Diabetes has been well documented for decades, and continues to be one of the leading causes of chronic illness. There are not enough pages on this website to go over everything pertaining to diabetes. I will focus on the difference between type 1 and 2, as well as symptoms, and a quick review of treatments.
Diabetes Type 2
Diabetes type 2 is what most people think of when they hear about the “diabetic epidemic”. We will start here. Type 2 diabetes (DMII) parallels increasing rates of obesity worldwide. It is commonly referred to as “adult onset diabetes”, but has an increasing prevalence among children.
Type 2 diabetes generally means insulin resistance. To paint the picture, I will demonstrate, stepwise, the body’s response to sugar in a non-diabetic patient.
- Ingestion of sugar
- Elevation in blood sugar
- Release of insulin from a functioning pancreas into bloodstream
- Insulin attaches to cells and directs movement of sugar from blood to inside cells
- Sugar inside cells is used as fuel for metabolic processes
Our body is fascinating as it continues to respond to stimulus throughout our entire lives. Just as our tolerance to opioid medications works, our cells likewise become tolerant to insulin. That’s correct, our own cells become desensitized to our own insulin.
Too much sugar causes too much insulin release. A cell stops responding to insulin after years of a hyper-insulin state. This in turn keeps sugar high in the blood stream. High blood sugar causes cell damage to different organs.
Type 2 diabetes is a very complicated disease. There is more to the cause than just eating too much sugar. Genetics play a very strong roll in DMII, and even the skinniest, healthiest person may not be able to escape the diagnosis.
Diabetes Type 1
Diabetetes type 1 is characterized by a typical onset during childhood. While the end result is the same (high blood sugar), the process is different.
Refer to the same scenario in a non-diabetic patient. Instead of having insulin resistance, eliminate step 3. A type 1 diabetic does not have the ability to secrete insulin from a functioning pancreas. Antibodies destroy the part of the pancreas that is responsible for secreting insulin.
Without insulin, sugar stays high in the blood. Sugar in the blood again causes damage to various organs.
Symptoms of Diabetes
Diabetes Type 2
Without primary care checkups, type 2 diabetes is typically diagnosed 10 years after the onset of disease. It commonly goes undetected without screening. Although the disease is associated with obesity, the first signs may actually be weight loss. Classic symptoms include:
- polyuria (increased urination)
- polydipsia (increased drinking)
- nocturia (urinating at night)
- blurred vision
- peripheral neuropathy (numbness in extremities)
Not surprisingly, there are many other symptoms of type 2 diabetes that are generally called complications. These include:
- poor wound healing
- diabetic kidney disease
- heart attack
Diabetes Type 1
Pediatricians usually diagnose diabetes type 1 during childhood wellness exams. A common and obvious symptom of onset is weight loss in children. Other side effects are similar to type 2 diabetics and include:
- fatigue or lethargy
The approach to treatment of diabetes type 1 and diabetes type 2 is different. There are many treatment options to diabetes type 2. There are limited treatment options for diabetes type 1.
Treatment Diabetes Type 2
The first and most important treatment option is diet and exercise. All medication for diabetes type 2 is supplemental to diet and exercise. Medication alone will not optimize treatment.
Medications for diabetes type 2 have been developed over the past 30-40 years. They are generally oral medications. Early medications were focused on forcing the pancreas to secrete more insulin. These medications are know as sulfonylureas. Glipizide and glimepiride are examples of sulfonylureas.
Metformin is the backbone of diabetes type 2 medications. It is focused on increasing insulin sensitivity. A type 2 diabetic will typically start on metformin before starting other medications.
There are a few newer medications for diabetes type 2 in recent years. Some oral medications (ie: Invokana, Farxiga) focus on excreting sugar in the urine. There are also oral (ie: Januvia) and injectable medications (ie: Bydureon, Victoza) that target multiple metabolic pathways.
When diet/exercise, oral and injectable medications fail, insulin is used for treatment. There are many options for insulin. It gives the doctor and patient the freedom to titrate doses.
Treatment Diabetes Type 1
Unfortunately insulin is the only treatment for a type 1 diabetic. A type 1 diabetic must get insulin from the outside (exogenous), because they cannot create their own.
As stated before, insulin comes in many forms. There is fast acting, medium acting, mixtures, and long acting insulin. The doses are gently titrated by the patient and doctor. Today, there are insulin pumps and continuous glucose systems. These make glucose monitoring and insulin delivery more convenient and accurate.
Diabetes is as complex a disease as any other. It does not affect one organ or one metabolic pathway. While type 1 and type 2 share a similar name, they have major differences that dictate their presentation and treatment.