Diabetes Type 1 and Type 2

What is Diabetes?

Diabetes is a chronic metabolic condition where the body cannot effectively control the amount of sugar present in the blood stream and other organs, most notably the brain and muscles. This follows the failure of the pancreas to produce little to no insulin (Type 1 Diabetes) or as a result of one’s cells becoming insulin resistant (Type 2 Diabetes).

Insulin – A Transporter of Energy

Insulin is a hormone produced by the pancreas’ beta cells and plays an important role in several metabolic processes. In the case of diabetes, it is responsible for transporting glucose (a form of sugar) to your body’s cells where the glucose is used for energy. It is also responsible for the hepatic storage of glucose in the form of glycogen which serves as a reservoir of energy. Thus, the absence or resistance of insulin  has a direct effect in both the transportation and storage of energy in our bodies. The results are blood glucose levels that are persistently high. If not managed well, the condition leads to acute and chronic complications.

Types of diabetes

There are two main types.

  1. Diabetes Type 1

Type 1 is characterized by total failure of the pancreas to produce insulin as a result of autoimmune cells destroying the beta cells in the pancreas responsible for the production of insulin. This scenario necessitates daily insulin injections for the patient. That’s why diabetes type 1 is also referred to as insulin dependent diabetes mellitus (IDDM). The condition can occur at any age but its onset is mostly seen in childhood.  When it starts in adulthood, the patient is likely to be below 40 years of age.

Patients with this condition are usually first seen as emergencies when their blood sugars have gone too high.

  1. Diabetes Type 2

The main pathology for type 2 diabetes is the ineffectiveness (resistance from the accepting cell) of the insulin produced or in some cases it is characterized by the extremely low production of insulin. Our cells contain insulin receptors which allow insulin to attach to the cell membrane. This attachment causes the cell membrane to “accept” the glucose molecule that the insulin transports. When there is resistance to insulin, it cannot attach to the appropriate receptors and thus, glucose is not able to enter the cell for energy use. This failed mechanism is what causes glucose molecules to stay in the blood stream instead of going to our muscle cells or brain cells where they are of utmost importance.

It is mostly seen in adults above 25 years of age but younger people are being affected as well, especially since the obesity epidemic began. It is associated with lifestyle factors and therefore part of its management involves changes in lifestyle.

A person can live with type 2 diabetes for a long time and it may never be diagnosed. On the other hand the disease can progress to a point where the patient will have to use insulin injections.

Symptoms of diabetes

The symptoms regardless of the type include:

  • Excessive thirst
  • Urinating frequently
  • Abnormal hunger
  • Lethargy
  • Unintended weight loss
  • Chronic wounds
  • recurrent oral, vaginal or penile fungal infections
  • Loss of sensation in the extremities
  • Impaired vision

Causes and risk factors of diabetes

The causes and risk factors differ according to the type:

Diabetes Type 1

  • Autoimmunity where the body’s immune system destroys insulin producing cells in the pancreas
  • Genetic predisposition
  • Environmental risk factors including viral infections such as cytomegalovirus and mumps virus.
  • Formula feeding babies on cow’s milk and cereals before the age of 4 months.
Diabetes Type 2

  • Insulin resistance or low production thereof.
  • Genetic susceptibility
  • Obesity
  • Sedentary lifestyle
  • Hypertension
  • Excessive production of glucose in the liver in a way that insulin cannot cope. There is poor coordination between glucose production in the liver and glucagon production in the pancreas

Some people with Diabetes Type 2 may have no symptoms and are usually diagnosed during screening tests or during other medical checkups.

Diagnosis

Diabetes can be diagnosed with a combination of simple blood tests:

  • Glycohemoglobin test: HbA1c (or A1c), is a hemoglobin molecule that serves as a marker for a 3 month average of glucose levels. As plasma glucose levels increase in the blood, so do the levels of HbA1c. An abnormal amount of glucose during a 3 month average will result in an abnormally high reading of HbA1c and thus supports diagnosis of diabetes. A reading above 5.7% is considered hgih and will clue in on the diagnosis.
  • Glucose test (also referred to as fasting plasma glucose test or FPG): Allows the laboratory a very accurate read of blood glucose levels. As implicated in its name, fasting is necessary to food from interfering in blood glucose levels the lab techs are looking for. A reading above 126 mg/dL or higher tells us it is diabetes.
  • Oral Glucose Tolerance test: Glucose is given to the patient and blood samples are collected after 2 hours. What the lab looks for in this test is how rapidly glucose loses its presence in the blood in that 2 hour time frame. A blood glucose reading of 200 mg/dL or above indicates diabetes.

There are other diagnostic tools such as history, clinical presentation and examination. Also, a person that is considered pre-diabetic are advised of diet and lifestyle changes so as to avoid its pre-diabetic condition from progressing into full blown diabetes.

 

Treatment of diabetes

The main difference in the treatment of diabetes type 1 and diabetes type 2 is that in type 1 insulin injections are mandatory. In type 2, the blood sugar can be controlled through diabetic medications and diet. It is possible for diabetes type 2 patients to cease medication and still maintain healthy blood sugar levels with dietary and lifestyle adjustments. General treatment measures applicable to both types of diabetes include:

  • Medications for associated health problems
  • Following a healthy diet
  • Maintaining a healthy weight
  • Leading a physically active life
  • Maintaining normal blood pressure
  • Keeping cholesterol levels within normal range.

If properly managed, people with diabetes type 1 or diabetes type 2 can lead a normal life and avoid possible serious and chronic diabetic complications.

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