Rising incidence of Type 1 diabetes

and subsequent hyperandrogenism

By Laura Neville, ND | December 29, 2020

The rising incidence rates of type 1 diabetes around the world indicate an increase in environmental triggers or altered immune system management of such triggers. Statistics are difficult to gather for many reasons: not all countries have a type 1 diabetes registry, statistics gathered do not often differentiate between type 2 and type 1 diabetes, and inequalities in access to quality healthcare persist, particularly in low- and -middle-income countries. Type 1 diabetes is often undiagnosed or misdiagnosed as malaria, pneumonia or influenza.  

However, 2011 data from the International Diabetes Federation on children ages 0-14 found Finland to have the highest incidence at 57.6 cases per 10,000 people, followed by Sweden, Saudi Arabia and Norway. The US had the 6th highest incidence at 23.7 cases per 10,000 people. Venezuela has one of the lowest incidence rates at 0.1 out of every 100,000 people. The CDC reports a 21% increase in people diagnosed with type 1 diabetes between 2001 and 2009 under the age of 20 in the United States. 1

The stress of a virus such as the flu or COVID-19 can often be the final catalyst to cause pancreatic beta cell destruction, resulting in diabetic-related ketones and thus the common symptoms of type 1 diabetes. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes Covid-19, binds to angiotensin-converting enzyme 2 (ACE2) receptors, which are expressed in key metabolic organs and tissues, including pancreatic beta cells, adipose tissue, the small intestine, and the kidneys. Thus, it is plausible that SARS-CoV-2 may cause pleiotropic alterations of glucose metabolism that could complicate the pathophysiology of preexisting diabetes or lead to new mechanisms of this disease. 2

Due to worldwide rising incidences, practitioners once unfamiliar with type 1 diabetes management may now need to expand their knowledge and be aware of the altered hormone mechanisms seen within this illness.     

A close relationship between insulin and androgen metabolism has been found in a number of studies. In one study, basal total and free testosterone, dehydroepiandrosterone-sulfate (DHEA-S), dihydrotestosterone (DHT), sex hormone binding globulin (SHBG) and 3α-androstanediol glucuronide (3αdiol-G) plasma concentrations were measured in 36 pubertal boys and 31 pubertal girls with type 1 diabetes and in 59 sex- and pubertal stage-matched control subjects without diabetes. Significantly higher serum total testosterone (p<0.01) and free testosterone (p<0.05) levels were found in females and males with type 1 diabetes than in controls at pubertal stage 5. However, this study showed no correlation between daily insulin requirements and serum androgen levels. 3 

Another study found hirsutism in 28.6% of type 1 diabetics compared to 0.0% of controls (P < 0.001). Biochemical hyperandrogenism was present in 23.8 % of the type 1s and 7.9% of the controls. Type 1 diabetic women had higher levels of testosterone and androstenedione and larger ovarian volume and follicle number by ovary when compared to non-diabetic controls. Polycystic ovarian morphology (PCOM), defined as either an ovary with 12 or more follicles, ranging in size from 2 mm to 10 mm, in a single plane or an ovarian volume of more than 10 mL without a dominant follicle, was present in 54.8% of type 1 diabetics and 13.2% of controls (P < 0.001). The frequency of PCOS was 40.5% in type 1 diabetics 2.6% in the controls (P < 0.0001). As opposed to the previous study, this study found a correlation with insulin management in that the proportion of women using intensive insulin treatment (this is a type of flexible insulin dosing based on daily carbohydrate consumption) was higher in those with PCOM/PCOS (P < 0.05). 4  

It is well known that elevated androgen levels in females are associated with insulin resistance, reduced fertility, disorders of sexual maturation, and an increased risk for cardiovascular complications. Practitioners can utilize salivary androgen measurements as sensitive markers of early metabolic disruptions, especially in type 1 diabetics. Treatments to consider include anti-inflammatories, vitamin D, dietary reduction of carbohydrates necessitating less exogenous insulin, therefore the potential to normalize salivary and serum testosterone levels and improve long term health markers.   


1. Centers for Disease Control and Prevention. National Diabetes Statistics Report, 2017. Atlanta, GA: Centers for Disease Control and Prevention, U.S. Dept of Health and Human Services; 2017. 

2. Hamming I, Timens W, Bulthuis ML, Lely AT, Navis G, van Goor H. Tissue distribution of ACE2 protein, the functional receptor for SARS coronavirus: a first step in understanding SARS pathogenesis. J Pathol 2004;203:631-637. 

3. Meyer, K., Deutscher, J., Anil, M. et al. Serum androgen levels in adolescents with type 1 diabetes: Relationship to pubertal stage and metabolic control. J Endocrinol Invest 23, 362–368 (2000). https://doi.org/10.1007/BF03343739 

4. Ethel Codner, Nestor Soto, Patricia Lopez, León Trejo, Alejandra Ávila, Francisca C. Eyzaguirre, Germán Íniguez, Fernando Cassorla, Diagnostic Criteria for Polycystic Ovary Syndrome and Ovarian Morphology in Women with Type 1 Diabetes Mellitus, The Journal of Clinical Endocrinology & Metabolism, Volume 91, Issue 6, 1 June 2006, Pages 2250–2256, ﷟HYPs://doi.org/10.1210/jc.2006-0108

Laboratory, Endocrine and Neurotransmitter Symposium (LENS)

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Hormone Testing Options Compared: Saliva, Serum, Urine

By: Lylen Ferris, ND

January 6, 2021

Examine the pros and cons of testing hormones in various mediums: serum, urine and saliva.

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Review basic steroid hormone physiology.

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