What is the difference between type 1 and type 2 diabetes?

Both diabetes types have similar symptoms, but their causes and treatments differ

What is diabetes?

Diabetes is the collective term used for three disorders that are characterized by high blood sugar levels and associated symptoms. Type 2 diabetes is responsible for around 90% of all global diabetes cases, while Type 1 diabetes accounts for ~5-8%. The remainder 2-5% consists of temporary diabetes some women experience during pregnancy (gestational diabetes).

 Nearly 10% of the global population suffers from diabetes or pre-diabetes (on the way to developing full-blown diabetes). The percentages vary from country to country, but typically it’s the richer countries that have the highest diabetes prevalence. In the United States, about 13% of the population are estimated to have diabetes or pre-diabetes, and around 300,000 Americans are killed by the disease every year. Diabetes is considered a public health crisis, as it affects so many Americans and also is steadily increasing in prevalence — 60 years ago only 1% of Americans were diabetic.  

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Type 1 and Type 2 diabetes are caused by different mechanisms

Type 1 diabetes is an autoimmune disorder in which the immune system’s T-cells attack beta cells in the pancreas. These beta cells are crucial for the pancreas’ insulin production. Insulin helps you absorb and digest glucose (sugar) and certain fats. When beta cells are destroyed, insulin production decreases and too much glucose stays in the blood. The destruction of pancreatic beta cells is irreversible, which makes Type 1 diabetes a life-long condition.

The onset of Type 1 diabetes is most common during childhood or the teen years, and it often occurs in children who are otherwise healthy. Thus far, scientists have not determined what triggers the autoimmune reaction to pancreatic beta cells and why. However, a couple of facts stand: the occurrence of Type 1 diabetes has been steadily rising since the early 20th century, with 8.5% of people now having diabetes worldwide, and its prevalence differs greatly from region to region. For example, a child from Finland is about three times more likely to develop the disease than an American child. 

Genetic factors matter, but are not the sole determinant of whether a person will develop Type 1 diabetes. Having a parent or sibling with a history of the disease only makes it 3-8% more likely that you’ll get it too. Factors, such as a person's dietary habits and the impact this may have on microbes living in the gut, are thought to be the primary triggers behind Type 1 diabetes.  Exposure to chemicals (pesticides, etc.) as well as certain medications may also be triggers, but there’s no conclusive scientific evidence yet.

Type 2 diabetes also involves insulin, but in a different way from Type 1. The problem with Type 2 isn’t the pancreas — which is working properly and producing insulin — but the response of other body cells to that insulin. To simplify very complex biochemical processes: cells are growing insensitive to insulin and thus don’t get to work on reducing blood sugar levels. This is called “insulin resistance” and it’s the initial phase of Type 2 diabetes.

One of the main causes of insulin resistance is obesity, which is why obesity rates and the occurrence of Type 2 diabetes have been growing in tandem in many countries.  Fat tissue, especially the fat around the stomach and waist, generates chemical signals that cause the desensitization of the body’s cells to insulin. This is a long-term process and it may take decades before an overweight person develops diabetes, if at all.  Once you have Type 2 diabetes however, it is very unlikely to resolve.

Aside from obesity, other lifestyle factors that increase the risk of developing Type 2 diabetes are smoking, chronic lack of sleep and stress. There is also a genetic aspect, but its impact is comparatively modest. An unhealthy lifestyle remains the biggest risk factor. 

 

Are the symptoms the same for both Type 1 and Type 2 diabetes?

Both types share the same primary symptoms and, left untreated, can lead to severe and even fatal complications. These shared symptoms are:

  • Frequent urination
  • Increased thirst 
  • Increased appetite 
  • Dizziness
  • Fatigue
  • Impaired (blurry) vision
  • Slow healing of wounds 

Symptoms of Type 1 diabetes may also include weight loss and mood swings.

While the symptoms of both types are very similar, they tend to develop much faster in Type 1 diabetes, sometimes over the course of a month. In contrast, patients with Type 2 diabetes can be free of symptoms (or only have very light symptoms) for many years — even over a decade — until more serious complications develop. This late onset of symptoms is what makes Type 2 diabetes type so treacherous.  In the United States, it is estimated that there are approximately 10 million diabetics who are undiagnosed.

If diabetes isn’t treated, over time it will seriously damage the cardiovascular system, nervous system, kidneys, and other organs leading to potentially fatal complications.

If you think that you are at risk of getting diabetes, or may already have it, you should not delay discussing this with your doctor. Fortunately, screening for diabetes is part of an annual physical exam. So, make sure that you don’t miss your annual physical.  

 

Does the treatment of Type 1 and Type 2 diabetes differ?

Yes, there’s a different treatment approach for each diabetes type. Type 1 diabetes has to be managed with regular injections of insulin that make up for the lower output of the pancreatic beta cells. These injections thus help you to control your blood sugar levels. In addition, a Type 1 diabetic person will have to carefully watch what he or she is eating, minimizing sugar and carbohydrate intake. Maintaining a regular exercise regimen is also important.

With Type 2 diabetes you will also need to maintain a healthy, balanced diet and regular physical exercise. Managing your weight and body fat will be very important. An optimal BMI (body mass index) can make your diabetes more manageable.  However, even with a healthier lifestyle, you may need to take medication to slow the progress of the disease. For example, insulin sensitizers, like Metformin, can improve the responsiveness of cells to insulin and thus help control blood sugar levels.

 If you want to learn more about available treatment options for diabetes, speak to your usual doctor or an endocrinologist. 

 

References

  1. “2. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes—2018.” Diabetes Care, vol. 41, no. Supplement 1, 5 Aug. 2020, pp. S13–S27, 10.2337/dc18-s002. Accessed 5 Aug. 2020.
  2. Marín-Peñalver, Juan José, et al. “Update on the Treatment of Type 2 Diabetes Mellitus.” World Journal of Diabetes, vol. 7, no. 17, 6 Aug. 2020, p. 354, 10.4239/wjd.v7.i17.354.
  3. You, Wen-Peng, and Maciej Henneberg. “Type 1 Diabetes Prevalence Increasing Globally and Regionally: The Role of Natural Selection and Life Expectancy at Birth.” BMJ Open Diabetes Research & Care, vol. 4, no. 1, Mar. 2016, p. e000161, drc.bmj.com/content/4/1/e000161, 10.1136/bmjdrc-2015-000161. Accessed 6 Aug. 2020.
  4. “Symptoms & Causes of Diabetes | NIDDK.” National Institute of Diabetes and Digestive and Kidney Diseases, Mar. 2019, www.niddk.nih.gov/health-information/diabetes/overview/symptoms-causes. Accessed 5 Aug. 2020.
  5. WHO > Diabetes Fact Sheet https://www.who.int/news-room/fact-sheets/detail/diabetes

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