Diabetes isn’t going away any time soon. According to the American Diabetes Association, 1.5 million Americans are diagnosed with diabetes each year. And 84 million people in the United States with prediabetes are headed towards developing Type 2 diabetes. Diabetes isn’t unique to the United States: It’s a global issue, affecting hundreds of millions of people worldwide. Many people describe diabetes as being a pandemic.
When people are diagnosed with diabetes, they often have many questions, especially about the differences between Type 1 and Type 2 diabetes. There are, in fact, multiple different forms of diabetes, but the more common forms are Type 1 and Type 2. Let’s take a look at these and hopefully clear up any confusion or questions you may have.
Type 1 diabetes
Type 1 diabetes was formerly known as “juvenile diabetes” and “insulin-dependent diabetes.” These terms are inaccurate and obsolete. We know that it’s not just “juveniles” who get Type 1 diabetes — adults get Type 1, too, and many people who have Type 2 diabetes must take insulin. So, Type 1 diabetes is the correct term.
Type 1 diabetes (also known as Type 1 diabetes melluits, or T1DM) is an autoimmune condition. This means that the body’s immune system turns on itself; in this case, it attacks the beta cells of the pancreas. These are the cells that produce insulin. As a result, the pancreas produces very little, if any, insulin, meaning that a person with Type 1 must take insulin to survive.
Scientists don’t exactly know what causes Type 1 diabetes. However, it’s likely that genetics and environmental factors, such as certain types of viruses, play a role.
Type 1 diabetes accounts for about 5 percent to 10 percent of diabetes cases. It’s more commonly diagnosed in people under the age of 20, but it can occur at any age. Type 1 diabetes is also relatively uncommon, affecting roughly 1 in 250 Americans. It’s more common in whites than in African-Americans and Latinos, but it equally affects men and women.
High blood glucose (sugar) and, often, the presence of ketones (by-products of fat breakdown), are indicators of Type 1 diabetes. A person may present with symptoms of dehydration, weight loss, extreme thirst and frequent urination. To make the diagnosis, a physician may order an HbA1c test (which measures blood sugar control over the previous 2–3 months), a fasting blood sugar test or a random blood sugar test. A random blood sugar level of 200 mg/dl or higher, a fasting blood sugar of 126 mg/dl or higher, or an HbA1c result of 6.5 percent or higher indicates diabetes. The doctor may also check C-peptide levels (C-peptide is a by-product of the creation of insulin in the pancreas; a low level usually indicates Type 1 diabetes), along with antibody tests, especially if it’s unclear which type of diabetes a person has.
There’s no cure for Type 1 diabetes. Treatment consists of injecting insulin with a syringe or insulin pen or infusing insulin via a device called an insulin pump. There’s also an ultra-rapid-acting inhalable form of insulin, but someone with Type 1 diabetes still needs to inject a long-acting insulin, as well. At this time, there’s no oral form of insulin available.
Blood glucose monitoring
Most people with Type 1 diabetes need to check their blood sugars, at a minimum, four times a day, but six to ten times a day is more likely. Continuous glucose monitoring (CGM) is also an option for those with Type 1 diabetes, and using CGM can help to greatly reduce the number of fingersticks someone needs to do to determine glucose levels.
A healthy eating plan that consists of counting and controlling carbohydrate intake is generally a mainstay for those with Type 1 diabetes. If desired, a person can base meal-time insulin doses on how much carb they choose to eat at a meal. Physical activity is encouraged, but may require adjustments to insulin doses and/or carb intake to prevent hypoglycemia (low blood sugar).
Type 2 diabetes
Type 2 diabetes (also known as Type 2 diabetes mellitus or T2DM) was formerly known as “adult-onset diabetes” and “non-insulin-dependent diabetes.” These two terms are incorrect, as children and teens also get Type 2 diabetes, and, as previously mentioned, many people with Type 2 diabetes use insulin.
Type 2 diabetes is not an autoimmune condition. Rather, it’s a chronic condition that affects how the body uses glucose. Type 2 diabetes generally results in part from insulin resistance, which means that the body has difficulty using insulin, along with impaired insulin secretion. As a result, glucose builds up in the bloodstream. Some people label Type 2 diabetes as being “not as serious” as Type 1 diabetes; however, both forms of diabetes are equally serious as they can both lead to complications, including heart disease, eye disease, kidney disease, and nerve damage.
A combination of genetics and lifestyle factors can cause Type 2 diabetes by causing insulin resistance. If your parents or siblings have Type 2 diabetes, your chances of getting it are increased. In addition, being overweight, not doing enough physical activity, and eating an unhealthful diet of processed and sugary foods can raise your risk.
Type 2 diabetes is the more common form of diabetes, accounting for 90 percent to 95 percent of cases. It can run in the family, and certain racial and ethnic groups have a higher risk, including African-Americans, Latinos, Asian Americans, Native Americans and Pacific Islanders. Also, women who have gestational diabetes have a higher risk of getting Type 2 diabetes within 5 to 10 years. According to current projections, by 2050, one in three adults in the U.S. will have Type 2 diabetes, and more than 5,000 children and teens are diagnosed with this condition every year.
Type 2 diabetes is diagnosed with a blood test. This may be a random blood sugar test, a fasting blood sugar test, an oral glucose tolerance test, or an HbA1c test. A random blood sugar level of 200 mg/dl or higher, fasting blood sugar of 126 mg/dl or higher, oral glucose tolerance test result of 200 mg/dl or higher after two hours, or an HbA1c result of 6.5 percent or higher indicates diabetes. The tests may be repeated before confirming a diagnosis. Some people may have symptoms, such as thirst and increased urination, but many people with Type 2 have no symptoms. It’s important to get checked regularly for Type 2 diabetes, especially if you are at high risk.
As with Type 1 diabetes, there is no cure for Type 2 diabetes. Bariatric surgery can put Type 2 diabetes into remission, but it’s not a cure. This condition can be managed in a number of ways, including using lifestyle measures (weight loss, controlling carb intake, and physical activity), and taking medication. Medications available to help manage Type 2 diabetes include diabetes pills, non-insulin injectable medications, and insulin. Type 2 diabetes tends to change over time, which usually means that more medication, including insulin, is needed to keep blood glucose levels in a safe range.
Blood glucose monitoring
Not everyone with Type 2 diabetes checks their blood sugars, but checking your blood sugar is a good thing to do, as it gives you and your diabetes team helpful information to see how your diabetes is doing and to adjust your treatment plan, if needed. The frequency of checking depends on how your diabetes is treated and how well it’s managed. Talk with your doctor about whether checking your blood sugars would be helpful for you. And CGM use is becoming more prevalent among people with Type 2 diabetes, especially those who take insulin — this may be an option for you, as well.
A healthy eating plan that controls carb intake, 5 percent to 10 percent of body weight (if needed), and becoming and staying active are important steps to fit into your lifestyle. Medication may be one part of your treatment plan, but it works hand-in-hand with these lifestyle measures. For more information on what, when and how much to eat, ask your doctor for a referral to a registered dietitian, or look for a diabetes program in your community that provides classes.
Both Type 1 and Type 2 diabetes are serious, chronic conditions that require a lot of attention and self-management. Left unmanaged, the risk for complications greatly increases. It can be hard to do this on your own, so seek out support and information from your health-care team, online communities, and credible websites (like this one) to educate yourself, stay informed and keep abreast of new developments and therapies.
Want to learn more about the different types of diabetes? Read “Reviewing the Types of Diabetes,” then try your hand at our quiz on the different types of diabetes.