What's the Difference Between Type 1 and Type 2 Diabetes?

Type 1 diabetes and type 2 diabetes are not the same disease. Find out the essential differences and how they affect the body.

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By Chris Iliades, MD

Medically reviewed by Pat F. Bass III, MD, MPH

Type 1 diabetes and type 2 diabetes share the problem of high levels of blood sugar. The inability to control blood sugar causes the symptoms and the complications of both types of diabetes. But type 1 and type 2 diabetes are two different diseases in many ways. In the United States, 25.8 million people have diabetes — that’s about 8.3 percent of the population. But type 1 diabetes affects just 5 percent of those adults, with type 2 diabetes affecting up to 95 percent. Here’s what else you need to know to be health-savvy in the age of the diabetes epidemic.

What Causes Diabetes?

"Type 1 diabetes is an autoimmune disease — the body's immune system attacks the cells in the pancreas that make insulin," a hormone, says Andjela Drincic, MD, an associate professor of medicine in diabetes and endocrinology at the Nebraska Medical Center in Omaha. The exact cause is not known, but it is probably a combination of the genes a person is born with and something in the environment that triggers the genes to become active.

"The cause of type 2 diabetes is multifactorial," says Dr. Drincic. "People inherit genes that make them susceptible to type 2, but lifestyle factors like obesity and inactivity are also important. In type 2 diabetes, at least in the early stages, there is enough insulin, but the body becomes resistant to it." Risk factors for type 2 diabetes include a family history of the disease, a poor diet, a sedentary lifestyle, obesity, and being a certain ethnicity.

Juvenile or Adult-Onset: When Does Diabetes Start?

Usually, type 1 diabetes in diagnosed in childhood, where type 2 diabetes is typically diagnosed after age 40. But these rules are no longer hard-and-fast: People are getting type 2 diabetes at increasingly younger ages and more adults are getting type 1 diabetes, says Shannon Knapp, RN, BSN, a diabetes educator at the Cleveland Clinic, highlighting the need for diabetes prevention at all ages.

What Does Diabetes Do to the Body?

People with type 1 diabetes do not produce insulin, which allows sugar to build up in the blood instead of going into the cells, where it is needed for energy. In type 1 diabetes, high blood sugar causes symptoms like thirst, hunger, and fatigue and can cause devastating consequences, including damage to the nerves, blood vessels, and internal organs. The same scary complications of diabetes appear in type 2 as well. The difference is that people with type 2 diabetes still produce insulin; their bodies just become less sensitive to it over time, which is what causes the complications.

Are the Symptoms of Diabetes Different?

The first symptoms of type 1 diabetes appear when blood sugar gets too high. Symptoms include thirst, hunger, fatigue, frequent urination, weight loss, tingling or numbness in the feet, and blurred vision. Very high blood sugar can cause rapid breathing, dry skin, fruity breath, and nausea.

Meanwhile, the first symptoms of type 2 diabetes may not show up for many years, meaning the disease can ravage a person’s body without them realizing it. Early symptoms include frequent infections, fatigue, frequent urination, thirst, hunger, blurred vision, erectile dysfunction in men, and pain or numbness in the hands or feet. Drincic notes that "symptoms of type 2 diabetes don't start as suddenly as symptoms of type 1 diabetes."

Is Diagnosing Diabetes Types 1 and 2 Similar?

Blood tests used to diagnose type 1 and type 2 include fasting blood sugar, a hemoglobin A1C test, and a glucose tolerance test. The A1C test measures the average blood sugar level over the past few months. The glucose tolerance test measures blood sugar after a sugary drink is given.

"The blood sugar testing we do to diagnose and manage type 1 diabetes is very similar to the testing we do for type 2 diabetes," says Drincic. "We can do a blood test that looks for antibodies. That tells us if it is type 1 or 2." In type 1 diabetes, the immune system makes antibodies against the cells in the pancreas that make insulin, and these antibodies can be detected in a blood test. Your doctor may suspect type 2 diabetes based on your symptoms and risk factors like obesity and family history.

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 medications 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 blood sugar, but usually only once or twice a day.

What Are the Complications of Diabetes?

"Whether it's type 1 or type 2, the big picture for diabetes is all about preventing complications," Drincic says, mostly nerve and blood vessel damage. For example, if you have either type of diabetes, you have the twice the risk of heart attack or heart disease than 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 research stage." 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.

"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, one study followed 522 men 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 about 60 percent compared with those who didn't follow the diet or exercise. The findings were published in the journal Clinical Diabetes.

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More Sugar Equals More Diabetes, Study Finds

A new study found an association between sugar availability and diabetes rates in 175 countries.

By Johannah Sakimura, Everyday Health Staff Writer

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WEDNESDAY, Feb. 27, 2013 — Countries that have higher amounts of sugar in their food supply have higher rates of diabetes, according to an analysis of 175 countries published today in the journal PLOS ONE. While this type of study cannot prove that a high-sugar diet causes diabetes, it is consistent with other research suggesting that sugar plays an independent role in the development of type 2 diabetes, above and beyond its contribution to weight gain.

Diabetes is a global epidemic. The number of adults with diabetes worldwide has more than doubled in the past thirty years, and the International Diabetes Federation (IDF) estimates that at least 1 in 10 people will be living with the disease by 2030.

In the new study, researchers from the Stanford University School of Medicine, the University of California-Berkeley, and the University of California-San Francisco looked at changes in the amount of sugar in countries' food supply between the years 2000 and 2010. Their analysis showed that an increase of 150 calories of sugar per person per day resulted in a 1.1 percent jump in the country's diabetes rate after adjusting for socioeconomic and demographic factors, obesity, and other variables. A 150-calorie dose of sugar is equivalent to the amount in one 12-ounce can of regular soda.

“In countries where sugar availability was going up, we saw increasing rates of diabetes, and in countries where sugar availability was going down we saw decreasing rates of diabetes,” says Robert Lustig, MD, the study’s senior author and a professor of pediatrics at the University of California-San Francisco. Examining trends in sugar supply and diabetes prevalence for an extended period, as opposed to a single moment in time, strengthens the findings, he says.

Importantly, the association between sugar and diabetes endured even after taking into account total calories in the food supply and countries’ obesity rates. A diet high in sugar may also be high in calories, and excess calories can cause weight gain and ultimately increase risk for type 2 diabetes. This connection complicates scientists’ attempts to isolate the effect of sugar on diabetes risk. In the new analysis, there was an independent relationship between sugar availability and diabetes rates in countries that could not be explained by a simultaneous increase in obesity or total calories.

The study used annual estimates of diabetes prevalence from the IDF for the 175 countries analyzed and data on sugar availability from the United Nations Food and Agricultural Organization.

According to Dr. Lustig, the report “overturns the idea that a calorie is a calorie.” The authors say the study supports the theory that calories from sugar have a greater impact on diabetes risk compared to calories from other sources.

Because the study examined data from whole populations rather than individuals, it cannot prove that a diet high in sugar causes diabetes.

“No epidemiological study will ever be able to prove causation. This study is as close as we will ever come. It is the same scrutiny of analysis that we used to implicate cigarettes as the cause of lung cancer and done with the same criteria,” says Lustig.

Though the researchers used a sophisticated analysis, the findings are of limited value because this type of study is not designed to prove that a sugary diet is a risk factor for diabetes, counters Elizabeth Mayer-Davis, PhD, professor of nutrition and medicine at the University of North Carolina at Chapel Hill, who was not involved with the study. Still, she says the results are in line with previous research. "This is not a game changer, it's not a new concept. There are stronger study designs that have given similar conclusions."

"At the end of the day, I think there is increasing evidence that added sugar, particularly sugar-sweetened beverages, may very well increase risk for diabetes. These findings are consistent with that," says Dr. Mayer-Davis.

The study authors call for more research to understand the role sugar may play in the development of type 2 diabetes, but some experts are urging health organizations to begin emphasizing sugar reduction to the public now. “How much circumstantial evidence do you need before you take action?” Marion Nestle, PhD, a professor of nutrition, food studies and public health at New York University, who did not contribute to the research, wrote in the study press release. “At this point we have enough circumstantial evidence to advise people to keep their sugar a lot lower than it normally is.”

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10 Steps to Ease a Gout Attack

Pain management is a crucial part of living with gout. Try these simple tips, which include bed rest, applying an ice pack, and taking the right medicine, to manage a painful gout attack.

By Chris Iliades, MD

Medically reviewed by Pat F. Bass III, MD, MPH

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The classic gout attack occurs in an overweight man who has been drinking a little too much and has let his cholesterol get out of control. He may also have high blood pressure and diabetes. The gout attack will wake him up in the middle of the night with severe pain in the joint of a big toe. Of course, not all gout attacks play out this way. Women get gout, too, especially after menopause, and gout can also attack in other places.

"The big toe was the most common place to get gout, but now gout is as likely to be seen in the knee, wrist, or fingers," explains James C.C. Leisen, MD, head of rheumatology at Henry Ford Hospital in Detroit. "In my hospital-based practice, gout is the most common type of arthritis I see, even more common than rheumatoid arthritis."

10-Point Plan: Easing an Acute Gout Attack

"A gout attack can be extremely painful. The affected joint becomes swollen, warm to the touch, and very red. Even slight pressure on the joint can be very painful. Fortunately, a gout attack is self-limited and will clear in time," explains Dr. Leisen. Here are 10 steps you can take to manage a gout attack:

1. See your doctor. "The first thing you need to do is make sure it's gout. If there is any doubt about the diagnosis, the best test for gout is to remove fluid from the joint and examine it under a microscope," says Leisen.
2. Rest. The best place to be during a gout attack is in bed.
3. Ice it down. Putting ice on the affected joint will reduce the inflammation.
4. Get naked. At least the part that hurts. Keep the foot bare, and probably your leg, too. The weight of any clothing or bedding material probably will add to your pain.
5. Watch your diet. Gout can be aggravated by a diet high in animal protein and by alcohol, so limit your intake of meat and avoid alcohol completely during a gout attack.
6. Stay hydrated. "It's important to drink enough water during a gout attack,” advises Leisen. This can help flush the uric acid crystals that cause gout out of your system.
7. Take over-the-counter pain medication. Ibuprofen (Motrin) is a typical non-steroidal anti-inflammatory drug (NSAID) used for management of acute gout pain. "If you don't have renal disease, NSAIDs are the best drugs for pain management," says Leisen.
8. Try steroids. The steroid drug prednisone can be used for patients who can't take NSAIDs. Prednisone is usually given by mouth with the dose tapered down over 10 to 14 days. If you’re hospitalized, steroids can be given intravenously.
9. Ask your doctor about gout-specific drugs. Colchicine (Colcrys) is taken orally to relieve an acute gout attack. It works by blocking the uric acid crystals that lodge inside your joint and cause gout. Colchicine is usually effective if taken within 12 to 24 hours of a gout attack. Allopurinol (Zyloprim) may be given to people who have repeated attacks of gout; it interferes with the development of uric acid. Probenecid is a medication that works by helping your kidneys get rid of uric acid. For more on newer drugs to treat gout, see “Get the Latest on Gout Medications.”
10. Be patient. "Sometimes the best advice is to be patient and wait it out. A gout attack usually clears up within a few days. Take the medicine prescribed by your doctor and stay in bed. You will get better soon," says Dr. Leisen.

Many patients will go a long time between attacks. In fact, for 62 percent of patients the next attack will be more than a year away, and some won't have another attack in the next 10 years. However, if you begin to have more frequent attacks, talk to your doctor about which long-term drug therapy might be helpful for you.

The sooner you start treatment and pain management, the more quickly you will be back on your feet.

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Less sleep leads to more eating, weight gain - study

By: Agence France-Presse

WASHINGTON DC - Sleeping a mere five hours a night during a workweek with unlimited access to snacks isn't good for your waistline, according to findings released Monday.

The study, led by the University of Colorado at Boulder, found that participants gained nearly two pounds (about 1 kilogram) when put in such a situation.

Previous studies have shown that a lack of shut-eye can lead to the packing on of pounds but the reasons for the extra weight were unclear, according to the authors of the latest research.

Published in the Proceedings of the National Academy of Sciences, the newest findings show that, while staying awake longer did indeed require more energy, the extra calories burned were more than offset by the amount of food the study participants consumed.

"Just getting less sleep, by itself, is not going to lead to weight gain," said Kenneth Wright, director of CU-Boulder's Sleep and Chronobiology Laboratory that lead the study. "But when people get insufficient sleep, it leads them to eat more than they actually need."

The researchers monitored 16 young, lean and healthy men and women who lived for two weeks at the University of Colorado Hospital, which has a "sleep suite."

They measured how much energy participants used by keeping tabs on the amount of oxygen they breathed in and the amount of carbon dioxide they exhaled.

After all participants spent the first three days with the opportunity to sleep nine hours a night and eating controlled meals meant to maintain their weight, they were split into two groups.
The first group then spent five days with only five hours during which to sleep, while the other group spent those days with nine hours during which to rest.

After the first five days, the groups switched. In both groups, participants were offered larger meals and access to snacks that included ice cream and potato chips but also healthier options such as fruit and yoghurt.

On average, those who slept for up to five hours a night burned five percent more energy than those who snoozed up to nine hours. However, those with less shut-eye also consumed six percent more calories.

Those getting less rest tended to eat smaller breakfasts but binged on after-dinner snacks, according to the researchers.

In fact, the late-night food intake totaled more in calories than individual meals, they said.
The authors of the study also found that men and women responded differently to having access to unrestricted amounts of food.

While both males and females put on weight when only allowed to sleep five hours, men gained -- even with "adequate" rest -- when they could eat as much as they desired. Women, however, maintained their weight when they had "adequate" sleep, no matter how much food was at their disposal.

A separate study out last month said sleep deficit -- even just a week's worth -- can have damaging effects on our genes.

Lack of adequate shut-eye had already been linked to conditions from heart disease and cognitive impairment to obesity.

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Sweet news for diabetics: Researchers foresee end to daily insulin shots

By: Agence France-Presse

SYDNEY - Breakthrough Australian research mapping how insulin works at a molecular level could open the door to novel new diabetes treatments, ending daily needle jabs for millions, scientists said Thursday.

A Melbourne team have been able to lay out for the first time how the insulin hormone binds to the surface of cells, triggering the passage of glucose from the bloodstream to be stored as energy.

Lead researcher Mike Lawrence said the discovery, more than 20 years in the making, would make new and more effective kinds of diabetes medication possible.

"Until now we have not been able to see how these molecules interact with cells," said Lawrence, from the Walter and Eliza Hall Institute of Medical Research.

"We can now exploit this knowledge to design new insulin medications with improved properties, which is very exciting."

Lawrence said the team's study, published in the latest edition of Nature, had revealed a "molecular handshake" between the insulin and its receptor on the surface of cells.

"Both insulin and its receptor undergo rearrangement as they interact - a piece of insulin folds out and key pieces within the receptor move to engage the insulin hormone," he said of the "unusual" binding method.

Understanding how insulin attaches to cells was key to developing "novel" treatments of diabetes, a chronic condition in which the pancreas does not produce enough insulin or the body cannot use it properly.

"The generation of new types of insulin have been limited by our inability to see how insulin docks into its receptor in the body," said Lawrence.

"This discovery could conceivably lead to new types of insulin that could be given in ways other than injection, or an insulin that has improved properties or longer activity so that it doesn't need to be taken as often."

Importantly, he said it could also have ramifications for the treatment of diabetes in developing nations, allowing for the creation of more stable insulins that do not need refrigeration.

There are an estimated 347 million diabetes sufferers worldwide and diagnoses are increasing, particularly in developing countries, due to growing levels of obesity and physical inactivity.

It is expected to be the seventh leading cause of death in the world by 2030, with the World Health Organization projecting total deaths from diabetes will rise by more than 50 percent in the next 10 years.

Complications of diabetes include blindness, limb amputation and kidney failure.

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SWEET BUT UGLY TRUTH | Diabetes numbers swelling, 6.16M Filipinos could have it in 2030

By: Jet Villa, InterAksyon.com

MANILA, Philippines - The number of Filipinos with diabetes--a metabolic disorder with serious complications like stroke, nerve damage and kidney failure—could nearly double in the next 17 years, an alarming trend that mirrors the global situation, health experts said Tuesday
As of 2010, the number of diabetics was listed at 3.4 million, and at the rate cases are increasing, that figure could be 6.16 million in 2030, said the experts.

Dr. Joey Miranda, secretary of the American Association of Clinical Endocrinology-Philippines, said the 3.4 million diabetes cases in 2010 meant a prevalence rate of 7.7 percent, which is seen to rise to 8.9 percent or 6.16 million cases in year 2030.

Miranda said in a press conference there’s just no underestimating the problem, considering the myriad health problems associated with diabetes. “This will be a big problem that we will encounter in 2030. We already have a big problem at present what more about 17 years from now? Our hands will be full in tackling this problem.”

He echoed earlier characterizations of diabetes being a “growing global epidemic.” Some 360 million diabetics worldwide were counted in 2011, and, Miranda said, this was projected to increase to 550 million by year 2030.

Dr. Elizabeth Paz-Pacheco, former president of the Philippine Society of Endocrinology and Metabolism, underscored the need to mitigate the effects of diabetes by focusing on prevention and proper management of cases.

One way, she said, is to get the blood sugar to normalize as quickly as possible “for the majority of patients who are newly diagnosed, younger and they have a longer life ahead of them.”
For those who cannot do so, a lifestyle change and obedience to the drug regimen prescribed by doctors is necessary to prevent diabetes complications.

Diabetes is described in a fact sheet given out by the health experts as “a serious, lifelong disease and is a disorder of metabolism – the way our body uses the food we eat for growth and energy.”

The long-term complications of diabetes include blindness, heart and blood vessel disease, kidney failure, amputation of limbs, nerve damage and stroke.

Type 1 diabetes is caused by a genetic predisposition and Type 2, which accounts for over 90 percent of Philippine cases, is associated with lifestyle. The last type is gestational diabetes, a condition of pregnant women during pregnancy.

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Diabetes News | Diabetes may be linked to hearing loss: study

By: Andrew Seaman, Reuters

NEW YORK - Diabetes has already been tied to an increased risk of kidney and cardiovascular troubles, nerve damage and vision loss, and now a Japanese study finds diabetics to be more than twice as likely as those without the disease to have hearing impairment.

In a review of past research on the issue, published in the Journal of Clinical Endocrinology and Metabolism, scientists found that younger diabetics were at even higher risk than older adults, though they could not explain why.

"Current meta-analysis suggests that the higher prevalence of hearing impairment in diabetic patients compared with nondiabetic patients was consistent regardless of age," wrote lead researcher Chika Horikawa, at Niigata University Faculty of Medicine, and colleagues.

It's not the first time researchers have found a link between diabetes and hearing loss. In 2008, researchers from the US National Institutes of Health (NIH) saw similar patterns in a sample of more than 11,000 people, with people with diabetes twice as likely to have hearing loss as those without.

It's thought that high blood sugar levels brought on by diabetes may lead to hearing loss by damaging blood vessels in the ears, said Horikawa.

Horikawa and colleagues collected information from 13 previous studies examining the link between diabetes and hearing loss and published between 1977 and 2011. Together, the data covered 7,377 diabetes and 12,817 people without the condition.

Overall, Horikawa's team found that diabetics were 2.15 times as likely as people without the disease to have hearing loss. But when the results were broken down by age, people under 60 had 2.61 times the risk while people over 60 had 1.58 times higher risk.

Some experts caution that this kind of study does not prove that diabetes is directly responsible for the greater hearing loss rates.

"It doesn't definitively answer the question, but it continues to raise an important point that patients might ask about," said Steven Smith, a diabetes specialist at the Mayo Clinic in Rochester, Minnesota.

The researchers note that future studies that take more factors into account, such as age and noisy environment, are needed to clarify the link between diabetes and hearing loss.
Still, Horikawa told Reuters Health in an email, people should recognize that diabetics may be at risk for hearing loss based on their results.

"Furthermore, these results propose that diabetic patients are screened for hearing impairment from (an) earlier age compared with non-diabetics," said Horikawa, adding that hearing loss has also been linked to an increased risk of depression and dementia. 

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