Difference Between Type 1 and Type 2 Diabetes
People with type 1 diabetes don’t produce insulin. You can think of it as not having a key. People with type 2 diabetes don’t respond to insulin as well as they should and later in the disease often don’t make enough insulin. You can think of it as having a broken key.
Dr Richard Bebb, MD, ABIM, FRCPC, discusses What is your Prevalence of Diabetes.
Understanding the Difference Between Type 1 and Type 2 Diabetes
What is diabetes? Well, there are two kinds of diabetes: type 1 and type 2 diabetes mostly. And they’re interrelated but not similar, and well, that’s related to insulin.
So first let’s talk about insulin. What’s insulin, how does it work, everyone knows insulin is related to diabetes. Well, insulin is a hormone, it’s a messenger. It means that it has a message to give to the body.
Insulin is secreted by the pancreas, which is big like my hand, it’s right in the back of the stomach, and when we eat, the food is absorbed, goes next to the pancreas who sees the food, and sends insulin with it in order to inform the whole body that the food is in the blood.
So the role of insulin is a little bit like the helper that would go from the milkman’s truck, ring the doorbell of the house and say “You know what? There’s milk on the street ready to be stored in your refrigerator. Do you want some?” And you’ll say “I want two bags”, they’ll give you the two bags and then they go to the next house.
Insulin works the same way: it rings the doorbell of a cell, whether it’s a fat cell, whether it’s a muscle cell, or a liver cell, and says “There’s food in the blood. Do you want to store it?” And the cells say “Yes, I’ll take some food and I’ll store it.” And all this allows that all the food we absorb after a meal is stored in our body within the bowel for two hours.
Now there are two diseases where this can go wrong, and the first one, type 1 diabetes, there’s no insulin being produced. So what happens is that the food is absorbed normally with the meal, goes in the blood, but the cells never see it. So they don’t try to store it, they don’t see it.
So the food just circulates, nobody takes it, it comes the next meal, you eat again, more food goes in the blood, and the next meal more food – so the food accumulates in the blood without ever going anywhere.
Up to the point where the kidney sees that and goes “Whoa, the sugar levels are really too high, it’s becoming maple syrup more than blood, it’s becoming difficult to pump, let’s get rid of sugar.”
So it takes the sugar and sends it into urine, in order to get rid of it. If we urinated little squares of sugar that would be painful. So the kidneys, when they expel the sugar, make sure they send a lot of water to dilute it.
That’s what causes the classical symptoms of urinating a lot, because all the water comes out with the sugar, losing water causes thirst so people drink a lot, and they urinate a lot. So that’s the classic symptoms of diabetes. At the same time people with type 1 diabetes are diagnosed, they lose a lot of weight, because all the food they eat ends up in urine, not in their cells.
So, these are the classical signs of diabetes at first, and the only treatment that we have is to give insulin, and try to coordinate it with the food to reproduce what’s normal. So people with type 1 diabetes need to take insulin many times a day in order to have the normal physiology restored.
Type 2 diabetes is totally different. In type 2 diabetes initially, the pancreas is okay, and it’s related to being obese. So what happens there? Food is absorbed, insulin goes with the food, rings the doorbell, “Do you want to store food?” But there, the cells say “No. I’m full.” The person is obese, all the stores of fat are full.
So the cell resists, the same way as if the milkman comes to your house and says “Do you want milk?” Your fridge is full of milk. You’ll say “No, no, no, no, no. I resist you, I don’t want to have any food, any milk, go and sell that to my neighbour.”
So the cells resist insulin. They say “No, no, no, no no, I don’t want any food, go and store it elsewhere.” Now if the body has difficulty finding a few cells to serve food, well of course the food stays in the blood for a longer period of time, because there’s no place to store it, the next meal arrives, and the next meal, and it starts accumulating and it does a little bit like it does in type 1 diabetes, that is the kidney sees that, sends the glucose into urine, sends water with it, causes thirst, so people pee a lot and drink a lot.
Except that here what’s different, is the fact that if we want to treat the best way, is to make the cells more able to respond to insulin, and that’s why making them leaner, so by losing weight, by lifestyle, whether it’s by doing exercise or by dieting, if you lose weight the cells are more empty, and they’ll say yes to more insulin and they’ll store the food, and that’s the way diabetes can disappear with lifestyle.
There are other ways, other medications that can be given that increase the action of insulin, but initially the importance of lifestyle comes from the basic causes of type 1 and type 2 diabetes. Type 1 and Type 2 Diabetes Diabetes Now Patient Communication System
Local Practitioners: Endocrinologist
Lori Berard, RN, CDE, Registered Nurse, talks about what tests and targets are important for patients living with Diabetes.
What is the Prevalence of Diabetes?
Diabetes is becoming more prevalent for a number of reasons.
First of all, there’s two types, two main types of diabetes. There’s type 1 diabetes, where individuals run out of insulin, and that tends to occur more in younger people.
And then there’s type 2, which is the more common type. And that’s the type of diabetes that’s becoming more and more common, and it’s for a number of reasons.
First of all, to a certain degree it’s a disease of aging, the older you get the less insulin your body makes, and hence your blood sugars tend to drift up, but it’s also a disease of lifestyle.
We tend to be more sedentary earlier in life. In the old days you kicked the kids out of the house and sent them to the park and said don’t come back until dinner. Now they don’t go to the park, they sit in front of the TV, they play on their Gameboy and they are not physically active, and that sets the stage for weight change and an increase in blood sugars.
And we’re seeing type 2 diabetes which we didn’t used to in individuals under the age of 20 now, which was very very unusual 20, 30 years ago. So it’s a lifestyle issue, it’s an aging issue, and there is also a significant genetic component so if either of your parents had type 2 diabetes you are more likely to develop it. Type 1 and Type 2 Diabetes Diabetes Now Patient Communication System
Local Practitioners: Endocrinologist
Despite our advances in the treatment of diabetes, many patients still don’t achieve target. Although many are comfortable with the traditional medications that we use to treat diabetes, many also seek alternatives. And there are alternatives in complementary and alternative medication.
Generally speaking, complementary medication means taking a non-traditional, non-Western medication in addition to those, while alternative medication means taking it instead of that.
So what’s the data with diabetes? Well there have been studies looking at a number of non-traditional, complementary medications for diabetes. Unfortunately many of them are of short duration, and not sufficiently powered to make clear conclusions that they are of benefit.
There are a number of health products that have been studied, particularly some at least for three months, and have been showing promise with at least a reduction in the A1-C of about five percent. And there’s a list of those available in the chapter on complementary and alternative medicine in the Canadian Diabetes Association Clinical Practice Guidelines.
I would like to stress that there are some that are more popular and commonly used for diabetes, such as chromium and vitamin D, and these have actually been studied in a little more detail, and unfortunately they have not been shown to be of benefit in the treatment of diabetes.
There are a number of other complementary and alternative therapies such as yoga, acupuncture and hands-on treatment such as chiropractic, massage etc. Unfortunately, many of these just don’t have studies specific to diabetes to be able to make comments whether they are of benefit or not. Some, such as acupuncture, have shown some promise in some of the complications of diabetes, such as gastroparesis or neuropathy, but again they’re very limited.
So we recommend that there are some natural health products that are showing promise for the treatment of diabetes and they should be explored further. There are some that have clearly been shown to be not of benefit, and the most important thing is that patients should be telling their healthcare providers if they are taking any of these natural healthcare products, because not only can some of them have side effects, but some of them may actually contain non-declared medicinal products.
The important thing is that many people think that because they’re natural health products, they’re natural, and they don’t have any side effects. And that’s not the case, many of them can have significant side effects or interactions with their other medications. So it is very important that people with diabetes let their healthcare provider know if they are taking any of these products.
For more information about complementary and alternative medicine for diabetes, speak to your physician, diabetes nurse educator or endocrinologist. Type 1 and Type 2 Diabetes Diabetes Now Patient Communication System
Local Practitioners: Endocrinologist