Diabetes Information
Type 1 Diabetes

Also known as: juvenile diabetes, insulin-dependent diabetes mellitus (IDDM), childhood diabetes, and ketosis prone diabetes (Note: some of these terms are now outdated).

Type 1 diabetes accounts for between 5 and 10% of all diagnosed diabetes in the United States. Although type 1 diabetes develops most often in children and young adults (one in every 400-500 children has type 1 diabetes), the disease can be diagnosed at any age throughout the lifespan, and is equally distributed among males and females. Unlike type 2 diabetes, type 1 diabetes is more common in Caucasians than in those of Hispanic, African-American, or other non-Caucasian backgrounds.

Type 1 diabetes is an autoimmune disease that occurs when the insulin-producing beta cells within the pancreas are gradually destroyed and eventually fail to produce insulin. Insulin is a hormone that helps the body's cells use glucose for energy. Blood glucose (or blood sugar) is manufactured from the food we eat (primarily carbohydrates) and by the liver. If glucose can't be absorbed by the cells, it builds up in the bloodstream instead, and high blood sugar is the result. Over time, the high blood glucose levels of uncontrolled diabetes can be toxic to virtually every system of the body.

Because type 1 diabetes is frequently diagnosed in childhood, it is sometimes referred to as juvenile diabetes. However, it can develop at any age throughout adulthood. Early diagnosis is important to prevent some of the more serious complications of diabetes, which include heart disease, blindness, high blood pressure, nerve damage, and kidney failure. In addition to following an exercise and healthy eating plan, individuals with type 1 diabetes require insulin injections.

The causes of type 1 diabetes are complex and still not completely understood. People with type 1 diabetes are thought to have an inherited, or genetic, predisposition to the disease. Researchers believe that this genetic predisposition may remain dormant until it is activated by an environmental trigger such as a virus or a chemical. This starts an attack on the immune system that results in the eventual destruction of the beta cells of the pancreas.

There are several subtypes of type 1 diabetes, including type 1A diabetes, idiopathic diabetes (type 1B), and latent autoimmune diabetes of adulthood (LADA). The basic treatment (i.e., insulin injections) is the same for all.

Diabetes may include one or more of the following:

Many of the symptoms of type 1 diabetes are nonspecific—that is, they may be indications of any one of a number of different medical problems. If you’re experiencing any of these symptoms, please contact your healthcare provider immediately for medical evaluation.

Over time, high blood glucose levels can cause damage to virtually every organ system of the body, including:

Achieving good control over blood glucose levels with insulin and healthy lifestyle changes is the best way to prevent or slow diabetes-related complications. The Diabetes Control and Complications Trial (DCCT), a landmark ten year study of the impact of good blood sugar control on complications associated with type 1 diabetes, found that for every 1 percentage point a patient reduces their A1c (i.e., three month blood glucose average), they lower their risk of microvascular complications 37%. The study also found that keeping blood sugar levels as close to normal as possible slowed the progression of diabetes-related eye, kidney, and nerve diseases.1

People with type 1 diabetes require insulin injections to supplement or replace the failing insulin production of their pancreas. Insulin may be delivered by a syringe or other injection device, or through an infusion device called an insulin pump.

Good nutrition, careful monitoring of carbohydrate and fat intake, and regular physical activity are also important to controlling type 1 diabetes and preventing long-term complications.

The goal of type 1 diabetes treatment is to maintain blood glucose levels as close to normal as possible given an individual’s medical history. Regular blood glucose monitoring, called SMBG or self-monitoring of blood glucose levels, can help patients understand how food, exercise, illness, and other factors impact their blood glucose levels. The information provided by regular blood sugar checks also helps the healthcare team assess how effective a treatment plan is and provides data for making necessary adjustments.

Why is good blood glucose control important? Long-term research has demonstrated that keeping glucose levels as close to normal as possible — a treatment approach known as "tight control" or "intensive management"— significantly reduces the risk of eye, kidney, and nervous system complications for people with type 1 diabetes.

Type 2 Diabetes

Also known as: adult-onset diabetes and non-insulin dependent diabetes mellitus (NIDDM) (Note: These terms are now outdated).

Type 2 diabetes is more common in adults aged 50 and older, although it can occur in children and adolescents as well. Being overweight or obese and leading a sedentary (i.e., nonactive) lifestyle are major risk factors for developing type 2 diabetes, as is having a family history of the disease. People of African-American, American Indian, Asian American, Hispanic, and Pacific Islander background are more likely to develop type 2 diabetes.

Type 2 diabetes is the most prevalent form of the disease, accounting for 90 to 95% of all diabetes cases in America. Unlike type 1 diabetes, where destruction of the pancreas reduces and eventually stops the supply of the hormone insulin, most people with type 2 diabetes are still able to produce insulin at diagnosis. However, the insulin they produce is unable to perform its primary job, which is helping the body's cells use glucose for energy. Usually this is due to a problem with the body’s insulin receptors, the location on cells where insulin binds so that glucose can enter (although less frequently there may be a problem with the chemical makeup of the insulin itself). This condition is called insulin resistance.

If glucose can't be absorbed by the cells, it builds up in the bloodstream instead, and high blood sugar is the result. The pancreas keeps increasing insulin production in an effort to keep up with rising blood sugar levels, and high circulating levels of insulin (known as hyperinsulinemia) develop. Hyperinsulinemia increases the risk of cardiovascular disease and other health problems.

Over time, the high blood glucose levels from uncontrolled diabetes can cause serious long-term health problems with virtually every system in your body. Eventually, they may cause damage to the insulin-producing beta cells of the pancreas, reducing insulin output. An early diagnosis is important to prevent some of the other more serious complications of diabetes, which include heart disease, high blood pressure, nerve damage, and kidney failure. Fortunately, in many cases type 2 diabetes can be adequately controlled through a combination of proper nutrition and exercise, which is usually the first line of treatment. However, some people with type 2 diabetes do require oral medications or insulin injections.

Although the vast majority of individuals with type 2 diabetes are adults, children and adolescents are increasingly at risk for the disease due to growing childhood weight problems and sedentary lifestyles.

The exact causes of type 2 diabetes aren’t completely understood, but it is known that the disease has a strong hereditary component. Individuals who have a parent or sibling with type 2 diabetes have 10 to 15% chance of developing the disease (the risk is much higher if the sibling is an identical twin). Environmental factors like an inactive lifestyle or poor diet may act as a trigger for someone with a genetic tendency towards type 2 diabetes. Other potential causes of type 2 include chronic stress, low birth weight (and associated fetal malnourishment), and gene mutations.

Not everyone with type 2 diabetes has symptoms, particularly in the early stages of the disease. In fact, more than one quarter of the over 18 million Americans with type 2 diabetes are unaware that they have the disease.

Type 2 diabetes symptoms may include one or more of the following:

Unlike type 1 diabetes, which frequently has a sudden onset of symptoms and reaches a crisis point before diagnosis is made, the signs of type 2 diabetes may be gradual and more insidious. Often, the first symptoms that people with undiagnosed type 2 diabetes experience are those from complications of the disease, such as blurry vision (retinopathy) or foot pain (neuropathy).

If you’re experiencing any of the type 2 diabetes symptoms, please contact your healthcare provider immediately for medical evaluation.

Diabetes risk factors for developing type 2 diabetes include:

Over time, high blood glucose levels can cause damage to virtually every organ system of the body, including:

Achieving good control over blood glucose levels with insulin and healthy lifestyle changes is the best way to prevent or slow diabetes-related complications. The United Kingdom Prospective Diabetes Study (UKPDS), a ten-year study of over 5,000 patients with newly diagnosed type 2 diabetes, found that the diabetes-related complications of retinopathy, nephropathy, and neuropathy were reduced significantly in study subjects with type 2 diabetes who practiced intensive blood glucose control (i.e., a median HbA1c of 7%).

In addition, for every percentage point reduction in HbA1c (a blood test that measures the three-month average of blood glucose levels), study participants achieved a 35% reduction in the risk of complications. The UKPDS also found that aggressive control of high blood pressure significantly reduced cardiovascular complications and diabetic retinopathy in people with type 2 diabetes.

Research studies have found that lifestyle changes can prevent or delay the onset of type 2 diabetes among high-risk adults. These studies included people with IGT and other high-risk characteristics for developing diabetes. Lifestyle interventions included diet and moderate-intensity physical activity (such as walking for 2 1/2 hours each week). In the Diabetes Prevention Program, a large prevention study of people at high risk for diabetes, the development of diabetes was reduced 58% over 3 years.

Studies have also shown that medications have been successful in preventing diabetes in some population groups. In the Diabetes Prevention Program, people treated with the drug metformin reduced their risk of developing diabetes by 31% over 3 years. Treatment with metformin was most effective among younger, heavier people (those 25-40 years of age who were 50 to 80 pounds overweight) and less effective among older people and people who were not as overweight. Similarly, in the STOP-NIDDM Trial, treatment of people with IGT with the drug acarbose reduced the risk of developing diabetes by 25% over 3 years. Other medication studies are ongoing. In addition to preventing progression from IGT to diabetes, both lifestyle changes and medication have also been shown to increase the probability of reverting from IGT to normal glucose tolerance.

To learn more about diabetes go to the award-winning diabetes site www.dLife.com.