Understanding the Different Types of Diabetes
Knowing what disease you have is the first step to managing it.
By Ilana Prior
dLife Contributing Writer
Receiving a diagnosis of diabetes is, in itself, bewildering enough. Not understanding whether you have type 1 or type 2 – or something in between – makes that diagnosis even more confusing. Whereas we used to refer to type 1 as "juvenile onset" and type 2 as "adult onset", those easy age-based distinctions no longer hold up. We now know that type 1 diagnosis can occur at any age; are seeing an increasing number of type 2 diagnoses in children; and have learned that more than just two types of diabetes exist. However, due to a better understanding of how the disease affects the body on a cellular level, we can still distinguish between the different kinds of diabetes. Read on to find out more. Understanding your disease is the first step you can take toward managing it!
Type 1 diabetes is an autoimmune disorder. The immune system is responsible for protecting us from disease. It does so by identifying and destroying foreign bodies, such as infectious agents and unwanted bacteria. However, the immune system is not always able to differentiate between ‘good' and ‘bad' cells. Autoimmune diseases occur when the immune system mistakes the body's tissues for foreign bodies and attacks the body's own cells. Abnormal antibodies in the bloodstream are usually responsible for these cases of "mistaken identity." In type 1 diabetes, the immune system attacks and destroys the insulin producing cells – called beta cells – of the pancreas. Due to this attack, the beta cells gradually lose the ability to produce insulin. Without insulin, the body is unable to use glucose for energy.
Because type 1 diabetes is autoimmune, the majority of people with type 1 have antibodies for the cells of the pancreas in their bloodstream. About 70-80 percent of people with type 1 have an antibody called the GAD65 antibody. Many also have an antibody called the islet-cell antibody (ICA). A blood test can determine whether or not these antibodies are present.
Type 2, however, is not now considered autoimmune. Instead, type 2 diabetes develops as a result of the body incorrectly making or using insulin.
To understand how the body incorrectly uses insulin in people with type 2, you must first understand how the body correctly uses insulin. Metabolism is the process by which glucose, consumed as food, is turned into energy that is useful for the body. In a normally functioning metabolic system, the ingestion of food signals the pancreas to release insulin into the bloodstream. This insulin, in turn, signals liver, muscle, and fat cells to take up glucose from the bloodstream. The glucose is metabolized to provide the body with the energy it needs.
In people with type 2, however, this process does not function as intended. Type 2 diabetes is characterized by the jointly occurring dysfunction of this metabolic process and of beta cells. In people with type 2, the liver, muscle, and fat cells become "resistant" to insulin, meaning that these cells need increasing amounts of insulin to respond to the insulin's signal. To compensate, the pancreas begins producing more and more insulin every time food is consumed. However, the pancreatic cells in people with type 2 diabetes are not able to produce enough insulin, both because of the high demands of the liver, muscle, and fat cells and because of beta cell death. About 90 percent of people with type 2 have some degree of beta cell death at the time of diagnosis. Beta cell function continues to decline over time, leading to progression of the disease and its symptoms. When the pancreas is no longer able to produce enough insulin, glucose is not taken up out of the bloodstream to be metabolized into energy. This causes blood sugar levels to rise.
- 1 – American Diabetes Association. Standards of Medical Care in Diabetes – 2012. http://care.diabetesjournals.org/content/35/Supplement_1/S11.full. (Accessed 4/12).
- 2 – Bagust A, Beale S. (2003). Deteriorating beta-cell function in type 2 diabetes: a long-term model. QJM: An International Journal Of Medicine 96(4).
- 3 – Centers for Disease Control and Prevention. Diabetes: success and opportunity for population-based prevention and control at a glance 2011. http://www.cdc.gov/chronicdisease/resources/publications/AAG/ddt.htm. (Accessed 5/12).
- 4 – Gebel E. (2010). The other diabetes: LADA, or type 1.5. Diabetes Forecast.
- 5 – Imran S, Ur E. (2008). Atypical ketosis-prone diabetes. Canadian Family Physician 54.
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I had a work dinner last night with some leadership from my office. I always find diabetes etiquette at these things to be kind of tricky. It was a four course meal, with salad, soup, entree' and dessert and coffee. There was also a selection of gluten free and non-gluten free dinner rolls. I felt way too full of questions for waitress... "Could I get my dressing on the side? How much sugar is in it?" A course later...