Can you tell me the difference between Type 1 and Type 2 diabetes? Why does one type get to take pills while the other has to always take insulin?
Before I address the question “what is diabetes,” you first have to understand a little basic physiology. When we eat food whether we have diabetes or not our bodies break down that food first by us chewing and then enzymatic breakdown into component parts of carbohydrate, protein and fat and then into glucose. When the glucose level in our bloodstream rises, a message is sent from our brain to our pancreas basically saying, “Hey, pancreas, we’ve got a bowl of cereal and a banana coming down the pike!” The pancreas then secretes insulin which goes to our cells and acts like a key opening the door to the cell which allows the glucose (sugar) to go into the cell. In that way insulin basically allows us to use the food we eat for energy. It is a negative feedback system that works just like an air conditioner. When the temperature in your house goes up, the AC kicks on and when the temperature drops, the AC shuts off. In diabetes, this system of checks and balances of the glucose level is not working right. In type 1 diabetes, it is an absolute insulin deficiency. The brain sends the message to the pancreas reporting the incoming glucose rise, but the pancreas is unable to respond appropriately, either makes no insulin or not enough to do the job. People diagnosed with type 1 diabetes must take insulin injections to cover what their pancreas is not making or they would perish from starvation. In type 2 diabetes, the brain sends the message to the pancreas and the pancreas secretes insulin but the body does not use the insulin appropriately. It basically ignores the insulin. This is called insulin resistance. It is the hallmark feature of type 2 diabetes. It’s similar to getting a new key made for your door and the key goes in the lock but is unable to turn the lock. In Type 2 diabetes, there are medications available that help the body with its insulin resistance. These pills help the body use its own insulin better. Exercise and weight loss also improve insulin resistance. People with type 1 diabetes cannot take these pills because they do not make any or enough insulin.
Typically, Type 1 diabetes is diagnosed at an earlier age than type 2. Individuals often lose a lot of weight before diagnosis because their bodies are starving since they do not have any or enough insulin. There may or may not be any family history of diabetes. Type 1 diabetes is an autoimmune disease so there may be family history of those types of other autoimmune diseases such as thyroid disorders or rheumatoid arthritis.
Type 2 diabetes is typically diagnosed later in life. There is almost always a family history of diabetes and the person typically is overweight. Also African Americans, Hispanic Americans and Native Americans are at higher risk for developing Type 2 diabetes.
The etiologies and treatment of Type 1 and Type 2 diabetes are different but the bottom line is still the same. Blood sugar levels are above normal and should be treated to restore euglycemia (a.k.a. normal blood sugar). The treatment in Type 2 diabetes usually starts with diet and exercise with the emphasis on weight loss. Medications (pills) are usually added with the goal of improving insulin resistance and thus normalizing blood glucose. There are several types of pills on the market for Type 2 diabetes and they each affect a different region of the body, again with the hope of improving blood glucose. If these medications do not get the person’s blood sugar to goal levels, then insulin injections may be added.
In Type 1 diabetes, the only treatment is insulin. A regimen should be created with the healthcare provider to replace the insulin that the body no longer makes. The regimen ideally should match the person’s body’s needs and the food he/she eats.
No matter which type of diabetes you have, you should educate yourself about it so that you can understand what treatment plan your healthcare team may prescribe for you. Get to know your body and its responses to medicines, diet and exercise so you can explain your situation to your healthcare provider. Remember that the goal of therapy in diabetes is to have as close to normal blood sugars as possible and to feel good.