Type 1 Diabetes Screening and Early Detection: A Complete Guide

Proactively screening for type 1 diabetes allows people to benefit from a new treatment that can delay the onset of the disease and training that can help make the transition to life with diabetes safer and less traumatic.

There are multiple autoantibodies, and type 1 diabetes requires the presence of at least two different types to develop.

Screening allows doctors to confirm the presence of type 1 diabetes before it becomes dangerous.

Most people with type 1 diabetes are diagnosed only after they see a doctor to treat the symptoms of hyperglycemia (high blood sugar). These warning signs — which include blurry vision, increased thirst, frequent urination, unintentional weight loss, and intense hunger — indicate that blood sugar levels have risen into a dangerous range. These signs, however, represent only the final stage in the slow progression of type 1 diabetes.

• Stage 1 A blood test will show the presence of two or more autoantibodies, which will eventually cause the autoimmune attack that defines type 1 diabetes. During this stage, blood sugar levels are still normal and there are no symptoms.
• Stage 2 The autoimmune attack is under way and the pancreatic cells are in the process of being destroyed. At this point a glucose test will show abnormal blood sugar levels, which are not yet high enough to cause symptoms.
• Stage 3 The person has finally developed full-blown type 1 diabetes. By now, the patient has lost so many beta cells and creates so little insulin that they are experiencing the symptoms of hyperglycemia. Insulin treatment is now necessary.

Because the first and second stages of type 1 diabetes development have no obvious symptoms, they can only be discovered by screening. Though there is no way to prevent the development of type 1 diabetes, identifying these earlier stages of the condition can considerably improve prognosis.

There are two big benefits to early type 1 diabetes detection: DKA prevention and early treatment to delay symptom onset.

DKA Prevention

Perhaps the single largest benefit to type 1 diabetes screening is the reduced incidence of diabetic ketoacidosis (DKA), a consequence of severe hyperglycemia that can be deadly if not treated promptly.

“We could prevent a lot of DKA,” says Lewis.

Early detection also gives people time to learn about diabetes and the elements of diabetes treatment, such as carbohydrate counting, thus ensuring a far smoother and less stressful transition once they need to begin insulin therapy.

“It gives people time to cope with the diagnosis. There are a lot of psychosocial barriers, and it’s so much education. If people can learn it over time, rather than in a crash course, it would be helpful,” says Lewis.

Early Type 1 Diabetes Treatment

Lewis says that delaying insulin dependency by several years can have massive benefits, especially in younger people.

“It’s much easier to manage if they’re a little bit older. You have time to learn about it. If you delayed the onset from age 18 to age 22, someone could go through their whole college career without diabetes. That would make their life a lot easier.”

Lewis, who has type 1 diabetes herself, encouraged her siblings to get screened: “I have three younger brothers. They wanted to know so they could do something about it, or so they could have peace of mind if they knew they didn’t have it. We want all patients who have type 1 diabetes to think about getting their family members screened.”

“We see it at all ages,” says Lewis. “I would never say you’re too old to get screened.”

The push for type 1 diabetes screening is relatively new, and not all doctors’ offices or endocrinology clinics have made screening routine.

The first step is to ask your doctor about screening. They may be able to administer a test in their office or refer you to a local lab. If you go through your regular doctor it may help you secure health insurance coverage for the cost of testing.

In the United States, there are several other independent resources that can arrange screening tests, sometimes free of cost.

• TrialNet offers free type 1 diabetes screening to family members of people with diabetes. Your blood test results are made available to researchers working on type 1 diabetes prevention and cures.
• ASK — Autoimmunity Screening for Kids, an autoimmunity research effort, offers free screening for both type 1 diabetes and celiac disease to all children under the age of 18, regardless of family history.
• The Diabetes Link, a nonprofit community for young adults with type 1 diabetes, offers links to screening programs and advice on talking to your doctor and insurance company.
• Breakthrough T1D, a nonprofit devoted to type 1 diabetes advocacy and research, maintains a page of early detection links and information.

In addition, several private laboratories offer at-home testing kits.

• Type 1 diabetes progresses slowly, and can be identified in its earliest stages with a simple blood test.
• Experts recommend that family members of people with type 1 diabetes consider screening for the condition.
• Early detection allows patients and their families to prepare for the onset of symptoms, which can considerably reduce the danger, stress, and turmoil that often accompany diagnosis.
• If your doctor’s office doesn’t support type 1 diabetes screening, a number of resources can help make it convenient and affordable.