Type 1 vs. Type 2 Diabetes – What’s the Difference?

Diabetes mellitus, more commonly known as just diabetes, is a disease increasing in prevalence worldwide.

People of all ages can be affected by diabetes, so understandably people are wanting to learn more about it.

There are two main types of diabetes – type 1 vs type 2 diabetes – and despite sharing a name, they are quite different.

What Is Diabetes?

Diabetes is a disease affecting the pancreas and its ability to produce the hormone insulin. More specifically, the beta cells of the pancreas are responsible for producing insulin. Diabetes occurs when :

  • the beta cells of the pancreas are destroyed

  • when the beta cells don’t produce enough insulin to keep blood sugar levels regulated

  • or when the body doesn’t respond to insulin effectively.

Insulin helps blood glucose (blood sugar) enter our cells, where it’s used as fuel to support all of the body’s functions. Without enough insulin, sugar remains in the bloodstream and can become dangerously high.

Having high blood sugar over a prolonged period of time is detrimental to health. Our bodies make sugar and we also obtain it from certain foods we eat, such as carbohydrates.

High blood sugar damages arteries and blood vessels, which supply blood to all of our organs and body systems. It also damages nerves and can result in loss of sensation in limbs, which can lead to serious wounds and amputations.

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Prevalence of diabetes

Prediabetes is a condition where blood sugars are considered high, but not high enough to be diagnosed as diabetes.  Having prediabetes is a major risk factor for developing type 2 diabetes later on.

It’s estimated that around 34% of Americans over the age of 18 have prediabetes. Unfortunately, many people have undiagnosed prediabetes due to lack of obvious symptoms; it’s estimated that around 7.2 million Americans 18 years and older have undiagnosed prediabetes.

The American Diabetes Association has estimated that around 10.5% of the American population has diabetes. Of that group, about 1.6 million have type 1 diabetes, the more rare type. Type 1 diabetes affects about 187,000 children and adolescents, as it often is diagnosed under the age of 18.

Per the World Health Organization, the global prevalence of diabetes among adults over 18 years of age has risen from 4.7% in 1980 to 8.5% in 2014. 

Type 1 diabetes

Type 1 diabetes is an autoimmune disease. The body mistakenly views the beta cells of the pancreas as invaders, and it works to destroy them. People with type 1 diabetes have little to no beta cell function left, and must inject insulin in order to live a healthy life. 

Type 1 diabetes is the rarest of the types of diabetes, affecting about 2-5% of the world’s population and about 1 in 300 American adults before the age of 18. Type 1 usually occurs before age 18, which is why it’s also referred to as juvenile diabetes.

Unlike type 2 diabetes, type 1 diabetes isn’t associated with lifestyle factors such as weight, ethnicity, physical activity level, etc. In fact, many people with type 1 diabetes can appear thin and be at a normal weight or be underweight. This occurs due to the complete lack of insulin, which is needed to feed the body’s cells.

Type 2 diabetes

Type 2 diabetes is much different than type 1. It can occur in adolescence, but is more common in older adults. Unlike type 1 diabetes, it isn’t an autoimmune disease.

Type 2 diabetes occurs when the pancreas stops producing enough insulin, or the body doesn’t respond to insulin the way it should. When the body doesn’t use insulin effectively, it’s called insulin resistance.

Unlike type 1, people with type 2 diabetes may not always need to inject insulin to manage it. Other diabetes medications, many in pill form, can be used to treat type 2 diabetes. Some people with type 2 diabetes are even able to manage it through lifestyle alone, without the need for medication. 

Risk factors

Type 1: The risk factors for type 1 diabetes aren’t as well-understood as the other types of diabetes because of its nature as an autoimmune disease. Risk factors for developing type 1 diabetes include:

  • Family history: people with a parent or sibling with type 1 diabetes are more likely to develop it than people without a family history.

  • Genetics: certain genes tend to indicate an increased risk of type 1 diabetes.

  • Geography: incidence of type 1 diabetes tends to increase as distance from the equator increases.

  • Age: the first peak of diagnosis tends to occur between ages 4-7, and again between ages 10-14.

Type 2: The risk factors for type 2 diabetes are much more well-known than for type 1:

  • Weight: people who are considered overweight or obese according to their body mass index (BMI).

  • Age: people 45 and older are at increased risk.

  • Family history of diabetes

  • Race/ethnicity: diabetes tends to affect certain races more than others. At-risk races include African American, Alaska Native, American Indian, Asian American, Hispanic/Latino, Native Hawaiian, or Pacific Islander.

  • High blood pressure: if your blood pressure is higher than 120/80, you may be at increased risk.

  • Altered lipid levels: low levels of HDL “good” cholesterol and high levels of LDL “bad” cholesterol are risk factors, as well as high triglycerides (blood fat).

  • Pregnancy history: women with a history of gestational diabetes (GDM) or gave birth to a baby 9 pounds or heavier are at increased risk.

  • Physical activity: people who aren’t regularly active or who have a sedentary lifestyle are at increased risk.

  • Smoking status: Smokers are 30-40% more likely to develop type 2 diabetes than nonsmokers.

  • Health history: those with a history of heart attack or stroke have a higher likelihood of developing type 2 diabetes.

  • PCOS: Polycystic Ovarian Syndrome in women is a risk factor, as it usually is associated with insulin resistance.

  • Acanthosis nigricans: dark, velvety patches of skin are a sign of insulin resistance and are a risk factor for developing diabetes. These patches of skin usually occur around the neck or armpits.

Symptoms

The symptoms of type 1 and type 2 diabetes are similar. Symptoms arise as a result of the body trying to rid itself of high blood sugar in the absence of enough insulin.

  • Increased thirst

  • Frequent urination

  • Extreme hunger

  • Unexplained weight loss

  • Presence of ketones in the urine (ketones are a byproduct of the breakdown of muscle and fat that happens when there’s not enough available insulin)

  • Fatigue

  • Irritability

  • Blurred vision

  • Slow-healing sores

  • Frequent infections, such as gums or skin infections and vaginal infections

Diagnosis

Type 1 and type 2 diabetes are diagnosed using the same criteria:

  • Hemoglobin A1c: This test measures the average blood sugar over the last 60-9o days. It’s reported in a percentage, with a normal A1c being less than 5.7%. Diabetes is diagnosed with a hemoglobin A1c of 6.5% or higher.

  • Fasting blood sugar: Blood sugar is tested when the person hasn’t eaten anything for at least eight hours. A normal fasting blood sugar is below 100 mg/dL. Diabetes is diagnosed when the fasting blood sugar is greater than or equal to 126 mg/dL.

  • Random plasma glucose test: A blood sugar of 200 mg/dL or greater at any time can be used to diagnose diabetes, though most providers prefer to order a hemoglobin A1c as well to ensure it wasn’t a one-time high blood sugar.

  • Oral glucose tolerance test: The individual being tested drinks a solution with 75 grams of glucose in it. A blood test measures how much glucose is in the blood 2 hours after consuming the drink. A normal result is 139 mg/dL or lower, whereas diabetes is diagnosed when the result is 200 mg/dL or higher.

  • Antibody tests: Because type 1 diabetes is an autoimmune disease, there are specific antibody tests that can be ordered, including: C-peptide, IAA, IA-2A, ZnT8Ab,ICA, GADA or anti-GAD.

Complications

In type 1 diabetes, very high blood sugar can lead to a life-threatening condition called diabetic ketoacidosis (DKA).  DKA occurs when insulin levels are very low, which causes the body to start producing ketones to use as fuel instead of glucose. 

A sign of ketone bodies being present is fruity-smelling breath. The “type 2 version” of DKA is called hyperglycemic hyperosmolar syndrome (HHS)

Over time, diabetes increases the risk of:

  • Heart disease: High blood sugar causes hardening of the arteries called atherosclerosis, which is a risk factor for developing cardiovascular disease (heart disease).  If an artery becomes too narrow it can become blocked, which results in a heart attack (myocardial infarction) or stroke, depending on where the blockage occurs.

  • High blood pressure: People with diabetes are also more likely to have high blood pressure, which is another risk factor for heart disease.

  • Kidney problems: High blood sugar damages the vessels in the kidneys, which are responsible for removing waste from our blood and help to control blood pressure. If left untreated, chronic kidney disease can develop and lead to dialysis if the kidneys lose a significant amount of their function.

  • Neuropathy and retinopathy: High blood sugar can cause nerve damage, known as neuropathy.  Many people experience this in the form of peripheral neuropathy.  Diabetes can also damage the blood vessels in the eyes, which leads to retinopathy.  Retinopathy can potentially lead to loss of vision.

  • Wound healing problems: High blood sugar impairs the body’s ability to heal itself.  When wounds don’t heal quickly, there is a higher chance for infection.  If limbs are severely damaged from a poorly healing wound, it may need to be amputated.  In fact, diabetes is thought to be the leading cause of leg amputations worldwide.

Prevention

While there are no known prevention measures for type 1 diabetes, there are for type 2 diabetes, including:

  • Maintaining a healthy weight; losing 5-7% of starting body weight can drastically reduce type 2 diabetes risk. Type 2 diabetes is more prevalent in people who are considered overweight or obese (BMI of 25 and above).

  • Be more active, aiming for 30 minutes of moderate activity most days of the week. Avoiding sitting for prolonged periods of time is also beneficial.

  • Eat a healthy diet consisting of fruits, vegetables, whole grains, lean protein while avoiding added sugars. A Mediterranean-style diet is associated with lower mortality rates, including lower heart disease and diabetes risk.

 Treatment

Being physically active, eating foods that promote stable blood sugar (such as the plate method) and practicing good sleep hygiene are good lifestyle modifications to help improve blood sugar levels in both type 1 and type 2 diabetes.

If lifestyle changes aren’t enough, there are many medications available for the treatment of diabetes.  

Insulin therapy is typically the only medication used for type 1 diabetes, and is often used to treat type 2 diabetes as well.  Insulin comes in several forms, including long-lasting/basal, intermediate-acting and short-acting/mealtime.

People taking insulin often take a combination of short- and long-lasting insulin, but many different regimens are used depending on the individual’s treatment plan.

There are several other treatment options available for use in type 2 diabetes. Some of the more popular medications include:

  • Metformin: Helps to reduce the amount of sugar released by the liver and improves insulin sensitivity

  • Sulfonylureas: Stimulate the pancreas to secrete more insulin

  • GLP1 receptor agonists: Promote insulin production, decrease glucose release from liver and slows stomach emptying to increase satiety

  • DPP-4 inhibitors: Promote insulin production, decrease glucagon (a hormone that increases blood sugar) production and delays gastric emptying.

Conclusion

Diabetes is becoming more prevalent worldwide, especially type 2 diabetes. While type 1 and type 2 diabetes are very different in nature, they also share some similarities.

Both occur when the body doesn’t make enough insulin to promote healthy blood sugar levels, which results in distinct symptoms. The tests used to diagnose both types of diabetes also overlap, as well some treatments such as the use of insulin therapy and healthy lifestyle habits.

Sources

Dabelea D, Stafford JM, Mayer-Davis EJ, et al. Association of Type 1 Diabetes vs Type 2 Diabetes Diagnosed During Childhood and Adolescence With Complications During Teenage Years and Young Adulthood. JAMA. 2017;317(8):825–835. doi:10.1001/jama.2017.0686

https://www.diabetes.co.uk/difference-between-type1-and-type2-diabetes.html

Kahanovitz L, Sluss PM, Russell SJ. Type 1 Diabetes – A Clinical Perspective. Point Care. 2017;16(1):37–40. doi:10.1097/POC.0000000000000125

Ramachandran A. Know the signs and symptoms of diabetes. Indian J Med Res. 2014;140(5):579–581.

https://www.diabetes.org.uk/professionals/position-statements-reports/diagnosis-ongoing-management-monitoring/new_diagnostic_criteria_for_diabetes

Seth P, Kaur H, Kaur M. Clinical Profile of Diabetic Ketoacidosis: A Prospective Study in a Tertiary Care Hospital. J Clin Diagn Res. 2015;9(6):OC01–OC4. doi:10.7860/JCDR/2015/8586.5995

Alternative Text

Diana Gariglio-Clelland (RD)

Diana Gariglio-Clelland obtained her B.S. in Nutrition from the University of Idaho and is a Registered Dietitian with experience in the hospital, community and primary care health settings.

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