Most people are aware that diabetes is a disease characterized by having high blood glucose (sugar).  Indeed, an antiquated term for diabetes was “sugar diabetes”.  But under the umbrella of the disease that doctors refer to as “diabetes mellitus” are really two entities, Type 1 and Type 2 diabetes.

Type 1 Diabetes was previously known as juvenile-onset or insulin-dependent diabetes (IDDM), while Type 2 diabetes was called adult-onset or non-insulin-dependent diabetes (NIDDM). These titles, however, did a poor job of describing either the underlying disease process or who was affected with the disease.

The great majority of diabetics have Type 2 diabetes, accounting for 90-95 percent of the total.  As its former name suggested, Type 1 diabetes does develop more often during childhood, but adults can have Type 1 diabetes too.  Likewise, increasing numbers of younger individuals are being diagnosed with Type 2 diabetes.

Insulin, the common denominator: Insulin, a hormone made in the pancreas, is involved in the development of both Type 1 and Type 2 diabetes. Insulin allows the cells in the muscles, fat and liver to absorb glucose from carbohydrates that we eat to be used for energy production.  The way that insulin affects the development of the two types of diabetes, however, is markedly different. Type 1 diabetes is considered to be an autoimmune disease in which the body’s immune system attacks the cells in the pancreas responsible for producing insulin. Eventually, insulin production ceases and glucose is unable to enter the cells.  In Type 2 diabetes, insulin is still being produced but the body is unable to use this insulin effectively. This is called “insulin resistance.” Initially, the body compensates for this by increasing insulin production but over time not enough can be made. In either case, the body is unable to convert sugar and other starches into energy and blood glucose rises, sometimes to dangerous levels.

How Type 1 and Type 2 diabetes are similar:

1. High blood sugar levels occurring in both types of diabetes produce similar symptoms. These include production of large volumes of urine (polyuria), increased thirst necessitating drinking more (polydipsia), and increased appetite and eating (polyphagia).

2. Both types of diabetes greatly increase a person’s risk for serious complications. Persistently elevated blood sugar levels can damage the blood vessels, heart, nerve endings, kidneys and eyes. In the U.S., diabetes is the leading cause of kidney failure, lower-limb amputations, and adult-onset blindness. Stroke and heart disease risk increases 2 to 4 times in adults with diabetes.  Well managed diabetes can significantly reduce this risk of developing complications.

3. Making healthy food choices, attention to body weight, controlling blood sugar and cholesterol levels, and being physically active are the cornerstones of treatment of both types of diabetes.

How Type 1 and Type 2 diabetes are different:

1. As an autoimmune process, no one is really sure why Type 1 diabetes occurs, nor can it be prevented. Development of Type 2 diabetes is primarily due to genetics and lifestyle factors. Risk factors for the development of Type 2 diabetes include: 1) a family history of the disease, 2) excess body weight, 3) low physical activity, 4) high blood pressure, and 5) abnormal blood lipids.

2. Type 1 diabetes usually presents as an acute illness with the sudden development of symptoms.  A serious complication of Type 1 diabetes called “ketoacidosis” often develops as its initial manifestation. In Type 2 diabetes, symptoms develop much more gradually.

3. Before developing type 2 diabetes, most people have a condition known as “prediabetes”. This means that blood sugar levels are elevated but not yet in the range to be diagnosed as diabetes. The U.S. Centers for Disease Control (CDC) reports that 86 million Americans have pre-diabetes with 9 out of 10 of these individuals being unaware that they have it. Prediabetes can often be reversed with as little as 10-15 pounds of weight loss along with 30 minutes of moderate physical activity.

4. Treatment of Type 1 diabetes typically requires the use of insulin which can be delivered via injections or an insulin pump.  In some cases, insulin may be used in the management of Type 2 diabetes, but most patients can be managed with some combination of oral medications.

With one in three Americans having pre-diabetes, but most being unaware of their condition, the CDC has initiated a campaign to identify those who are at risk.  The Prevent Diabetes STAT program starts with a prediabetes screening test that can be found here.  Anyone with a risk score of 5 or above is encouraged to see their doctor to determine if additional testing is necessary.  Additionally, The United States Preventive Services Task Force (USPSTF) recommends screening for abnormal blood glucose in adults aged 40 to 70 years who are overweight or obese.

Sources for article:
Types of Diabetes from the National Institutes of Health
Diabetes Basics from the American Diabetes Association
Prevent Diabetes STAT from the Centers for Disease Control

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