For those of you who aren’t aware, I am T2 but am keenly interested in all forms of diabetes mellitus. I have close friends and former co-workers with T1. So this morning this popped up in my morning email
First looking at the toon, another Dan Heller masterpiece, I was confused as to what point he was making. Before reading the article, I did a search on non, functional, low and Max autoimmune, Then I read the article.
So, Type 1 is now divided into 2 subtypes A & B. The article suggests that research to develop cures of T1B should be given more consideration rather than 100% on the thorny problems of T1A.
Now that is interesting, but what is the cause of non-autoimmune T1? Is this confusing T1 with MODY or something else? I just hate the term idiopathic- 5 syllables to say “We don’t know.”
Curious, did a quick Gemini question, looks correct:
The core distinction comes down to why the insulin-producing beta cells in the pancreas are destroyed.
In medical terms, this divides Type 1 Diabetes into two categories: Type 1A (Autoimmune) and Type 1B (Idiopathic or Non-Autoimmune). While they share the exact same end result—a complete lack of insulin requiring lifelong insulin therapy—their underlying causes and clinical profiles are quite distinct.
Unknown (“idiopathic”); strongly linked to genetics, not immunity.
Biomarkers
Positive for autoantibodies (GAD65, ICA, IA-2, ZnT8).
Negative for all diabetes-related autoantibodies.
Demographics
Most common in Caucasians; usually diagnosed in youth.
Most common in people of African, Hispanic, or Asian descent.
Progression
Typically a steady, gradual destruction of beta cells.
Can be highly sporadic; alternating between severe lack of insulin and temporary recovery.
Type 1A: Autoimmune Diabetes
This is the classic form of Type 1 diabetes. For reasons involving a mix of genetic predisposition and environmental triggers, the body’s immune system misidentifies the pancreatic beta cells as foreign invaders.
The Smoking Gun: The defining trait of Type 1A is the presence of specific autoantibodies in the blood. These are proteins the immune system makes when it attacks its own tissue.
Other Autoimmune Links: Because the immune system is prone to overreacting in these individuals, people with Type 1A have a significantly higher risk of developing other autoimmune conditions, such as Celiac disease, Hashimoto’s thyroiditis, or vitiligo.
Type 1B: Non-Autoimmune (Idiopathic) Diabetes
“Idiopathic” is just a clinical way of saying “we don’t know the exact cause.” In Type 1B, beta cells are still destroyed, leading to absolute insulin deficiency, but the immune system leaves no fingerprints.
No Antibodies: If you run a comprehensive antibody panel on someone with Type 1B, the results will come back entirely negative.
The “Floundering” Pancreas: A unique feature of Type 1B is that insulin secretion can fluctuate wildly. Patients often present with severe diabetic ketoacidosis (DKA) due to a sudden drop in insulin, but later on, their need for injected insulin may drastically decrease for a period of time before dropping again.
Strong Hereditary Ties: While it lacks an autoimmune trigger, Type 1B is strongly inherited and does not carry the same associations with other autoimmune diseases.
Ultimately, because both paths lead to the same destination—the body losing its ability to regulate blood sugar via insulin—the day-to-day management, blood sugar tracking, and insulin requirements remain virtually identical once the condition is established.
