Are All Diabetics The Same?

Copyright (c) 2008 Mountain West Foot & Ankle Institute

To further understand diabetes, it must be understood that diabetes is not a singular condition, but a combination of multiple types of diabetes, all with distinct characteristics and treatment regimens. Often there will be different treatments related to each type of the disease, and you can only understand diabetes by understanding the types.

Type 1 Diabetes

This entity was once called juvenile onset or insulin dependant diabetes. These terms were indicative of the usual diagnosis in children or young adults and the fact that the body fails to produce insulin. Insulin is the hormone the body utilizes to convert sugar (glucose), starches and other foods into energy for the cells of the body. Since the body fails to produce insulin, insulin augmentation is necessary to correctly manage the blood glucose and provide the necessary energy for the body to continue to function. Neither of these terms should be utilized, however, as they have been proven incorrect (children are being diagnosed with Type 2 Diabetes and some Type 2 Diabetics have such poor control that insulin is required).

To understand Type 1 Diabetes, you first need to understand that the body produces insulin primarily in the islet cells of the pancreas. Since this is a failure of a system in the body, it may be seen at any age, but commonly is encountered earlier in life. There are some noted cases of pancreas damage from infections, toxic conditions or injury that have produced this diagnosis, but most cases are considered developmental or genetic. For this reason, newer treatments being utilized involve replacement of the failed systems by pancreas or islet cell transplants.

The common treatments for Type 1 Diabetes are insulin injections or insulin pumps that allow strict management of the blood sugars based on activity level and diet. This has allowed many children and young adults (as well as adults with this form of the disease) to lead fairly normal lives and participate fully in nearly any activity.

Type 2 Diabetes

Type 2 diabetes is by far the most common form of diabetes. It was once called adult onset or non-insulin dependant diabetes, because it was once principally diagnosed in adults and usually didn't require insulin treatment. This is no longer the case, as Type 2 Diabetes is diagnosed at any age and may require insulin to get the necessary control. These terms should therefore not be used.

To further understand Type 2 Diabetes, it must be therefore understood that the body either fails to produce enough insulin or the cells react poorly (or ignore) the insulin. When a food is eaten, the body utilizes insulin to break down sugar (glucose), starches or other foods into energy for the cells. If the cells fail to absorb the necessary energy (due toinsufficient or poorly functioning insulin), the blood sugar increases and the cells are starved for energy.

With this understanding, it should be no surprise that the treatments for Type 2 Diabetes include diet control, medications to decrease liver glucose production, medications to decrease glucose absorption from the kidneys, and medications to increase cell sensitivity to insulin. All treatments are designed to either decrease the blood sugar (glucose) or make teh insulin more effective. When these treatments fail, however, insulin may be added to further assist cells in getting the necessary energy. Transplants of islet cells or pancreas are usually not considered treatments for Type 2 Diabetes.

Other Types

Although Type 1 and Type 2 are the most common encountered forms of diabetes, others that should also be understood include Pre-Diabetes and Gestational Diabetes and will be discussed at a later time.