Despite sharing the name, some symptoms, and complications, diabetes types 1 and 2 are different in many ways. Let’s review in this article the main differences between type 1 and type 2 diabetes.
Time of diagnosis and prevalence
Diabetes type 1, also known as juvenile diabetes predominantly affects children and young adults. Diabetes type 2 mostly develops later on in life, especially after 45 years of age. Overall, about 90-95% of cases of diabetes are type 2 diabetes. According to the Centers for Disease Control and Prevention (CDC), over 34 million Americans have diabetes, including almost 27 million who have been diagnosed, and the remaining 7 million have this condition but have not been diagnosed. Prediabetes, a condition in which blood sugar levels are higher than normal, but below the levels to diagnose diabetes, affects about 88 million Americans.
Genetic predisposition and environmental factors had been identified in both conditions. In both cases, the blood sugar levels are higher than normal. Diabetes type 1 is considered an autoimmune disease, where the immune system mistakenly attacks the insulin-producing cells of the pancreas. A viral infection or other environmental causes the onset of diabetes type 1 in genetically susceptible individuals. The exact cause of diabetes type 2 is unknown, but risk factors like increased weight, sedentary life, high blood pressure, and cholesterol levels are risk factors. In diabetes type 2 the pancreas does not produce enough insulin or does not respond to it normally, wherein diabetes type 1 the autoimmune attack damages the pancreatic cells and the organ is unable to produce insulin. Insulin resistance, a condition in which the cells become resistant to insulin and become unable to take in enough sugar, is well known to be associated with diabetes type 2. However, recent research shows this problem is also seen in diabetes type 1, as well.
Signs and Symptoms
In diabetes type 1, the onset of symptoms is abrupt and diabetic ketoacidosis is more likely to develop due to very high levels of glucose in the blood. In diabetes type 2, it may take decades until a person experiences symptoms, and these symptoms occur gradually over time. Signs and symptoms of both diabetes type 1 and 2 include the 3Ps: polyuria (increased urination), polydipsia (increased thirst, drinking more water), and polyphagia (increased appetite), as well as fatigue, nausea, vomiting, blurry vision. Frequent infections and slow healing sores are also signs of diabetes. Unlike diabetes type 2, diabetes type 1 is sometimes associated with the so-called “honeymoon period” where symptoms go in remission for weeks to months, upon starting insulin therapy.
The most reliable sign of diabetes is the blood sugar test, which is recorded during the fasting state, 1-2 hours after a meal. The HbA1c test indicates how well diabetes is controlled long-term. According to the American Diabetes Association, here are the ideal numbers to maintain blood sugar levels in check. During fasting, the blood sugar levels for someone without diabetes should be 70–99 mg/dl (3.9–5.5 mmol/L) and for someone with diabetes 80–130 mg/dl (4.4–7.2 mmol/L). Tests are taken 1-2 hours after a meal, blood sugar levels should be less than 140 mg/dl (7.8 mmol/L) for those without diabetes and less than 180 mg/dl (10.0 mmol/L) for individuals with diabetes. The HbA1c should be less than 5.7% for those without diabetes and less than 7.0% for those with diabetes.
Diabetic ketoacidosis (DKA) develops usually as a complication of diabetes type 1 when the blood sugar levels are very high. The cells break down fats and muscles for energy, leading to the accumulation of ketones in the blood and urine. This condition causes excessive thirst and urination initially, followed by deep rapid breathing, loss of consciousness. It can be fatal if left untreated. Both diabetes types 1 and 2 can cause complications affecting the eyes (loss of vision and even blindness, glaucoma, cataract), heart (heart diseases, including heart attacks), brain (strokes), kidney (diabetic nephropathy), and nerve damage (diabetic neuropathy). Individuals with diabetes are also at increased risk of anxiety and depression.
Insulin is the main treatment for diabetes type 1, as the pancreas is no longer able to produce insulin. Dietary changes and regular exercise are also recommended. Diabetes type 2 is managed with diet and lifestyle changes, oral diabetes medication, and insulin (if there is not enough response to oral medication).
Diabetes type 2 has a variety of drug options. Oral medication drugs for diabetes type 2 include Biguanides (ie metformin), Sulfonylureas (glyburide), Thiazolidinediones (ie Pioglitazone), Alpha-glucosidase inhibitors ( ie Acarbose), Meglitinide( Repaglinide), DPP-4 inhibitors (Sitagliptin), SGLT2 inhibitors (ie Canagliflozin)
The treatment of diabetes type 1 (and some cases of diabetes type 2) is insulin. Different brands of insulin are available and vary in onset, peak time, and duration. They are classified as: rapid-acting, rapid-acting inhalation, regular/short-acting, intermediate-acting, long-acting, ultra-long acting, and premixed insulin.