More thanhave diabetes in the United States, according to the American Diabetes Association. Even more (84 million) are living with elevated glucose levels — AKA high blood sugar — that indicate they have prediabetes, reports the Center for Disease Control and Prevention (CDC).
Diabetes is also the seventh leading cause of death in the U.S. Despite all of this, many are still operating on outdated assumptions about what diabetes is, its causes, and its risk factors.
So let's set the record straight. If you or someone you love is worried about diabetes, here’s what you should know about the differences between the type 1 and 2 varieties.
What is type 1 diabetes?
Type 1 diabetes is often referred to as “juvenile diabetes” because back in the early 1900s, it was classically diagnosed in children and quickly turned deadly. “Before the discovery of insulin, [these] children generally died within weeks or months [of diagnosis],” says Irl Hirsch, M.D., professor of metabolism, endocrinology, and nutrition at the University of Washington School of Medicine.
But doctors now recognize the disease can develop beyond childhood. A study out of the University of Exeter Medical School found that more than 40 percent of type 1 diabetes cases were diagnosed after age 30. It still remains the rarer form though, with only about 5 percent of diabetics having type 1.
Unfortunately, type 1 diabetes is still a tricky disease, and experts at the Mayo Clinic say it isn't entirely clear what triggers it. Family history, genetics, geography, viruses, and other environmental factors may all play a role, and while research suggests having a parent or sibling with the disease increases a person's risk factor, it's also not uncommon for only one identical twin to develop type 1 diabetes in a family. Which just goes to show how confusing a diagnosis can really be.
What's more clear-cut though is the fact that type 1 diabetes is an autoimmune disease, says Rita Kalyani, M.D., associate professor of medicine and physician of endocrinology, diabetes, and metabolism at Johns Hopkins University. What happens is that the body attacks the pancreatic cells that are responsible for making insulin, Dr. Hirsch says. As a result, the body isn't able to produce enough, or in many cases, any, insulin to function properly.
That's a real problem because when we eat or drink calories, our bodies turn carbohydrates into glucose (AKA sugar) that enters our bloodstream. The pancreas produces insulin in order to move that glucose into the tissues of our body, which is then used for energy or, in the case of our liver, is stored as glycogen that's released between meals to keep blood sugar levels stable. Without enough insulin, our bodies aren’t able to regulate our blood sugar levels and energize us appropriately.
That's why the symptoms for type 1 diabetes are often connected to how much energy we have, though they can range from increased thirst, frequent urination, and blurred vision to mood changes (including irritability), extreme hunger, and weakness or fatigue. These symptoms are essentially the same as the ones present for type 2 diabetes, but the Mayo Clinic notes that their onset can occur faster in type 1 patients, and may even feel more aggressive.
How do you treat type 1 diabetes?
To date, the only option is to have insulin injected into the body, usually between three and four times a day, Kalyani says. That's often done via needle, but for those who are squeamish there's also the option of an insulin pump that functions as a partial or full artificial pancreas, Hirsch adds. The device is attached to the body (often the abdomen) through a catheter, and it allows patients to administer some or all of their insulin needs without multiple injections.
It's also important for those with type 1 diabetes to keep a close eye on their blood sugar levels. Finger pricks are the traditional method, but some patients opt to use a glucose monitoring device like Dexcom G6, as it continuously checks your levels via a catheter similar to the insulin pump, and sends updates to your smart phone without having to constantly prick your finger.
What is type 2 diabetes?
While type 1 diabetes is nicknamed “juvenile diabetes,” type 2 is sometimes referred to as “adult-onset diabetes” because, as we're sure you can guess, historically patients have been diagnosed as adults. But it is still possible to get type 2 diabetes as a child, especially after puberty, Hirsch says.
Unlike type 1 diabetes, people with type 2 are able to produce insulin, but at some point their bodies begin to develop a resistance to it. To compensate, the pancreas creates even more insulin to try to overcome the resistance. This can work for a little while, but eventually the body won't be able to create the amount necessary to overcome the resistance. At that point, the body can't lower blood glucose the way it needs to, and prediabetes develops. Then, once blood glucose levels reach a certain threshold, you're considered to have type 2 diabetes.
Type 2 diabetes also isn't an autoimmune disease, but rather a chronic condition that's often triggered by environmental factors, like being overweight or obese, storing fat in the abdomen, or living a sedentary or low-activity lifestyle, Dr. Kalyani explains. Moms who developed gestational diabetes during pregnancy also have a 50% lifetime risk of developing type 2 diabetes, she adds.
There are genetic risks to think about, too. If a parent has the disease, for example, a child’s risk is 2-4 times higher, according to a 2017 study published in Current Diabetes Reviews. African Americans, Hispanics, American Indians, and Asian-Americans also have a higher risk, notes the Mayo Clinic.
The symptoms are similar to those with type 1 diabetes, but the problem with type 2 is that many people often go symptom-free. “Somebody can have type 2 diabetes for a decade before any typical symptoms occur,” Hirsch explains. All that time without treatment means the undiagnosed diabetes can quietly wreak havoc, eventually causing problems like blurred vision and nerve damage, reports the Mayo Clinic.
How do you treat type 2 diabetes?
Once someone is diagnosed as prediabetic, it's common for doctors to recommend healthy lifestyle changes as the first form of treatment. “Being physically active, weight loss of about 5 to 7% [in overweight or obese patients], and eating a healthy diet can help prevent type 2 diabetes from developing,” Dr. Kalyani says.
But if someone already has type 2, their doctor may suggest insulin injections or oral medications that can either make the body more sensitive to insulin, help the pancreas release more insulin (such as insulin secretagogues), or prevent the stores of glucose in the liver from breaking down, Dr. Kalyani says. While medication is often necessary, Dr. Hirsch says that aggressive lifestyle changes may also help get blood sugar under control enough that some patients are able to reduce or get off of medication entirely.
While type 1 and type 2 diabetes have similar symptoms, ultimately their impact on the body is quite different, and the treatments can vary. That’s why it's important that you’re diagnosed correctly, so that you can receive care that fits the disease and gets you back on a path of feeling well.