I’ve often been asked this question by type 2 patients who have to start insulin. This is a reasonable question since for many years when control was not so stringent, type 2 patients rarely used insulin. They managed diabetes with oral medications, dietary changes, weight loss and physical activity. However, years ago we didn’t realize the damage to our bodies as a result of long standing elevated blood glucose values (i.e. eye damage, kidney damage, amputations, heart disease). Some people have told me that I am a "bad diabetic" because I have to use insulin. I so dislike this phrase but rather than appearing annoyed I take it upon myself to explain to them that type 1 diabetes patients must use insulin. In my world, there is no such thing as a "bad diabetic". I hope you all agree.
Today I want to help you understand the causes of type 1 and type 2, the differences and similarities between them and answer the above question.
There are many forms of diabetes such as diabetes during pregnancy but today we will concentrate on type 1 and type 2 since these are the two most common forms.
Diabetes Mellitus (DM) is a metabolic disorder identified by hyperglycemia. In type 1 diabetes, our body attacks the cells in the pancreas that make insulin. For this reason, it is referred to as an autoimmune (the body attacks itself) disease. Survival is dependent on the administration of insulin by some method (needles, pens, pumps). The cause of type 1 is still not known, but researchers seem to think that genetics and environmental factors are involved. Type 1 most often occurs in the younger population (children, adolescents and younger adults) but, in fact, it can develop at any age.
Type 2 accounts for about 90% of the diabetes population and usually occurs in middle aged or older adults. In type 2, the body is unable to use its’ own insulin the way it should, and this leads to higher glucose levels in the bloodstream and over time, the pancreas can no longer produce enough insulin to meet the needs of the body. The end result is high blood glucose levels. Remember, insulin is the key that takes glucose from the blood and moves it into the cells so the cells can use it for energy. Take a minute to watch this video to learn more. For this reason, type 2 is referred to as a condition known as “insulin resistance”. One comparison may be a car battery. You can only boost it so many times until you have to replace it. Oral medications could be considered the boost to the pancreas and finally we need insulin as a replacement.
There are many treatment options for type 2 diabetes such as synthetic drugs, physical activity, healthier diet, and if required losing weight. The activity will use up the glucose in the blood, the dietary changes would include less carbohydrate foods (that break down into sugars) or smaller portions at meal times and losing some weight will help make the body more sensitive to the insulin that is being produced and thus the insulin resistance decreases. You may be surprised what a difference even the loss of 5 kg (11 pounds) can make. Ask for a referral to a dietitian who can help you in making wiser food choices to meet the nutritional needs of your body.
I said that many options are available for type 2 management. Along with a healthier lifestyle as mentioned above, there has been an explosion of diabetes medication approved the last few years. These medications work by various actions such as : 1) increasing insulin sensitivity and reducing the production of glucose by your liver 2) some make the pancreas work harder to push out that last little bit of insulin and 3) some increase the amount of sugar that is excreted in the urine. There are others that work differently and you will see these on this table taken from the Diabetes Canada guidelines.
When the doctor is prescribing your medication they take into consideration such factors as:
1. Your own preferences and the goals you have, age and life expectancy
2. Degree of high blood glucose ( is it 10 mmol/L versus 20 mmol/L at diagnosis)and what are your current symptoms ( excess thirst, increase in urination, etc)
3. Kidney function, eye sight
4. Presence of other health concerns such as heart disease
5. Your eating patterns (do you work shifts, do you drive for 8 hours a day)
6. Your current performance level such as are you living on your own, do you need help with activities of daily living, can you administer injections safely, hand flexibility/steadiness
7. Side effect profile of the medications
8. If you have insurance to cover medication cost
9. If you are on multiple medications already
Every case must be individualized. Luckily there are guidelines published by organizations like Diabetes Canada, The American Diabetes Association, etc to assist health care providers make the best choice. Often a combination of drugs are used to achieve your goals. Some of the new classes of agents have shown to be of benefit for those with heart disease, renal disease or for those who have multiple risk factors for heart disease.
Diabetes is a progressive disease and the body may require insulin injections to act as a supplement to the declining insulin production by the body. If you ever need to start insulin, please DO NOT THINK YOU HAVE FAILED or should it been seen as a setback. Most often the insulin is an add on to the medications you are already taking. It may seem overwhelming but keep in mind these drugs are working in a special way in the body to help you live a better life and reduce the risk of diabetes complications.
By now you realize that type 2 diabetes even with insulin use is not considered to be
type 1. However with all things in life, there are exceptions. Adults may develop a specific form of type 1 diabetes known as LADA (latent autoimmune diabetes of adulthood). LADA tends to develop more slowly than type 1 diabetes in children and young adults and people could be misdiagnosed as having type 2 diabetes initially.
Some differences between type 1 and 2 include:
The cause for diabetes and age of diagnosis
Risk factors: for type 1 we don’t know but type 2 we know risk factors include being overweight, ethnicity
Type 1 requires insulin whereas type 2 has more options for management
Type 1 has no cure; type 2 cannot be cured but in many cases it can be prevented and/or reversed
Greater risk for hypoglycemia because of insulin use and the balancing of food, insulin dose and activity in type 1
Similarities between type 1 and type 2 include:
Symptoms such as increase thirst &urination, losing weight, blurred vision
Both require blood glucose monitoring
Both require eating a well balanced meal plan
Physical activity recommended as per health care provider recommendations
Development of long term complications
Many people have told me that they refused to start insulin when the physician recommended it but now that they have started they feel so much better and wonder why they didn’t start sooner. Each individual affected by diabetes will have their own reason and we as health care providers need to listen to what our patient is saying. Likewise, as a patient your health care team’s goal is to provide you with a better quality of life and avoid complications so if the discussion starts, please don’t dismiss it but give it some serious thought.
Happy Mother's Day to everyone on May 9th, 2021.
I chose this week’s tune from the group The Shirelles which was released in 1961 as a single and hit the top ten list :https://www.youtube.com/watch?v=mzCKwMOyogk
#type1&type2 #type2becomingtype1
References:
Websites included in the above
Diabetes Management: Short Communication 2018 8 (1), 19-21
Personal experience and knowledge
The information in this blog does not replace information or advice from your health care team. It is for information purposes only. Always consult with your health care team before making any changes to your diabetes management.
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