Type 1 insulin dependent diabetes is an auto-immune disease. It is the form that usually starts in younger people, most commonly under the age of 30. There is no association with obesity but it has a strong genetic and racial bias. It is associated with specific HLA antigen types. Although a genetic tendency has been recognised for generations, it has also been accepted for some years that it is a likely environmental factor that in many cases precipitates the onset of the trouble. It is quite possible that diet is one such factor and some doctors have suspected that this could be exposure to cows’ milk.

At other times the suspicion has fallen on exposure to gluten in cereals early in babyhood, low vitamin D concentrations in the diet, and it has been observed that when nitrate levels are high in the drinking water so is the incidence of diabetes type 1. This last possibility should not be a problem in Britain, where the nitrate levels in drinking water are now carefully checked.

Another precipitating factor may well be infection with a virus; viruses such as the Epstein Barr virus (glandular fever) and the coxsackie virus have been blamed and any of these could be among those responsible.

Some of the increase in type 1 diabetes may be because more genetically susceptible children are surviving birth. The death rate of babies born to diabetic mothers, and it is these children who are most likely to carry the genetic tendency for diabetes type 1, used to be appalling but now an ever increasing number are surviving. The other possibility is that whatever triggers the auto-immune response in young people is linked to whatever is increasing the number of allergic diseases such as asthma and eczema.

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