Practice Tip of the Week | Detecting Type 1 Diabetes

By Dr. Cassie Moffitt, PhD, MSN-Ed, BSN, RN

Most nurses have a “why,” the story of what brought them to the profession. My story began December 17th, 1983. Until that day, I was a “normal” 17-month-old—other than losing a lot of weight, regressing on my milestones, and laying on a cold floor and crying most of the time. While my family fought for me, a pediatrician told them that I was too young to have diabetes. After seeing my blood glucose, and admitting that I might have diabetes after all, said provider gave me intravenous dextrose and sent me on a 30-minute-ambulance ride, at the end of which I would present to a pediatric facility with a blood sugar over 1400 mg/dL. I was in active diabetic ketoacidosis (DKA).  

Most individuals who are diagnosed with type 1 diabetes present in DKA—a dangerous and costly complication with cumulative effects (Bell & Lain, 2025). In the emergent phase, DKA is traumatizing and debilitating. At the same time, approximately 50-60% of new diagnoses of type 1 diabetes are in the adult population. Juvenile-onset and adult-onset diabetes no longer exist (American Diabetes Association [ADA], n.d.). Approximately 50-60% of newly-diagnosed patients are adults ages 20 and above (Fang et al., 2023). Given the current health state of the nation, as many as two-thirds of patients with type 1 are considered overweight or obese (Fang et al., 2023). Type 1 diabetes does not discriminate by age or size. I cannot stress enough the importance of discarding these stereotypes. Many patients have been misdiagnosed—almost to their demise—because of these preconceived notions.  

Did you know that it is now possible to screen individuals for autoantibodies associated with type 1 diabetes so that they are aware before they can reach a DKA state? Type 1 diabetes is now identified by three separate stages (Insel et al., 2015). The third stage is clinical diabetes, the stage in which type 1 is confirmed—usually in a DKA stage (Fang et al., 2023). Not only is screening available, there are also medications available to be given in stage 2 that can delay the need for insulin and preserve insulin-making cells for years before they actually need injected insulin. All it takes is a simple blood test. While these can be done in screening centers nationwide, outside labs, or even at home, Breakthrough T1D (formerly Juvenile Diabetes Research Foundation [JDRF], n.d.) has an excellent screening decision tool that assists care providers and families in determining their screening options.  

Why is it important? As a long-term patient, it would be easy for me to say, “They’re going to develop autoimmune diabetes—it doesn’t matter when they find out.” If the prevention of DKA and its associated complications aren’t enough to convince you, let me tell you a little more of my story: I grew up in a rural setting in a situation for which Medicaid wasn’t possible, even though my single-parent household income was below the poverty line. As pre-existing conditions as they pertained to health insurance were in effect, I did not qualify for coverage. As a result, my mother spent half her income every month buying the supplies necessary to keep me alive. No child should ever learn to divide by watching their parent spend most of their income on their medical condition.  

When I think about that, I wonder, “What if I knew I would have time to plan for this?” Type 1 diabetes is a costly condition accompanied by continuous financial hurdles. As of right now, it’s a lifelong process. This is for a condition they never asked for and they couldn’t have stopped. Yes, it is true that patients with two or more antibodies will almost certainly develop clinical autoimmune type 1 diabetes (Ziegler et al., 2013). However, if patients had time to plan, isn’t that worth it? We as nurses would have more time to advocate for our patients and provide education that can prevent costly episodes of DKA.  

The good news is that screening is easier than ever. At a basic level, all you have to do is plant the seed simply by making families aware that this a possibility within their reach. These conversations can be had at the bedside, in the clinic setting, or even over coffee. If a family is still unsure of whether or not they should be screened, you can direct patients to this link that will provide information about the benefits of screening, next steps, and general answers to frequently asked questions. One of the most important things you can do is honor an individual’s wishes if they ask to be screened. Direct them to a screening center or an at-home kit.  

At a higher level, you can make families aware of screening centers, or provide information regarding how to obtain an at-home screening kit. When you’re providing an introduction to this concept, it is very important that you don’t make promises or guarantees. For example, just because a potential patient exhibits one autoantibody does not mean they will develop additional antibodies or clinical autoimmune diabetes.  

In the landscape that is type 1 diabetes, these are exciting times. What was an almost guaranteed scenario at diagnosis is now becoming a memory. Nurses have the opportunity to be at the forefront of these efforts.

What can you do? Recommend screening of all first-degree relatives in your setting, regardless of age. This is one of the easiest things you can do in your practice to ease financial, physical, and emotional burden. What a powerful place to be. If I had to guess, these are things that fulfill the why that brought us to this forward-facing profession in the first place.  

As for me? My story has been full of successes and setbacks—and I am proud to have used all of those to help others rewrite their story. You are in a powerful position to do the same.  

 

REFERENCES


American Diabetes Association. (n.d.). Diabetes related common terms. https://diabetes.org/about-diabetes/common-terms  

Bell, K. J., & Lain, S. J. (2025). The changing epidemiology of type 1 diabetes: A global perspective. Diabetes, Obesity and Metabolism, 27(Supp. 6), 3-14. https://doi.org/10.1111/dom.16501  

Breakthrough T1D. (n.d.). Detecting type 1 diabetes. https://www.breakthrought1d.org/early-detection/  

Fang, M., Jeon, Y., Echouffo-Tcheugui, J. B., & Selvin, E. (2023). Prevalence and management of obesity in U.S. adults with type 1 diabetes. Annals of Internal Medicine, 176(4), 427-429. https://doi.org/10.7326/m22-3078  

Fang, M., Wang, D., & Echouffo-Tcheugui. (2023). Age at diagnosis in U.S. adults with type 1 diabetes. Annals of Internal Medicine, 176(11), 1567-1568. https://doi.org10.7326/m23-1707  

Insel, R. A., Dunne, J. L., Atkinson, M. A., Chiang, J. L., Dabelea, D., Gottlieb, P. A., Greenbaum, C. J., Herold, K. C., Krischer, J. P., Lernmark, A., Ratner, R. E., Rewers, M. J., Schatz, D. A., Skyler, J. S., Sosenko, J. M., & Ziegler, A-. G. (2015). Staging presymptomatic type 1 diabetes: A scientific statement of JDRF, the Endocrine Society, and the American Diabetes Association. Diabetes Care, 38(10), 1964-1974. https://doi.org/10.2337/dc15-1419  

Ziegler, A. G., Rewers, M., & Simell, O. (2013). Seroconversion to multiple islet autoantibodies and risk of progression to diabetes. JAMA, 309(23), 2473-2479. https://doi.org/10.1001/jama.2013.6285