September 21st, 2011
10:37 AM ET

What's the difference in diabetes?

Every weekday, a CNNHealth expert doctor answers a viewer question. On Wednesdays, it's Dr. Otis Brawley, chief medical officer at the American Cancer Society.

Question from Steve from San Bruno, California:

What's the difference between type 1 and type 2 diabetes?

Expert answer:

First, the formal name for what we commonly call diabetes is diabetes mellitus, which translates from the Greek as making lots of urine with sugar in it or making lots of sweet urine.

Type 1 and type 2 diabetes mellitus are diseases that have in common, sugar in the urine and the increased urination.

When there are high amounts of sugar in the blood, the kidneys filter sugar into the urine. Sugar can be measured in the urine through a lab test commonly called a urinalysis. Urine dipsticks are also used to show sugar in the urine.

Patients who develop diabetes mellitus most commonly have initial symptoms of increased thirst, increased urination and blurred vision due to high amounts of sugar in the fluids of the eye.

Type 1 diabetes results from a rheumatologic-like autoimmune reaction in which one's own body attacks and destroys the beta cells of the pancreas. These are the cells that normally produce insulin. Type 1 is a disease in which the patient in a relatively short time has no insulin production.

All patients with type 1 diabetes can also develop a serious metabolic disorder called ketoacidosis when their blood sugars are high and there is not enough insulin in their body. Ketoacidosis can be fatal unless treated as an emergency with hydration and insulin.

Type 1 was once commonly called juvenile diabetes mellitus because it is most commonly diagnosed in children. It should be noted that even older adults in their 60s have occasionally been diagnosed with type 1 diabetes mellitus.

One should think of it as a disease of high blood sugars due to a deficiency of insulin production. It must be treated by administration of insulin. Insulin is given at least twice a day and is often given four times a day in type 1 diabetes.

Type 2 diabetes rates are growing dramatically in the United States and Western Europe. Type 2 is the result of the muscles and other tissues of the body developing a resistance to insulin produced by the beta cells of the pancreas. The pancreas first tries to overcome this resistance to insulin by making more insulin. The blood sugar goes up as a patient's body is no longer able to make enough insulin.

Most patients with type 2 diabetes mellitus are overweight or obese. For most, but not all, maintenance of a normal weight and a good diet will prevent development of type 2 diabetes.

Most type 2 diabetes is diagnosed after age 40. For this reason, many have referred to type 2 as adult-onset diabetes mellitus. This latter name has lost favor as the obesity epidemic has caused a number of people to be diagnosed with type 2 as early as 10 or 11.

Type 2 can often be treated with diet modification and can improve significantly with weight loss and exercise. Some patients will be effectively treated with medications such as metformin that increase peripheral sensitivity of organs to insulin.

Still more severe disease will require oral medications that encourage the pancreas to make more insulin such as glyburide or glipizide Some patients with even more severe type 2 disease are treated with subcutaneous injections of insulin.

The higher amounts of insulin in the body overcome the peripheral resistance to insulin and bring blood sugar levels back toward normal range. In a few type 2 patients, years of insulin overproduction cause the beta cells to burn out and stop making insulin. These patients can develop ketoacidosis just like the type 1 diabetic, and they must be treated with insulin injections.

The result of both long-term type 1 and type 2 diabetes mellitus is end-organ damage. Patients can develop blindness, kidney failure and vascular disease.

The blindness is due to diabetic retinopathy in which additional blood vessels grow into the retina of the eye. The vascular disease can manifest itself as decreased blood flow to the feet leading to foot sores, ulceration and infection requiring leg amputation. Vascular disease can also lead to heart attacks and strokes.

All of these complications are best delayed through good blood sugar control.

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soundoff (30 Responses)
  1. ann

    "All of these complications are best delayed through good blood sugar control."

    It was my understanding that so long as good blood sugar control was maintained, then the complications weren't just delayed but were put back on the same level as someone who doesn't have diabetes so long as they continue to maintain said blood sugar control.

    Are you suggesting that they will have the complications eventually no matter what?

    My husband has had type 1 diabetes since he was 13 (he's 33 now). So I would definitely like to know the answer.

    September 21, 2011 at 11:53 | Report abuse | Reply
    • Flo

      Ann – I too am a type 1, diagnosed at age 7 and am now 41. I was taught that the tight control would mean no complications, but in my late 20s I developed diabetic retinopathy even though my A1Cs were always within/below normal limits. I found that very discouraging as i had been doing all the right things for so many years. I feel that the complications are inevitable, much like my late father's doctor told him, "if you live long enough, you'll develop diabetes." Which he did, long after I had. He was a perfectly healthy guy whose only bad thing was smoking, which he gave up about 10 years before he died when he lost his vision due to macular degeneration...the doctor said my father was a perfect example of the body catching up with you and deteriorating. Anyway, I still take care of myself like doing so will completely prevent the complications, but to some extent, I've lost faith that doing so will prevent them. Now I guess I look at it more as "it is what it is," and I will take care of myself because I'm sure it would be worse if I didn't.

      September 21, 2011 at 13:02 | Report abuse |
    • Lucy

      Hi Ann and Flo – I have been a type 1 diabetic for 15 yrs (since I was 10 years old). The statistic I've heard is that after 20 years of having type 1 diabetes, 99% of type 1s will have some form of retinopathy, and that included people with both dozens of spots in their retinal blood vessels and people who had just one. However, retinopathy can heal on its own as long as blood sugars can be managed (I no longer use the word "control" because I feel it implies the diabetic has more authority over their body than is real or possible), so my dr. told me not to feel like I failed for having a couple spots of retinopathy because it is just a normal part of being type 1! The more severe issue of blindness caused by retinopathy may result from prolonged periods of high blood sugars, which is the same thing that causes kidney and heart damage in type 1s. Thus, some complications, like minor retinopathy are a normal and expected part of being type 1, where as the more severe complications may in fact, as Flo said, be avoided all together if blood sugars are well managed. Don't be discouraged! It's a hard disease and every type 1 is brave for living day-to-day with such a tough disease, even if they can't perfectly manage it all the time.

      September 21, 2011 at 13:32 | Report abuse |
    • Jason Glugla

      I am 44 and have had type 1 since I was 10. I was in very good shape until roughly 2 years ago when I got hit with Hodgkins disease. If you do plenty of exercise, monitor the sugar levels closely and get regular opthalmological exams, chances are good to prevent complications. I know it is hard but try not to get depressed.

      September 21, 2011 at 14:48 | Report abuse |
    • Mike R - Type 1 24 yrs

      Hi Ann. Both statements are correct. Good control delays complications. Good control can also reverse complications. However, a diabetic who is in good control will still experience some moments of higher than normal blood sugars. All of these little moments add up over time. If a diabetic is showing early signs of retinopathy or microalbumulin in the kidneys and is running A1c's >8, several months of an A1c in the <7 range can very likely reverse those early symptoms. However, even if I kept my A1c <6, that doesn't mean I never have high blood sugar...it just means that over time my blood sugar levels are balancing out. And as I mentioned earlier, even those few moments of high blood sugar, rare as they may be, still add up and cause damage in the long haul.

      September 21, 2011 at 23:50 | Report abuse |
    • mybustedpancreas

      Unfortunately, with regard to type 1 diabetes, there is still a lot that is unknown when it comes to the development of complications. As a type 1 for close to 30 years, I know this all too well. While the correlation between A1Cs and complications is fairly evident in type 2 diabetes, the correlation is not as well established among type 1s. This is because the autoimmune form of diabetes (type 1) results in the production loss of other hormones – specifically, amylin and c-peptide (type 2s still produce these hormones). While these hormones are not necessary for immediate survival the way insulin is, it is suspected they play a role in preventing micro- and macro-vascular damage, which is basically the result of most diabetic complications. So, type 1s who lose these hormones because of the autoimmune destruction of the beta cells could be destined to develop complications, regardless of how "good" their A1Cs are.

      This is not to say that we type 1s should throw "good control" out the window. Keeping blood sugar levels within acceptable range does help prevent complications, but it won't totally prevent them. And this is where I get frustrated – when type 1s develop complications, the first thing people seem to assume is that their "control" wasn't good. Well, let me tell you, being a pancreas is hard, if not impossible, work! It's virtually impossible to manually keep blood sugar levels in "normal" range.

      Sadly, it seems that research into cures and treatments for type 1 has slowed down immensely, largely due to the overwhelming increase in type 2 diabetes (a condition that is largely preventable). Drug and device manufacturers are putting a lot of effort into developing treatments for type 2 because that's where the money is. While type 1 has increased over the years, the increas is NOTHING like that in type 2.

      September 26, 2011 at 09:09 | Report abuse |
    • teresa


      October 17, 2011 at 22:42 | Report abuse |
    • What are diabetes

      You are right. Healthy diet with proper live style can delay a diabetes for so long.
      What are diabetes

      January 12, 2012 at 10:54 | Report abuse |
  2. Julie

    I have a 4 yo with Type 1 and at a recent JDRF event I attended they mentioned that recent studies are suggesting that for individuals with type 1, genetics plays a huge part in the severity of complications. They are finding that as Flo stated above, some people with good control can develop terrible complications while some people with terrible contol have minimal complications. It seems to be dependent on both your genes and how well controlled your BG's are. Guess we just have to do the best to control what we can and find a way to accept what we can't control. Good luck everyone.

    September 21, 2011 at 13:34 | Report abuse | Reply
  3. Nelle

    All- you need to read and listen to Dr. Richard Bernstein, author of The Diabetes Solution. He also has a website. He is a type 1 almost 80 years old and has had diabetes since the 1940s. He will tell you that what most Drs and the American Diabetes Association will tell you is a "normal" A1C is NOT. You should be aiming for an A1C under 5. Then you won't have the complications.

    September 21, 2011 at 15:48 | Report abuse | Reply
    • Michael

      I am sorry to disagree with you Nellie and with the mentioned doctor, but I have lived with an AIC below 5, and it was not good. My blood sugars were too low all the time, I was having medics in my home often (they knew me by name) Most days during this time I was lucky to have my blood sugars to 80. This experience was very dangerous at those levels. My lowest range was 4.2. I am now at about 6.0 and have no problems. Just for the record, I am a type 1 with 36 years under my belt, and no complications at all.

      September 21, 2011 at 16:14 | Report abuse |
    • MommyMD

      I have only been diabetic for 9 years (misdiagnosed as gestational, then type 2, before we figured out it was type1), but I know that an A1c of 5 will kill me a lot quicker than an a1c of 10 or higher. The lows scare me more than ANYTHING with this disease. Even DKA can be caught pretty early if I check often, but with really tight control, a drop to <30 can happen in minutes without warning and if I'm stuck somewhere without my glucagon or food or someone who know me or god forbid asleep. I might not recover from that.

      October 25, 2011 at 19:23 | Report abuse |
  4. Roger

    I have been a type-1 diabetic for about 25 years and I'm now 40. I have had my A1C under fairly good control (< 7) for most of the past several years. I was in another country before that and didn't do my A1C tests regularly although I was eating healthier food and doing more exercises there. I was diagnosed with a mild retinopathy a couple of years ago. I very occasionally have nerve pain in my feet and that started a couple of years ago too. I recently suffered some gastric problems (indigestion, belching, bloating, nausea etc) and my GI thought it was gastroparesis (aka stomach paralysis) which has no cure or treatment and in most cases the patient would have to resort to liquid food. My heart sunk when I heard that but, I was asked to undergo Gastric Emptying Test and thankfully that came back negative. I also underwent an endoscopy and turned out it was some bacterial infection of some sort. My stomach problems seem to have disappeared after taking antibiotics. But, my doctor still thinks it might be GP because he says GP is very common in long term type-1 diabetics. I'm hoping he's wrong but only time will tell. I wake up every day fearing if today is that day GP hits me. But, I still have a little hope that the cure for type-1 (BCG) will come through within the next 3 years even though my gut feeling says this multi-billion dollar industry could not be shutdown so easily.

    September 21, 2011 at 15:59 | Report abuse | Reply
    • Christina

      @Roger – I have been Type 1 for 14 years. I was diagnosed when I was 14 so in addition to standard teenage rebellion, I rebelled against my diabetes. I rarely checked my sugars, ate whatever I wanted. Because of it my A1C's were awful, as high as 12.5. I was diagnosed with gastroparesis only 4 years after my diabetes diagnosis. It was terrible to deal with at the time, but I've since gotten my sugars in much better control and I very rarely experience the GP symptoms. I really only notice it when I've been running a little high and I have a huge meal. Just wanted to let you know that you don't have to go on a permanent liquid diet if you are ever diagnosed with GP. Keeping good sugar control and small, frequent meals has worked for me. Hope that helps!

      September 23, 2011 at 17:09 | Report abuse |
  5. Daniel

    please understand that something caused DM type 1 to happen, the article points to the underling rheum. disorder to attack the pancreas beta cells. While keeping A1C less than 6.5 will help, patients with DM type 1 still have underlying conditions with their autoimmune system that may cause problems. Also, note that A1C is a 90 day average, it does not record spikes or troughs. Diabetes is a very complicated condition, and with type 1 sugar may only be the tip of the iceburg that we see.

    September 21, 2011 at 17:54 | Report abuse | Reply
  6. Travis

    My son was diagnosed type 1 a little over a year ago and is now 3 years old. It's frustrating to know that he may have a lot of trouble as he gets older. I hope that more advances will be made soon. I can't stomach the thought of outliving my son because of this horrible disease!

    September 21, 2011 at 18:29 | Report abuse | Reply
  7. Alicia

    I have had Type 1 for (almost!) 25 years and I am 29 years old. Back in the days of NPH and Regular, good control in a child was not easy to come by. I grew up having relatively ok control but I had an endocrinologist that told my parents that the best thing they could do for me is to not make me feel different, to let me play tons of sports and be in a bunch of activities, and try to keep me in the best control possible. That has been a lifesaver for me. My A1C as an adult has been good (typically <6, sometimes a tad higher around 6.1, 6.2), and I am active. Other than a few spots in my eyes, I am good. The most frustrating thing is when I let people know that I am diabetic- having them tell me that I am not fat, and if I change my diet, I can be cured. Sure. Then I have to launch into a diatribe on what T-1 is vs T-2. Articles like this at least help people understand the difference. Although most Type 1s I know are carb-counting and on multiple daily injections, and aren't simply injecting insulin 2-4 times a day. Or they are on a pump

    September 21, 2011 at 21:20 | Report abuse | Reply
  8. annie

    I have had Type 1 for 35 yrs. and being part rabbit was shocked to hear I had to have a bypass. I have gastroperesis and it is brutal. I also have neuropathy but my eyes are good. This is not a pleasant disease to have and I too get frustrated when people don't know the difference between Type l & Type 2. The gastroperesis makes it very difficult to control blood sugar levels and I check 6 – 8 times a day. But, having sugar too low makes it hard to do anything without having a reaction and now I understand, too many lows can cause brain damage. My doctor says (and I know they all say differently) that 6 is too low and I should aim for a 7 AIC

    September 21, 2011 at 23:37 | Report abuse | Reply
  9. Bryan

    While I appreciate an article that at least distinguishes the two major types of diabetes, I have to ask: Couldn't CNNHealth have asked a specialist in endocrinology to field this question, rather than an oncologist? While this article did at least distinguish the two conditions, it really didn't go beyond that. Honestly, it looks like it came from a basic guidebook or manual, and it's information on treatment, while not wrong, is behind the times by at least a decade. Alicia nailed it: most Type 1s are managing their diabetes with carb-counting and MDI or pumps. BTW, Julie, I've heard the same arguments (that genetics seems to play a role in complications); also, according to UCSF, good control for the first two years after diagnosis reduces complications overall, as does good control beyond that point.

    September 22, 2011 at 01:39 | Report abuse | Reply
  10. Devin

    Given the huge volume of clinical evidence in support of hypnosis for medical conditions in general, it is sad that medical professionals have not considered the benefits of hypnosis for diabetes. But alas, so many people have a knee-jerk response to something they know nothing about which is a shame. Someday science will catch up.

    September 23, 2011 at 13:58 | Report abuse | Reply
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  13. Ladawn Nakamatsu

    Unlike people with type 1 diabetes, the bodies of people with type 2 diabetes make insulin. But either their pancreas does not make enough insulin or the body cannot use the insulin well enough. This is called insulin resistance. When there isn't enough insulin or the insulin is not used as it should be, glucose (sugar) can't get into the body's cells. When glucose builds up in the blood instead of going into cells, the body's cells are not able to function properly. ;-,`

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