Understanding Type 1 and Type 2 diabetes
Around 25.8 million people in the United States are affected by diabetes, according to the Centers for Disease Control and Prevention (CDC). Some 18.8 million people have been diagnosed with the disease. An estimated seven million are undiagnosed.
Some 90% to 95% of diabetics have Type 2 diabetes, previously known non-insulin dependent or adult onset diabetes.
Around 5% have Type 1 diabetes, formerly called insulin-dependent or juvenile onset diabetes. Type 1 diabetes is usually seen in children and teens, but can occur at any age, according to the CDC.
Gestational diabetes develops in 2% to 10% of all pregnant women but generally resolves after the pregnancy ends. Diabetes can also result from specific genetic conditions, infections, illnesses, surgery and medications.
Diabetes complications include heart disease, stroke, high blood pressure, blindness, kidney disease, nervous system damage, amputations and susceptibility to other illnesses.
Type 1 diabetes
In Type 1 diabetes, the pancreas stops making insulin because the body attacks the gland. Insulin has to be administered through injections or an insulin pump.
Type 1 diabetics carry a genetic marker that makes them susceptible to the disease, said registered nurse Ann Williams, new War Memorial Hospital diabetes educator. An environmental trigger—often a virus—sets off the attack on the pancreas. Without the trigger, those with the genetic marker don’t develop the disease.
Type 1 diabetes comes on very suddenly, she said. Kids are very ill and very thirsty. They’re drinking fluid and urinating all the time and are up all night every hour or two urinating. They may drop a lot of weight quickly.
Type 1 diabetes patients usually end up at a doctor’s office or an emergency room with very high blood sugar levels. They also have ketones in their urine, which Type 2 diabetics don’t have, Williams said.
There may be a honeymoon phase where a Type 1 diabetic doesn’t need insulin or just tiny amounts of it, she noted. If they’re put on insulin very quickly, the pancreas can recover somewhat.
However, once the immune system attack on the pancreas begins, it’s a matter of time before they need insulin shots or a pump, she said.
Some end up with other autoimmune conditions like Hashimoto’s thyroiditis when other glands like the thyroid come under attack, Williams said. There is also slow onset Type 1 diabetes that is seen in adults.
Type 2 diabetes
With Type 2 diabetes, the cells of the pancreas may range from making too much insulin to none at all or the body may not be using the insulin it produces very well, Williams said. Exercise is one way of getting the cells more sensitized and using insulin better.
Usually Type 2 diabetes patients are older, overweight and commonly have one or more family members with the disease. That strong family tie isn’t there in Type 1 diabetes. Where Type 2 diabetes generally struck older adults years ago, there are children now with the disease, she said.
In both Type 1 and Type 2 diabetes, there is extreme fatigue, Williams said. Those with Type 2 diabetes may have some thirst and frequent urination. Their Type 2 diabetes may not be causing any symptoms. It may be discovered during other fasting lab work.
Fasting blood sugar tests
The blood sugar levels of Type 2 diabetics can be high, but aren’t as high as Type 1 levels. It’s critical to not eat or drink anything before a fasting blood sugar test, she emphasized. The caffeine in black coffee could cause a misdiagnosis of diabetes. Drinking water is okay.
A fasting blood sugar test less than 100 mg/dl is considered normal, 100 to 125 pre-diabetic and 126 or more diabetic. Two fasting blood sugar tests or one fasting and one after-meal blood sugar test are needed for a diagnosis of pre-diabetes, Williams said.
Treatment of Type 1 and Type 2 diabetes includes healthy eating, exercise and blood sugar monitoring. Type 1 diabetics also check for ketones, Williams said.
Type 1 diabetics require insulin shots or an insulin pump while Type 2 diabetics may take oral medications or insulin injections, if prescribed. Patients must manage their day-to-day care and prevent their blood sugar levels from going too high or too low.
Research has shown that regular physical activity and a change in eating habits can decrease the risk of developing Type 2 diabetes. There is no known way to prevent Type 1 diabetes.
Those at high risk for diabetes can prevent its onset by making lifestyle changes with diet, physical activity and weight loss sooner than later, Williams said. If someone has diabetes, they can prevent some of the complications if they make those changes now.
Williams recommended that those at high risk of diabetes have fasting blood sugar tests done at least once a year.