Most deaths in people with type 1 diabetes are attributable to diabetes; even among children, diabetics have about twice the risk of death.
Most people who die of diabetes die from heart disease.
However, among those who have certain risk factors- diagnosis in teens or twenties, African American, hypertensive- kidney failure is a real risk (and even with kidney failure, cause of death may be heart disease because kidney disease exacerbates heart disease). In the studies I have read, the median age for type 1 diabetics whose kidneys failed ranged from 37- 42. That is not old.
To reassure those of you reading this blog who are parents of kids with diabetes, I would like to point out that people diagnosed in the 15-20 age range have about 20x the risk of major kidney disease than those diagnosed in the 1-5 age range.
Out of more than 17,000 kidney-pancreas transplants done in the United States since 1988, more than 15,000 were done in people under 50. More than 5,000 were done on people under 35. Only 19 were done on people 65 or older. Admittedly, this is partly because of the bias in who gets transplants.
But among non-diabetics who received kidney transplants, 9% were over 65, compared to less than a tenth of a percent among diabetics who received kidney transplants. Source? http://optn.transplant.hrsa.gov/latestData/rptData.asp
So I can understand why a person might get fatalistic if they have diabetes. I listen to people worrying about passing on diabetes to their children... I'm more worried about abandoning children by getting sick and dying while they're young. I'd rather be diabetic than have a parent be sick and dying during my childhood, I think.
I find little comfort in the idea that better control means slower progression of complications. Frankly, control seems out of my control most of the time. But in addition to knowing that complications can happen despite my efforts, I also know that longevity happens to some people with diabetes despite their lack of control.
Joslin gives a medal to people who have made it 75 years with insulin dependent diabetes. They first awarded such a medal in 1996. That means the person had been diagnosed with diabetes before insulin was available and still made it for another 75 years. Whoa! Joslin has awarded 1-2 such medals per year since then.
If I made it 75 years with diagnosed diabetes, I would be 92 years old, and I don't think you have to factor in diabetes for me to not get that far- both of my grandfathers died at age 79.
While I tend to believe that people who make it 50 or more years with diabetes do probably have genes that most of us don't, I still keep in mind that most of us don't know what genes we do or don't have. I talked to a woman on tudiabetes chat back when it had a chatroom, who told me that she had a bunch of diabetic family members who died as young adults and she herself assumed that she was going to die young and when she got to thirty and was still perfectly healthy, other than the diabetes, she realized that she hadn't done anything to prepare to live the life she'd want to lead if she was going to live for a while yet.
In one of the books I read about diabetes, there's a story of a woman with diabetes who assumed she would die young, so she did a lot of dangerous things. She smoked on the theory that she would die before lung cancer could get her (bad idea- smoking triples risk of amputations with diabetes), she took drugs- and then she died young, not of diabetes but of a drug overdose. In numerous studies, youth with diabetes are at a higher risk of smoking, drinking, and using illegal substances compared to nondiabetic youth. I believe that this is partly because of the sense that we have got to do our living now.
While I was searching for information on Joslin medalists, I found the story of a guy who was on insulin for more than fifty years... and then found he didn't have type 1 diabetes after all! http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1547158/?page=1
I think he should get to keep the medal- he should get something for putting up with fifty plus years of shots!