One name, two diseases.
Diabetes, or simply high blood sugar, is a chronic, progressive metabolic condition. There are three main types of diabetes, but for the purposes of this article, we will discuss only the two most common types.
In type 1 diabetes, for some reason the pancreas fails to produce enough insulin. You can think of it as not having a key, the key being insulin. Type 1 diabetes is also called “Juvenile Diabetes” because it is usually diagnosed in childhood, although it was recently discovered that more than 40% of cases of type 1 diabetes occurs after age 30 as well. This means that adults presenting with diabetes symptoms can be misdiagnosed as having type 2 diabetes, which can delay treatment.
On the other hand, in type 2 diabetes, the pancreas may still produce insulin, but the body, specifically the muscle cells, don’t respond to it. Think of it as having a broken lock, the lock being the insulin receptors on the muscle cells. About 96% of all diabetes cases are type 2.
To understand what happens in a body with diabetes, it’s important to know what happens in a healthy, normal body.
Sugar, which comes from carbohydrates, is the body’s energy currency. When you eat carbs, enzymes in your saliva and pancreas work together to break them all down into its simple form called glucose. After this digestive process, glucose goes through the liver and is eventually absorbed into the bloodstream. As soon as glucose enters the bloodstream, the pancreas senses its presence and immediately sends out insulin.
Insulin is a hormone made by the beta cells in the islets of Langerhans of the pancreas. This hormone is essentially a key that unlocks the gates of the cell to allow all the glucose to enter for use in energy production. Unused glucose is then used to build muscles or stored as fat.
Normally, most of the glucose goes inside the cell, but 5% stays behind in the bloodstream and is converted to another sugar that is capable of mutating the proteins of the blood vessels. With both types of diabetes, glucose builds up in the bloodstream and can’t be used for energy production.
The hallmark of type 1 diabetes is the destruction of the pancreatic beta cells. It has been found to be caused by an autoimmune response against the beta cells. What this means is that the body’s immune system develops antibodies against the beta cells and attacks them as they would a virus or a bacteria.
There are as many as 50 genes associated with the development of type 1 diabetes. Some of these have a direct effect on the insulin-producing beta cells, like the Human Leukocyte Antigen which is responsible for at least 50% of a person’s risk and antibodies against glutamic acid decarboxylase 65, which is present in 80% of people with type 1 diabetes.
The autoimmune process often starts in infancy, peaks at nine months of age, and remains asymptomatic until 80 to 90% of the beta cells have been destroyed. Because autoimmunity develops very early in life, it is almost impossible to prevent unless we somehow found a way to realistically develop a vaccine.
A child who has only one type of antibody may never develop the disease. On the other hand, a child who tests positive for multiple antibodies has a lifetime risk of 100%.
Other risk factors:
- Infections. Infections caused by viruses including mumps, human enterovirus, and rubella have been associated with beta cell autoimmunity. Early upper respiratory infections can also significantly increase a child’s risk for type 1 diabetes.
- Race and ethnicity. Caucasians in the United States and Northern Europe have the highest rates of type 1 diabetes. On the other hand, East Asians have the lowest risk.
- Early diet. Infants who are fed with cow’s milk have been found to have higher levels of anti-insulin antibodies. Infants who are not breastfed also have a two-fold risk of developing type 1 diabetes.
- Family history.
- Geographic location. People living in northern latitudes are at higher risk for developing type 1 diabetes. It’s been suggested that the lack of vitamin D has something to do with this.
The hallmark of type 2 diabetes is insulin resistance. But for full-blown type 2 diabetes to happen, insulin resistance must be accompanied by inadequate insulin levels. For example, even though all overweight and obese individuals have insulin resistance, diabetes will only develop in those who cannot compensate for their body’s resistance to insulin by increasing insulin production.
So, what are the major risk factors for type 2 diabetes?
- Obesity. Affecting approximately 90% of all diabetics, obesity (>120% of normal weight) is the largest contributor to type 2 diabetes risk, for one reason. Obesity almost always comes with chronic low-grade inflammation. Put simply, chronic inflammation and inflammatory proteins inhibit the insulin signaling activity, which prevents glucose from going inside the cells.
- Diet. Independent of obesity, a high-calorie diet increases the risk for type 2 diabetes by as much as 60%.
- Low birth weight
- Race. Type 2 diabetes is more common among African Americans, Asian Americans, American Indians, Mexican Americans, Polynesians and Native Hawaiians, partly because they are also more likely to be overweight.
- Lack of exercise.
- Age. Type 2 diabetes usually affects individuals aged 40 and above, but is currently becoming more prevalent among the young.
Both types of diabetes have similar symptoms resulting from high blood sugar levels.
- Increased hunger
- Increased thirst
- Fatigue and weakness
- Increased urination
- Increased susceptibility to infections
- Blurry vision
- Poor wound healing
- Symptom onset: Although they share similar symptoms, each type presents very differently. People with diabetes remain asymptomatic for 4-7 years as type 2 diabetes develops only after the beta cells can no longer compensate for the insulin resistance. This means that some people may never experience any symptoms until they develop complications like heart disease, eye damage and kidney disease.
- Type 1 diabetes develops over several years, but the disease and its symptoms can progress from bad to worse real fast, sometimes over the course of days to weeks. Type 1 diabetes often presents as Diabetic Ketoacidosis.
- Weight loss: Another difference is that type 1 diabetes presents with weight loss, while type 2 diabetes presents with weight gain at the time of diagnosis.
- Acanthosis nigricans is a darkening of the skin and neck folds associated with type 2 diabetes
- Age: Type 1 diabetes develops in people below age 40.
- Antibody testing: Testing for antibodies against beta cells, insulin and glutamic acid decarboxylase 65 has a 90% diagnostic accuracy for type 1 diabetes.
- Glucose clamp procedure: Gold standard test for type 2 diabetes. However, this test is labor-intensive and expensive, and is use by most institutions for research purposes only.
- Diet: There’s really no officially recommended diet for type 1 diabetes. The best you can do is follow a well-balanced diet that includes 45% carbohydrates from whole grains, fruits and vegetables, 20% protein from lean meats and 10% fat from fish, seeds and nuts. However, if you are overweight (which is rare if you have diabetes), you are recommended to restrict caloric intake to 10 cal per lb of body weight
- Exercise: Moderate aerobic exercise at least 30 minutes 5 days per week. Strength training at least 20 minutes twice per week.
- Insulin therapy: People with type 1 diabetes will require insulin therapy for the rest of their lives. Insulin can be administered through subcutaneous injections on the abdomen or thigh or through an insulin pump.
- Diet: You can see the effects of different diets on type 2 diabetes here.
- Oral medications: Oral antidiabetic drugs, specifically Metformin, are typically the first-line of treatment. Although Metformin has been associated with increase in survival and quality of life, it is contraindicated in those with liver and kidney disease.
- Insulin therapy: When beta cells fail, patients with type 2 diabetes may need insulin shots aside from oral drugs.
- Bariatric surgery: Weight loss surgery appears to effectively treat diabetes and increase survival in obese people.
- Weight loss: Modest weight loss of at least 10% improves heart health, reduces blood pressure,and increases good cholesterol in patients with type 2 diabetes. Benefits are even greater at losses of 15% of body weight.