- What’s the Difference Between Type 1 and Type 2 Diabetes?
- Is Diabetes Treatment Different, Too?
- What Are the Complications of Diabetes?
- Can Diabetes Be Prevented or Cured?
- Diabetes Standards of Care & Clinical Practice Resources
- Differences between Type 1 and Type 2 diabetes
- Type 1 and Type 2 differences
- What happens when you have Type 1 and Type 2 diabetes?
- Are there different risk factors for Type 1 and Type 2?
- Symptoms of Type 1 and Type 2
- Managing and treating Type 1 and Type 2
- The emotional impact of Type 1 and Type 2 diabetes
- Can Type 1 or Type 2 be cured or prevented?
- 5 Differences Between Type 1 and Type 2 Diabetes
- 1. CAUSES
- 2. INSULIN PRODUCTION
- 3. PREVENTION
- 4. TREATMENT
- 5. RISK FACTORS
- Differentiating Between Type 1 and Type 2 Diabetes
- Type 1 Diabetes vs. Type 2 Diabetes
- Case Study: New-Onset Diabetes: How to Tell the Difference Between Type 1 and Type 2 Diabetes
- What’s the difference between type 1 and type 2 diabetes?
- Other types of diabetes?
What’s the Difference Between Type 1 and Type 2 Diabetes?
Is Diabetes Treatment Different, Too?
A good diabetes diet and regular exercise matters for people with type 1 and type 2 diabetes, Knapp explains. “The big difference is that everybody with type 1 diabetes needs to take insulin,” she says. “People with type 1 diabetes need to check their blood sugar level with a device called a glucometer about four times a day to know how much insulin to take.”
Treatment for type 2 diabetes also starts with diet and exercise, and oral medication can also be used to increase the amount of insulin the pancreas makes, Knapp says. “Over time, if the pancreas stops making insulin, some people with type 2 will also need insulin.” People with type 2 diabetes also need to check their blood sugar, from one to several times a day, depending on their state of health.
What Are the Complications of Diabetes?
“Whether it’s type 1 or type 2,” Drinsic says, “the big picture for diabetes is all about preventing complications,” which are mostly related to nerve and blood vessel damage. For example, if you have either type of diabetes, you have twice the risk of heart attack or heart disease as compared with someone without the disease. Other complications include eye problems, kidney disease, foot infections, skin infections, stroke, high blood pressure, cognitive decline, and high cholesterol.
Can Diabetes Be Prevented or Cured?
“As of now there is no way to prevent or cure type 1 diabetes,” Drincic notes. “There is lots of promising research, but it is still in the early stages.” Some of the initiatives involve targeting the cells in the immune system that cause the autoimmune response. Other possibilities include the use of stem cells or pancreas transplants.
Another area of research is diet and its effects on both prevention and diabetes maintenance. A study published in March 2017 in the British Journal of Nutrition reported that following a diet high in plant nutrients and low in meat consumption lowers a person’s risk of developing type 2 diabetes. The results indicated that certain compounds found in meat, rather than specific proteins, increased the risk of type 2 diabetes. Aside from eating healthy foods rich in plant nutrients, a large number of studies indicate that exercise is paramount not only for weight control, but also for maintaining a healthy, optimistic outlook.
“The best cure for type 2 diabetes is prevention, and research on that is very exciting,” Drincic says. “Losing a moderate amount of weight and exercising regularly can reduce or delay type 2 diabetes significantly.” For example, The Finnish Diabetes Prevention Study (DPS), a landmark study published in December 2003 in the journal Diabetes Care, followed 522 middle-aged, overweight subjects with risk factors for type 2 diabetes. A weight-loss diet and 30 minutes of daily exercise lowered their risk of developing type 2 diabetes by 58 percent compared with those who didn’t follow the diet or exercise.
Diabetes Standards of Care & Clinical Practice Resources
Measurement of Endogenous Insulin Secretion
The results for tests to measure endogenous insulin secretion may be low in type 2 diabetes patients with glucose toxicity. If in doubt, measure the following after glycemic control has been restored for several weeks:
- Fasting insulin level – if the patient is not on exogenous insulin
- C-peptide (the other half of pro-insulin) – this is useful even if the patient is taking insulin injections.
Positive antibody tests denote an autoimmune process, but negative tests do not rule it out:
- IA-2 (Insulinoma-associated protein-2)
- GAD-65 (Glutamic acid decarboxylate-65)
- Other antibody tests have been used in research and clinical settings – e.g., ZnT8 (Zinc Transporter 8), thyroid peroxidase antibodies, insulin autoantibodies
Other Lab Tests and Exams
Although some overweight type 1 diabetes patients may have some signs of insulin resistance, in general, they will not have the usual type 2 diabetes measurements at diagnosis. Gauging the degree of insulin deficiency versus insulin resistance with the following tests can be helpful:
- Lipids – Most type 2 diabetes patients have the typical low HDL/high triglyceride pattern.
- Blood pressure – Type 2 diabetes patients often have some degree of hypertension at time of diabetes diagnosis.
- Ketones – Although patients with type 2 diabetes can present with ketonuria and even diabetic ketoacidosis (DKA), generally these only occur at very high glucose levels or with a serious concurrent illness or infection. More often, it is patients with type 1 diabetes who present with significant ketosis and who are more profoundly acidotic with DKA.
- Microvascular complications – Many type 2 diabetes patients already have some degree of retinopathy, microalbuminuria, or neuropathy at the time of diabetes diagnosis. This is seldom true of patients with type 1 diabetes.
- Weight loss – The degree and speed of weight loss before diagnosis is usually more rapid in patients with type 1 diabetes than with type 2 diabetes.
Even taking the results of these tests into consideration, there still will be a few patients whose type of new-onset diabetes is not initially clear; over time, however, the diagnosis will become apparent. In the meantime, if there is concern that the patient may become acidotic if taken off insulin or if insulin is needed for glycemic control, insulin therapy should be continued, at least until it is established that it is no longer necessary.
Differences between Type 1 and Type 2 diabetes
We know some people get confused between Type 1 and Type 2 diabetes. And we’re often asked about the differences between them.
Although Type 1 and Type 2 diabetes both have stuff in common, there are lots of differences. Like what causes them, who they affect, and how you should manage them. There are other types of diabetes like gestational and MODY. But this page is mainly about the differences between Type 1 and Type 2.
For a start, Type 1 affects 8% of everyone with diabetes. While Type 2 diabetes affects about 90%.
Lots of people get confused between Type 1 and Type 2 diabetes. This can mean you have to explain that what works for one type doesn’t work for the other, and that there are different causes.
The main thing to remember is that both are as serious as each other. Having high blood glucose (or sugar) levels can lead to serious health complications, no matter whether you have Type 1 or Type 2 diabetes. So if you have either condition, you need to take the right steps to manage it.
Type 1 and Type 2 differences
Below is a guide to some of the main differences between Type 1 and Type 2.
What is happening?
Your body attacks the cells in your pancreas which means it cannot make any insulin.
Your body is unable to make enough insulin or the insulin you do make doesn’t work properly.
We don’t currently know what causes Type 1 diabetes.
We know some things can put you at risk of having Type 2 like weight and ethnicity.
The symptoms for Type 1 appear more quickly.
Type 2 symptoms can be easier to miss because they appear more slowly.
Type 1 is managed by taking insulin to control your blood sugar.
You can manage Type 2 diabetes in more ways than Type 1. These include through medication, exercise and diet. People with Type 2 can also be prescribed insulin.
Cure and Prevention
Currently there is no cure for Type 1 but research continues.
Type 2 cannot be cured but there is evidence to say in many cases it can be prevented and put into remission.
What happens when you have Type 1 and Type 2 diabetes?
If you have either Type 1 or Type 2 diabetes, it means you have too much glucose (a type of sugar) in your blood. This is the same for both types. But the difference between them is how this happens.
If you have Type 1 diabetes, it means you have an autoimmune condition. This means your body has attacked and destroyed the cells that make a hormone called insulin. So you can’t make insulin anymore.
We all need insulin as it helps take the glucose from our blood into our body’s cells. We then use this glucose for energy. Without insulin, the glucose level in your blood gets too high.
Type 2 diabetes is different. If you’ve got Type 2, either your body doesn’t make enough insulin, or your insulin doesn’t work properly. This is known as insulin resistance. Like Type 1, this means the level of glucose in your blood is too high.
Are there different risk factors for Type 1 and Type 2?
We don’t know exactly what causes Type 1 or Type 2 diabetes, but we do know the different risk factors. So we know why you might be likely to get one type over the other. Even though we know this, it’s good to remember these aren’t set in stone.
A big difference between the two is that Type 1 isn’t affected by your lifestyle. Or your weight. That means you can’t affect your risk of developing Type 1 by lifestyle changes.
People up to the age of 40 are more likely to be diagnosed with it, especially children. In fact, most children with diabetes have Type 1. But, although it’s less common, people over 40 can also be diagnosed with it.
It’s different for Type 2 diabetes. We know some things put you at more risk:
- your family history
- ethnic background
- if you’re overweight or obese.
We also know that there are things you can to reduce your risk of developing Type 2 diabetes. Things like eating healthily, being active and maintaining a healthy weight can help you to prevent Type 2.
You’re also more likely to get Type 2 if you’re over 40. Or if you’re South Asian, if you’re over 25. But Type 2 is also becoming more common in younger people. More and more children and young people get diagnosed with Type 2 in the UK each year.
Symptoms of Type 1 and Type 2
Type 1 and Type 2 diabetes share common symptoms. They are:
- going to the toilet a lot, especially at night
- being really thirsty
- feeling more tired than usual
- losing weight without trying to
- genital itching or thrush
- cuts and wounds take longer to heal
- blurred vision.
But where Type 1 and Type 2 diabetes are different in symptom is how they appear. Type 1 can often appear quite quickly. That makes them harder to ignore. This is important because symptoms that are ignored can lead to diabetic ketoacidosis (DKA).
But Type 2 diabetes can be easier to miss. This is because it develops more slowly, especially in the early stages. That makes it harder to spot the symptoms. That is why it is important to know your risk of developing Type 2 diabetes. Some people have diabetes and don’t know it. They can have it for up to 10 years without knowing.
Managing and treating Type 1 and Type 2
Managing and treating your diabetes is so important. This is because it’ll help you avoid serious health complications. And it’ll play a big part in your daily life regardless of if you have Type 1 or Type 2.
If you have Type 1 diabetes, you’ll need to take insulin to control your blood sugar levels. You’ll also need to test your blood glucose levels regularly. And count how many carbs (carbohydrates) you eat and drink. Counting carbs will help you work out how much insulin you should take when you inject with your meals.
And generally you should be trying to have a healthy lifestyle. That includes regular physical activity and a healthy balanced diet. These will help you reduce your risk of diabetes complications.
If you have Type 2 diabetes, you also need to eat a healthy diet and be active. These things will help you manage your weight and diabetes.
But quite often people with Type 2 also need to take medication. Such as tablets and insulin, or other treatments too. Whether you need to test your blood glucose level like someone with Type 1, depends on the treatment you take. Your GP can tell you what you should do at home.
The emotional impact of Type 1 and Type 2 diabetes
Living with Type 1 or Type 2 diabetes can sometimes feel overwhelming.
Both types are different but feeling down or anxious because of your diabetes can affect anyone. It is important to understand that a long-term condition can come with an emotional impact, no matter how it has been caused or how you treat it.
If you’re struggling with your diabetes, remember that you’re not alone.
There is lots of support available to you, like our helpline. There you can speak to our highly trained advisors about how you’re feeling. And you can also speak to people who are going through similar experiences on our forum. There are lots of things you can do to help yourself and it’s just about finding what works for you.
It can be frustrating to explain the differences between Type 1 and Type 2.
Both types face confusion over what causes the condition and how it can be treated. This will be slightly different whether you’re Type 1 or the more common Type 2. Just because something is more common, doesn’t mean it is understood.
And while it is emotionally draining to constantly correct people, you should also know that you’re not alone. There are many people living with diabetes facing similar questions and struggles, regardless of type. You can reach out to them to give or receive support in the forum and at local groups.
Can Type 1 or Type 2 be cured or prevented?
Unfortunately, there’s currently no permanent cure for either Type 1 or Type 2 diabetes.
But there’s evidence that some people with Type 2 can put their diabetes into remission by losing weight. Following a very low-calorie diet under medical supervision, or having surgery are some ways you can put your Type 2 diabetes into remission.
We’re also funding some vital research projects to help transform treatment and care. And to help find a cure for both Type 1 and Type 2 diabetes.
5 Differences Between Type 1 and Type 2 Diabetes
Diabetes is one of the oldest and yet most misunderstood diseases. There are many different types of diabetes, however, the most common ones are Type 1 and Type 2 diabetes.
They differ based on how they are caused and treated.
But the main similarity that Type 1 and Type 2 diabetes do share is elevated blood glucose levels. The inability to control blood glucose levels will also cause the same symptoms and complications in both.
Type 1 Diabetes is an autoimmune disease. The immune system mistakes the insulin-producing cells in the pancreas as “invaders” and attacks them. Once this happens, the cells can no longer produce insulin and a person is, therefore, insulin-dependent for life in order to stay alive.
Type 2 Diabetes is a metabolic condition. It’s when the body doesn’t produce enough insulin or becomes resistant to it. The condition can sometimes be controlled with proper diet and exercise, or a drug to enhance sensitivity to the body’s insulin production. But sometimes natural insulin production is insufficient and insulin injections are then needed to sustain normal blood glucose levels.
2. INSULIN PRODUCTION
People with Type 1 Diabetes DO NOT produce insulin. Insulin is a hormone that a working pancreas releases to allow glucose (sugar) from carbohydrates that’s eaten to be absorbed for energy. Without this hormone, the body starves and eventually dies. This is why everyday insulin injections is necessary for survival and early diagnosis detection is SO IMPORTANT.
Insulin is normally still produced by people with Type 2 Diabetes. In order to regain sensitivity to insulin, proper diet and exercise is recommended. In some cases, insulin injections are needed to keep diabetes in better control.
Currently, there is no prevention for Type 1 Diabetes. Researchers are hard at work and there are preventative studies being done to find answers (https://www.trialnet.org/). Type 2 Diabetes is not always preventable but by staying active and eating healthy it can lower the risk of developing.
The treatment for Type 1 Diabetes is insulin injections and constant blood glucose monitoring. There is no diet, exercise, or any amount of weight loss that will cure Type 1. Type 2 Diabetes has a few options available, ranging from lifestyle changes, oral pills, and/or insulin injections. Both require careful vigilance in order to obtain good control.
5. RISK FACTORS
Risk factors for Type 1 Diabetes include: Family history, genetics, and environmental factors (such as a virus). Risk factors for Type 2 Diabetes include: Genetics, lifestyle choices, and being overweight.
Differentiating Between Type 1 and Type 2 Diabetes
While serving on an internal medicine inpatient consult service, I encountered several patients with new-onset diabetes whose conditions were difficult to characterize (based on initial history, physical examination, and lab values) as type 1 or type 2. After the management of acute issues, what are the recommendations for differentiating between type 1 and type 2 diabetes?
Vidur Mahadeva, MD
Response from Raymond A. Plodkowski, MD and Stanley Shane, MD
The clinical presentations of type 1 and type 2 diabetes have become blurred. In the past, it was often assumed that children and adolescents who presented in diabetic ketoacidosis had autoimmune destruction of their insulin-producing pancreatic beta cells. These youngsters were classified as type 1 diabetics. Middle-aged adults with diabetes were assumed to have insulin resistance that resulted in glucose intolerance, and they were classified as type 2 diabetics.
Unfortunately, obesity has become rampant in the adolescent population, and now there are many young people with insulin resistance and type 2 diabetes. In contrast, occasionally there are adults who have autoimmune-mediated destruction and failure of their beta cells. It is important to determine the type of diabetes so that appropriate therapy can be initiated. Patients who are insulinopenic due to beta-cell failure must be managed with insulin. Patients who have insulin resistance can be managed with oral therapies including thiazolidinediones, metformin, and/or sulfonylureas.
The process responsible for type 1 diabetes is destruction of insulin-secreting pancreatic islet cells. This is manifested by a mononuclear infiltrate and beta-cell lysis in the islets. The underlying defect that causes type 2 diabetes is insulin resistance. People with type 2 diabetes have an underlying genetic predisposition towards insulin resistance. There are 3 factors that cause insulin resistance to worsen and lead to diabetes: getting older, gaining weight, and becoming more sedentary. Normally, insulin acts as a signal to promote glucose uptake and metabolism in the muscle. However, in people with type 2 diabetes, the muscle is resistant to this signal. Therefore, the pancreatic beta cells have to increase insulin production and secretion to signal the defective muscle to metabolize glucose. As the patient’s insulin resistance becomes more severe over time, the beta cells are not able to fully compensate. Then, blood glucose levels rise and diabetes is diagnosed.
Although many people consider type 1 autoimmune diabetes to be a disease that begins in childhood, it can actually occur at any age. Approximately 50% of patients develop the disorder before the age 40. The remainder develop the disease as older adults. There are several autoimmune diseases associated with type 1 diabetes. Celiac disease is the most common, with a 5% incidence for patients with type 1 diabetes. The others are Graves’ disease, hypothyroidism, adrenal insufficiency, and pernicious anemia. There is also a genetic predisposition. If an individual has a parent, sibling, or child with type 1 diabetes, he or she has approximately a 5% lifetime chance of developing type 1 diabetes.
There are certain ethnic groups that are at greater risk for type 2 diabetes, including Native Americans, African Americans, Pacific Islanders, and Hispanics. Women who have a previous history of gestational diabetes also have a higher risk for type 2 diabetes. Patients at risk for type 2 diabetes often have features of the metabolic syndrome due to underlying insulin resistance. The criteria for the metabolic syndrome include abdominal obesity, which is defined as a waist circumference > 40 inches in men and > 35 inches in women. There are also lipid abnormalities, including triglycerides ≥ 150 mg/dL, and HDL cholesterol < 40 mg/dL in men and < 50 mg/dL in women. Additional criteria include blood pressure ≥ 130/85 mmHg and fasting blood glucose > 110 mg/dL. The Third National Health and Nutrition Examination Survey used these criteria and classified patients with any 3 as having the metabolic syndrome. The prevalence of the metabolic syndrome was 21.8% in this cross-sectional population aged 20 years and older.
People with type 1 diabetes often present in diabetic ketoacidosis. Unfortunately, some patients with type 2 diabetes can also present with diabetic ketoacidosis, so it is not a completely specific finding.Confusion can also occur because patients with type 1 diabetes can have a “honeymoon period.” These individuals with type 1 diabetes still have a small amount of beta cells that can transiently respond to sulfonylurea therapy, and the diagnosis can be confused with type 2 diabetes. However, progressive islet destruction occurs and the patient will eventually develop absolute insulinopenia and require exogenous insulin. As mentioned above, type 1 diabetes is associated with other autoimmune diseases. Therefore, a preexisting diagnosis of an autoimmune disease may suggest an autoimmune cause for diabetes.Patients with type 2 diabetes can have a darkening of the skin at the neck and in skin folds (acanthosis nigricans). These skin changes only occur in type 2 diabetics because of insulin resistance. Insulin resistance is also the underlying problem in female patients with polycystic ovary syndrome (PCOS). Therefore, patients with PCOS have an elevated incidence of type 2 diabetes.
Specific autoantibodies to islet cells, insulin, and glutamic acid decarboxylase help identify patients with autoimmune type 1 diabetes. Antibodies to glutamic acid decarboxylase 65 (GAD65) are considered by many diabetologists to be the most specific antibodies. Seventy to eighty percent of type 1 diabetics have GAD antibodies prior to or at the onset of disease. GAD65 is detected in less than 3% of control subjects. Islet cell antibodies (ICA) are also present in the serum of patients with type 1 diabetes. When the autoantibody assay for ICA is added to GAD65, it increases autoimmune disease detection to greater than 90%. Insulin autoantibodies can also be ordered. However, this must be done before the patient has any exposure to exogenous insulin. Recently, the tyrosine phosphatase-like autoantigen IA-2 has been identified as a potentially useful marker of autoimmune islet disease.
C-peptide can be measured to determine if endogenous insulin production is present. Proinsulin consists of insulin peptide and c-peptide portions. When the c-peptide is removed from the proinsulin peptide, it yields a fully active insulin molecule. C-peptide has no known biologic activity. The presence of c-peptide indicates endogenous insulin production. The normal values vary by laboratory. If c-peptide is not present at the time of diagnosis, then total beta-cell failure has occurred, suggesting type 1 diabetes. If c-peptide is present, then 2 situations could be present. First, the patient might be a type 1 diabetic early in the course of autoimmune beta-cell destruction with some residual insulin secretion. Or, more commonly, the patient might be a type 2 diabetic who is still producing endogenous insulin.
The gold standard to determine if a patient has insulin resistance consistent with type 2 diabetes is via a “glucose clamp” procedure. This procedure usually takes several hours and requires concurrent insulin and dextrose intravenous infusions. The procedure makes it possible to quantify how efficiently a patient disposes of the infused glucose. A patient with type 2 diabetes has decreased glucose disposal compared with a control patient. Unfortunately, the procedure is very time- and labor-intensive and is usually only used in research settings.
It is important to differentiate between autoimmune beta-cell destruction and an insulin-resistant state. Type 1 diabetics require insulin to prevent ketoacidosis. In contrast, patients with type 2 diabetes can be treated with oral therapy once the initial glucose toxicity resolves. Type 2 patients will benefit greatly from therapies that target insulin resistance (ie, thiazolidinediones) and suppress hepatic gluconeogenesis (ie, biguanides). These 2 medications are the preferred agents in early type 2 diabetes. Sulfonylureas are also useful in type 2 diabetes if the former 2 agents are not sufficient to control blood glucose levels. By employing family history, clinical clues, and lab tests, including autoantibodies, clinicians can make an educated decision regarding the etiology of a patient’s diabetes and the appropriate treatment can be prescribed.
Type 1 Diabetes vs. Type 2 Diabetes
A study published in May 2014 found that from 2001 to 2009, prevalence of type 1 diabetes increased 21%, and type 2 diabetes increased 30% among children and adolescents in the U.S.
One month later, in June 2014, the CDC released the latest statistics on diabetes and pre-diabetes. The highlights are provided below, but for further information see this infographic (all numbers pertain to the United States):
- 29 million people have diabetes, 8 million (1 in 4) of whom are undiagnosed
- 86 million people — more than a third of the population — have blood sugar levels high enough to indicate pre-diabetes. 90% of these people don’t know they have pre-diabetes.
- Without weight loss and physical activity, 15 to 30% of those with pre-diabetes will develop diabetes within 5 years.
- The risk of death for people with diabetes is twice that of people without diabetes. They are also at increased risk for serious health problems like blindness, kidney failure, heart disease, and loss of toes, feet, or legs.
- More than 18,000 youths are diagnosed with type 1 diabetes every year.
- Over 5,000 youths are diagnosed with type 2 diabetes every year.
- 5% of all diagnosed cases of diabetes in adults every year are for type 1 diabetes.
- Being overweight and leading a sedentary lifestyle are the biggest risk factors for diabetes. Adults who lose weight and engage in even moderate physical activity can significantly increase their chances of preventing or delaying the onset of diabetes.
- Diabetes Information NIH.gov
- Wikipedia: Diabetes mellitus#Classification
- Diabetes risk test – Diabetes.org
- National Diabetes Statistics Report, 2017 (pdf) – CDC.gov
- Type 2 Diabetes is Preventable – NIH.gov
Case Study: New-Onset Diabetes: How to Tell the Difference Between Type 1 and Type 2 Diabetes
L.C., a 25-year-old white woman, presented to the Emergency Department reporting that she was in good health until ~ 3 weeks ago, when she began experiencing polyuria and polydipsia. She had had an unintentional weight loss of ~ 10 lb in the past 2 months.
She denied visual disturbances, nausea, vomiting, abdominal pain, dysuria, history of the same symptoms, and recent illness. She also denied alcohol, tobacco, and illicit drug use. Her medications included only oral birth control pills, and she was a competitive volleyball player. Family history was negative for diabetes, hypertension, coronary artery disease, and autoimmune diseases.
Physical exam revealed a blood pressure of 129/82 mmHg, pulse of 88 bpm, and respiration rate of 20 breaths per minute. L.C.’s weight was 62 kg, and her BMI was 21 kg/m2. She seemed healthy and aware. Her eyes, throat, and thyroid were normal, and her neck was negative for lymphadenopathy. She had a regular heart rate and rhythm, negative for murmurs, rubs, or gallops, with normal first and second heart sounds. Lungs were clear with normal respirations. Abdominal exam revealed normal breath sounds and no tenderness, guarding, or rebound. Extremities were normal, and neurological motor and sensory functioning was intact.
L.C. was treated with intravenous (IV) saline and insulin. Her glucose was corrected to 191 mg/dl. She was prescribed metformin, 500 mg twice daily, and was discharged and instructed to follow up with her primary care provider (PCP).
She returned to the Emergency Department 3 days later complaining of continued hyperglycemia with fingerstick readings > 400 mg/dl. She had not yet seen her PCP.
Physical exam revealed a blood pressure of 116/83 mmHg, pulse of 88 bpm, and respirations of 18 breaths per minute. She appeared otherwise healthy and alert, and the remainder of her physical exam was normal.
Again, L.C. was treated with IV saline and insulin. Her glucose was corrected to 216 mg/dl. Her metformin was increased to 1,000 mg twice daily, and she was discharged and instructed to follow up with her PCP.
She saw the PCP the next day and had glipizide added to her metformin. After 2 more days, her PCP added glargine insulin, 10 units at bedtime, and lispro insulin, 4 units before meals three times per day.
After insulin initiation, her fingerstick glucose levels were vastly improved, at 47–126 mg/dl. She was continued on metformin and referred to an endocrinologist.
What’s the difference between type 1 and type 2 diabetes?
Type 2 diabetes is often preceded by a stage called pre-diabetes. It is a slow rise in the average amount of blood sugar in your body. It’s not enough to cause symptoms, but it’s a sign that you’re on your way to developing type 2 diabetes. If you are overweight or obese, you are much more likely to have pre-diabetes than thin people – but, it’s not all about weight. Genetic predisposition is another big factor. If it were as simple as weight, everyone with extra weight would be diagnosed with diabetes, and that’s not the case. Unlike type 1 diabetes, type 2 can often be managed for a long time with diet and exercise alone, especially when diagnosed early. Staying aware and educated, managing your diet, staying active, and regularly monitoring your blood sugars, you can put diabetes management on autopilot. While all the symptoms of type 1 can be present with a type 2, they are less severe unless there’s a serious problem. However, there are some symptoms that are a sign of chronic high blood sugar. These include increased infections, slower healing, impotence, and regular yeast infections or itching in the groin. In both types, chronic high blood sugars can cause long-term complications. The sugar causes damage to your body over time, especially to your nerves and vision. Your endocrinologist (a type of doctor that specializes in diabetes) can assess whether you’re dealing with any complications and what treatment options are available.
Other types of diabetes?
There are a few other types of diabetes, such as LADA, MODY, and gestational, for example. We’ll talk more about these in another article.