As someone who has been living with Type 1 diabetes since he was 10 years old, Mark Hosak says most people know about the disease’s potential devastating complications: blindness, kidney failure, and heart disease. What people often don’t realize, however, is the kind of toll the condition takes day in, day out.

“I have to do multiple injections a day,” Hosak, 26, says in a phone interview. “I have to be hypervigilant, constantly checking my blood sugar and knowing where I’m at….If my blood sugar’s high, I can’t get behind the wheel of a car. You have to plan for the worst at all times: have food with you and three days of insulin supplies with you regardless of what you’re doing.

“The real complication is you can never stop thinking about it,” he adds. “The unspoken thing is the day-to-day management. It’s a constant tightrope. It’s a chronic illness, and it’s a chronic burden.”

Also known as juvenile diabetes, Type 1 diabetes occurs when the pancreas produces little or no insulin, a hormone that helps the body control the level of glucose, or sugar, in the blood. Without insulin, glucose builds up in the blood instead of being used for energy. People with the disease must take insulin to survive.

There’s no cure, and the cause isn’t known. However, new research could reveal if and how the microbiome—the communities of bacteria, viruses, fungi, and other organisms that inhabit the body—affects the risk of the development of Type 1 diabetes, which usually starts in childhood or young adulthood.

Researchers at the Alkek Center for Metagenomics and Microbiome Research at Baylor College of Medicine (BCM) in Houston are embarking on an ambitious three-year study to help determine how the microbiome may be associated with Type 1 diabetes.

“One of the hypotheses is that there’s a viral trigger for Type 1 diabetes in people who are genetically susceptible to it, an enterovirus, in particular,” says Joseph Petrosino, director of the Alkek Center and an assistant professor of molecular virology and microbiology at BCM. “It’s a virus that everybody sees, but people with Type 1 diabetes deal with it very differently. There’s an autoimmune reaction that targets the beta cells of pancreas.”

If a microbial association can be established, the implications could be far-reaching.

“Everything from diagnostic [tools] to a potential vaccine would be on the table,” Petrosino says. “As scientists, we have cautious optimism….There’s a new appreciation how the microbiome impacts health and disease.”

The research, which is being done in conjunction with the University of South Florida, is part of the Environmental Determinants of Diabetes in the Young project (TEDDY), funded by the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health. TEDDY involves clinical centres at three U.S. and three European educational and research institutes.

Over the past eight years, the TEDDY project has enrolled more than 8,600 infants predisposed to develop diabetes because of family history or other genetic factors, as well as participants from the general population. The children will be monitored until they are 15 years old. Clinical samples are being collected, and the participants are also keeping diaries of their eating habits, sicknesses, allergies, and various life experiences.

The BCM study will look, specifically, at the microbiome in these youngsters. The microbiome analyses will be compiled with results from other facets of the TEDDY study to provide a clearer picture of the development of Type 1 diabetes.

That could be just the beginning.

“Even if we do find something [a microbial association] in these samples, it will not necessarily be the same around the world,” Petrosino says. “We’re looking for collaborations in Latin and South America and elsewhere in the world. Type 1 diabetes is on the rise in developing countries; we want to be gathering data to ascertain what’s going on in those countries as well.”

It’s exciting research, to be sure. But for the time being, people like Hosak who are living with Type 1 diabetes must continue to approach every day with great care.

“When you buy clothes, you have to ask things like, ‘Are these pockets deep enough for granola bars? Can I fit in insulin pens?’ In my car, I keep juice boxes and enough provisions to survive a small earthquake, extra insulin, and blood-test supplies.

Along with colleagues, family members, and friends, Hosak will be participating in the upcoming TELUS Walk to Cure Diabetes, which supports research into the disease. He works as a corporate fundraiser for the JDRF, but he was 11 when he started volunteering with the organization as a youth ambassador, educating youth and adults alike about Type 1 diabetes.

His parents initially took him to the doctor because of his insatiable thirst, which is one of the disease’s symptoms.

“My parents would see me having to go to the bathroom constantly, and I’d want to take a water bottle with me. I couldn’t get enough to drink.”

Other symptoms include weight loss, fatigue, and blurred vision.

Despite having the disease, Hosak hasn’t let it hold him back.

“I like to travel; I like to go hiking. I canoe and kayak,” he says. “I just need to be hypervigilant.”