If your child or someone you know has been recently diagnosed with type 1 diabetes, you may be wondering how the disease differs from type 2 diabetes -- the form people tend to know more about. What causes type 1 versus type 2 diabetes? Are the symptoms the same? And how is each treated? Here to clear up the confusion with an overview of key differences -- and similarities -- between these two types of diabetes are experts Julie Settles, M.S.N., A.C.N.P.-B.C., C.E.N., a clinical research scientist at Lilly Diabetes, and Rosemary Briars, N.D., P.N.P.-B.C., C.D.E., C.C.D.C., clinical director and program co-director of the Chicago Children’s Diabetes Center at La Rabida Children’s Hospital.
Diabetes, or diabetes mellitus, as it’s formally known in medical terms, describes a group of metabolic diseases in which a person develops high blood glucose (blood sugar). The underlying health factors causing the high blood sugar will determine whether someone is diagnosed with type 1 or type 2 diabetes.
Type 1 diabetes is an autoimmune disease in which “the body’s immune system starts to make antibodies that are targeted directly at the insulin-producing cells of the pancreas (islet cells),” explains Briars. Over time, the immune system “gradually destroys the islet cells, so insulin is no longer made and the person has to take insulin every day, from then on,” she says.
As for why this happens, Settles notes, “The immune system normally fights off viruses and bacteria that we do not want in our body, but when it causes diabetes, it is because something has gone wrong and now the body attacks its own cells.” Triggering this autoimmune response is a complex mix of genetic and environmental factors that researchers are still trying to fully understand.
On the other hand, when someone develops type 2 diabetes, the pancreas still produces insulin, but the body is unable to use it properly due to insulin resistance, a condition in which cells become less sensitive to insulin, thus making insulin less effective at lowering blood sugars.
Genetics also play a role in raising someone’s risk for type 2 diabetes, as they do with type 1. “When you have a family history of type 2 diabetes, it means that your body is more likely to resist insulin,” says Briars.
However, unlike with type 1 diabetes, lifestyle factors such as obesity and physical inactivity add greatly to a person’s risk for developing type 2 diabetes. According to Briars, “Being overweight and inactive contribute to the development of type 2 diabetes because they make it harder for insulin to work like it is supposed to.” While there is no known way to prevent a child or adult from developing type 1 diabetes, “Keeping active and staying within your ideal body weight can help prevent or delay type 2 diabetes,” says Settles.
Type 2 diabetes is considered a progressive disease, which means that insulin resistance can worsen over time. This can result in the pancreas needing to produce more and more insulin to overcome the resistance. As the pancreas works harder and harder, eventually “insulin producing cells can ‘burn out’ and stop producing insulin,” Briars says. This is why some people with type 2 diabetes end up needing to take insulin in the later stages of the disease.
How do doctors determine which form of diabetes a person has? With a blood test. “Blood tests can be done at the onset of diabetes to test for the presence of antibodies. Most children with type 1 are positive for some or all of the antibodies that are measured,” Briars explains.
Age of Onset
Type 1 diabetes is more commonly diagnosed among children. “Type 1 typically occurs before the age of 40, with a peak incidence at 12 to 14 years,” says Briars. That’s why it was once known as “juvenile diabetes.” That name is now considered somewhat inaccurate, however:
“Type 1 is usually diagnosed in children and young adults, but there is also LADA -- latent autoimmune diabetes in adults -- that usually occurs after people turn 30. This is why we have stopped calling it ‘juvenile diabetes’ because a significant number of people diagnosed are not children,” notes Settles.
In contrast, type 2 diabetes is generally diagnosed after the age of 40. When it occurs in childhood, type 2 is most often diagnosed at puberty, says Briars. Because weight and lifestyle are risk factors, the childhood obesity epidemic in the U.S. has led to rising numbers of children being diagnosed with type 2.
Both type 1 and type 2 diabetes share similar symptoms, including excessive thirst, increased urination, increased infections, fatigue, weight loss, and blurred vision. However, there are often differences in how rapidly symptoms show up. With type 1, the symptoms seem to come on in a day or two, while symptoms of type 2 diabetes may worsen over the course of years before being detected.
When type 1 diabetes is diagnosed, “Patients are immediately placed on insulin and will have to take insulin for the rest of their lives, every day and with every meal,” says Settles. Insulin can be injected through an insulin pen, a pump, or a traditional syringe. Insulin is not available in the form of a pill.
Briars adds that managing type 1 diabetes requires extensive education on how to prepare and inject insulin; what, when, and how to eat; how to check blood sugars; what to do if the blood sugar goes too high or too low; and what to do if you get sick and cannot eat.
With type 2 diabetes, there are several options for treatment. People with type 2 diabetes may be prescribed oral medications that can help cells become more sensitive to insulin. Later, if the disease progresses, it may be necessary to prescribe insulin.
Lifestyle changes are also considered an important part of managing type 2 diabetes, including making dietary changes designed to maintain a healthy weight and increasing physical activity. “Exercise is an important part of the treatment plan, as regular physical activity helps improve insulin sensitivity,” says Briars.
What’s one striking similarity between type 1 and type 2 diabetes? The need for support whenever someone is diagnosed with either form.
“Children with diabetes need a lot of support from the adults in their environment to help them grow into responsible, self-managing, healthy adults with diabetes,” says Briars. Education is essential to successful diabetes management no matter the type. This will likely come in the form of working closely with your child’s diabetes care providers and diabetes educator.
Beyond that, it’s all about family. Whether you have just found out that your child or loved one has type 1 or type 2, Briars encourages parents to remember that “a strong and supportive family environment is essential, so that the knowledge of good diabetes management can be applied on a daily basis.”
Disclaimer: The experiences and suggestions recounted in these articles are not intended as medical advice, and they are not necessarily the "typical" experiences of families with a child who has type 1 diabetes. These situations are unique to the families depicted. Families should check with their healthcare prof.essionals regarding the treatment of type 1 diabetes and the frequency of blood glucose monitoring.
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