? Your objectives will guide you to the most suitable presentation type. 

For instance, if you’re aiming to inform, an informative presentation would be a natural fit. On the other hand, a persuasive presentation suits the goal of swaying opinions.

2. Know your audience

Regardless if you’re giving an in-person or a virtual presentation — delve into the characteristics of your audience. Consider factors like their expertise level, familiarity with the topic, interests and expectations. 

If your audience consists of professionals in your field, a more technical presentation might be suitable. However, if your audience is diverse and includes newcomers, an approachable and engaging style might work better.

3. Analyze your content

Reflect on the content you intend to present. Is it data-heavy, rich in personal stories or focused on practical skills? Different presentation styles serve different content types. 

For data-driven content, an informative or instructional presentation might work best. For emotional stories, a motivational presentation could be a compelling choice.

4. Consider time constraints

Evaluate the time you have at your disposal. If your presentation needs to be concise due to time limitations, opt for a presentation style that allows you to convey your key points effectively within the available timeframe. A pitch presentation, for example, often requires delivering impactful information within a short span.

5. Leverage visuals

Visual aids are powerful tools in presentations. Consider whether your content would benefit from visual representation. If your PowerPoint presentations involve step-by-step instructions or demonstrations, a how-to presentation with clear visuals would be advantageous. Conversely, if your content is more conceptual, a motivational presentation could rely more on spoken words.

6. Align with the setting

Take the presentation environment into account. Are you presenting in a formal business setting, a casual workshop or a conference? Your setting can influence the level of formality and interactivity in your presentation. For instance, a demonstration presentation might be ideal for a hands-on workshop, while a persuasive presentation is great for conferences.

7. Gauge audience interaction

Determine the level of audience engagement you want. Interactive presentations work well for training sessions, workshops and small group settings, while informative or persuasive presentations might be more one-sided.

8. Flexibility

Stay open to adjusting your presentation style on the fly. Sometimes, unexpected factors might require a change of presentation style. Be prepared to adjust on the spot if audience engagement or reactions indicate that a different approach would be more effective.

Remember that there is no one-size-fits-all approach, and the best type of presentation may vary depending on the specific situation and your unique communication goals. By carefully considering these factors, you can choose the most effective presentation type to successfully engage and communicate with your audience.

To save time, use a presentation software or check out these presentation design and presentation background guides to create a presentation that stands out.    

What are some effective ways to begin and end a presentation?

Capture your audience’s attention from the start of your presentation by using a surprising statistic, a compelling story or a thought-provoking question related to your topic. 

To conclude your presentation , summarize your main points, reinforce your key message and leave a lasting impression with a powerful call to action or a memorable quote that resonates with your presentation’s theme.

How can I make my presentation more engaging and interactive?

To create an engaging and interactive presentation for your audience, incorporate visual elements such as images, graphs and videos to illustrate your points visually. Share relatable anecdotes or real-life examples to create a connection with your audience. 

You can also integrate interactive elements like live polls, open-ended questions or small group discussions to encourage participation and keep your audience actively engaged throughout your presentation.

Which types of presentations require special markings

Some presentation types require special markings such as how sales presentations require persuasive techniques like emphasizing benefits, addressing objections and using compelling visuals to showcase products or services. 

Demonstrations and how-to presentations on the other hand require clear markings for each step, ensuring the audience can follow along seamlessly. 

That aside, pitch presentations require highlighting unique selling points, market potential and the competitive edge of your idea, making it stand out to potential investors or partners.

Need some inspiration on how to make a presentation that will captivate an audience? Here are 120+ presentation ideas to help you get started. 

Creating a stunning and impactful presentation with Venngage is a breeze. Whether you’re crafting a business pitch, a training presentation or any other type of presentation, follow these five steps to create a professional presentation that stands out:

• Sign up and log in to Venngage to access the editor.
• Choose a presentation template that matches your topic or style.
• Customize content, colors, fonts, and background to personalize your presentation.
• Add images, icons, and charts to enhancevisual style and clarity.
• Save, export, and share your presentation as PDF or PNG files, or use Venngage’s Presentation Mode for online showcasing.

In the realm of presentations, understanding the different types of presentation formats is like having a versatile set of tools that empower you to craft compelling narratives for every occasion.

Remember, the key to a successful presentation lies not only in the content you deliver but also in the way you connect with your audience. Whether you’re informing, persuading or entertaining, tailoring your approach to the specific type of presentation you’re delivering can make all the difference.

Presentations are a powerful tool, and with practice and dedication (and a little help from Venngage), you’ll find yourself becoming a presentation pro in no time. Now, let’s get started and customize your next presentation!

Discover popular designs

Infographic maker

Brochure maker

White paper online

Newsletter creator

Flyer maker

Timeline maker

Letterhead maker

Mind map maker

Ebook maker

Education Presentations

From lack of information to misinformation, there is a lot that people confuse about type 1 diabetes . But we can change these misconceptions about type 1 diabetes (T1D) by educating them!

What is T1D? How do you get it? How do you manage it? Is there a cure? You can answer all these burning questions with our Education Presentations. Teaching others about type 1 diabetes is an empowering experience that also spreads awareness and fosters a better understanding of what you face on a daily basis, in the classroom and beyond.

Educate your classmates on what it means to live and thrive with T1D today!

Here’s how:

• Ask your school if you can give a presentation.
• Fill out the form below and submit! You’ll receive an email confirmation from us.*
• We will ship your flyers to the address provided.**

*If you haven’t received an email confirmation within a week of applying, please email at [email protected].

**If you haven’t received hard copies of flyers within three weeks, please email at [email protected].

What you’ll receive:

• Education Presentation ( Elementary School , Middle School , or High School )
• Accompanying notes
• Educational Posters from Beyond Type 1

EmbedManager.embed({ key: "https://fs3.formsite.com/res/showFormEmbed?EParam=iGs2D6QRb6L5dJ%2BjcDCMZ6TYtsqQEFEw&982116281", width: "100%", mobileResponsive: true });

Elementary school presentation ►.

[pdf-embedder url=”https://beyondtype1.org/wp-content/uploads/2020/10/2020-BT1-ELEMENTARY-GVOKE-EDUCATION-PRESENTATIONS-1-1.pdf” title=”2020-BT1-ELEMENTARY-GVOKE-EDUCATION-PRESENTATIONS-1″]

Middle School Presentation ►

[pdf-embedder url=”https://beyondtype1.org/wp-content/uploads/2020/10/2020-BT1-MIDDLE-SCHOOL-GVOKE-EDUCATION-PRESENTATIONS-1-1.pdf” title=”2020-BT1-MIDDLE-SCHOOL-GVOKE-EDUCATION-PRESENTATIONS-1″]

High School Presentation ►

[pdf-embedder url=”https://beyondtype1.org/wp-content/uploads/2020/10/2020-BT1-HIGH-SCHOOL-GVOKE-EDUCATION-PRESENTATIONS-1-1.pdf” title=”2020-BT1-HIGH-SCHOOL-GVOKE-EDUCATION-PRESENTATIONS-1″ download=”all”]

These presentations were updated in 2021 with support from Gvoke Glucagon. Learn more at GvokeGlucagon.com .

Learn more about Beyond Type 1 programs.

WRITTEN BY BT1 Editorial Team, POSTED 07/24/17, UPDATED 08/04/23

The night my son nearly died for a sprite -, a mother’s cautionary tale -, i can’t sleep -, understanding your a1c -, what is type 2 diabetes -.

• TERMS OF USE
• 400 CONCAR DR.
• SAN MATEO, CA 94402

• BEYOND TYPE 1 BEYOND TYPE 1 EN ESPAÑOL
• IN ENGLISH EN ESPANOL BEYOND TYPE 1 AUF DEUTSCH BEYOND TYPE 1 IN ITALIANO BEYOND TYPE 1 EN FRANÇAIS BEYOND TYPE 1 IN HET NEDERLANDS BEYOND TYPE 1 PÅ SVENSKA BEYOND TYPE 1 EM PORTUGUÊS BEYOND TYPE 1 بالعربية

• BEYOND TYPE 2 BEYOND TYPE 2 EN ESPAÑOL IN ENGLISH EN ESPANOL BEYOND TYPE 2 AUF DEUTSCH BEYOND TYPE 2 en Français BEYOND TYPE 2 in Italiano BEYOND TYPE 2 Canada (French) BEYOND TYPE 2 Canada (English)

Help | Advanced Search

Mathematics > Quantum Algebra

Title: rll-realization of two-parameter quantum affine algebra of type $b_n^{(1)}$.

Abstract: In this paper, we firstly provide the correspondence between the FRT formalism and the Drindeld-Jimbo presentation for $U_{r, s}(\mathfrak{so}_{2n+1})$, using the theory of finite dimensional weight modules. In the affine case $U_{r, s}(\widehat{\mathfrak{so}_{2n+1}}),$ we give its RLL realization via the Gauss decomposition. Thus we establish the correspondence between this realization and the Drinfeld realization.

Submission history

Access paper:.

• HTML (experimental)
• Other Formats

References & Citations

• Google Scholar
• Semantic Scholar

BibTeX formatted citation

Bibliographic and Citation Tools

Code, data and media associated with this article, recommenders and search tools.

• Institution

arXivLabs: experimental projects with community collaborators

arXivLabs is a framework that allows collaborators to develop and share new arXiv features directly on our website.

Both individuals and organizations that work with arXivLabs have embraced and accepted our values of openness, community, excellence, and user data privacy. arXiv is committed to these values and only works with partners that adhere to them.

Have an idea for a project that will add value for arXiv's community? Learn more about arXivLabs .