We can explore what happens in Type 1 because it really does depend on what kind of person you are and how your Type 1 diabetes evolved and developed.
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So I'm just going to plot a simple graph here where we are looking at insulin production on one side against time and if we imagine that a person who doesn't have Type 1 diabetes is producing 100% of their insulin needs. And so in producing 100% of their insulin needs something comes along that produces pancreatic trauma. Now that could be immediate. And that would be something like if your pancreas is removed and that often occurs if people have chronic pancreatitis or trauma or pancreatic carcinoma.
So the more typical person who has Type 1 diabetes has a very sort of rapid onset but takes weeks to months to develop. And in this situation the pancreatic trauma that occurs is related to antibodies production. Often it follows a viral infection, the body produces antibodies against that virus but unfortunately the antibodies also seem to look for the specific cells in the pancreas that produce insulin called beta cells and it destroys them over time. And people in that situation would develop symptoms over weeks to months where the pancreatic trauma event occurs and very quickly insulin production falls very dramatically. So symptoms start quite quickly and it becomes quite obvious.
But there is another group of people with Type 1 diabetes who have a very slow progression of diabetes. And they are often misrepresented and thought of as having Type 2 diabetes because it evolves so slowly that their diabetes control can actually deteriorate over years rather than weeks. This group are called LADA or Latent Autoimmune Diabetes in Adults. So our classic description of someone developing Type 1 diabetes over weeks doesn't quite fit that mould and this group of people are often missed and are often treated with insulin very late.
And then the final group of people that we see who have a pancreatic trauma event are people who have for whatever reason a small self-limiting event which takes out a percentage of their pancreatic production. So it may be that a virus comes along the pancreas is affected, it takes about 20% of beta cell function and then they recover. And it may be that they end up still producing a decent amount of insulin and can have a great result with a small amount of insulin to top them up, it may be that they have 50% production of insulin or it might be that they even have 20% or 30%. But this group of people continue to produce insulin forever and their short term self-limiting illness kind of resolves but leaves them with an ongoing permanent reduction in insulin production that requires them to manage their insulin deficiency with insulin in the long term.
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