Type 2 vs Type 1 Diabetes. Endocrinologist Review

Type 2 vs Type 1 Diabetes

Type 1 diabetes is a result of the destruction of beta cells versus type 2 diabetes is a combination of insulin resistance and destruction of beta cells.
Type 1 diabetes: Patients are positive for autoimmune markers such as certain antibodies vs Type 2 diabetes: There are no associated autoimmune markers for type 2 diabetes.
Type 2 diabetes: Insulin deficiency is relative versus type 1 diabetes insulin deficiency is absolute.
Type 1 diabetes: Patients are totally dependent on insulin versus type 2 diabetes: Total insulin dependency happens at very later stages of type 2 diabetes.
Type 2 diabetes: There are more than 80 different diabetic medications to treat versus type 1 diabetes: Patients can only use insulin, glucagon, and Symlin( pramlintide).
Type 1 diabetes: DKA (diabetic ketoacidosis) happens fairly frequently with insulin deficiency versus type 2 diabetes: DKA is very rare.
Type 2 diabetes: Patients tend to be overweight or obese versus type 1 diabetes patients are not overweight or obese most of the time.
Type 1 diabetes: Patients may have associated autoimmune disorders such as Hashimoto’s thyroiditis, celiac disease, or adrenal insufficiency versus type 2 diabetes: There is no association with other autoimmune disorders.
Type 2 diabetes: Low blood sugars (hypoglycemia) are not as common unless patients are on insulin or sulfonylurea versus type 1 diabetes hypoglycemia risk is much higher.

So, you may have a new diagnosis of diabetes or maybe you had diabetes for a few years now. You are still not sure what type of diabetes you have. Doctors also do not give a clear answer most of the time. So, how do you know you have type 1 versus type 2 diabetes. Are there any other types of diabetes? In today’s article, we will review type 1 versus type 2 diabetes in detail. This article is written by our lead endocrinologist/diabetes specialist Dr. Ergin.

Why does it matter to know the difference between type 1 versus type 2 diabetes?

Knowing the difference between type 2 diabetes versus type 1 diabetes makes all the difference. When you have type 1 diabetes you know that you are totally insulin-dependent. You know that your beta cells that make insulin are almost totally destroyed. You know that if you do not take your insulin you may end up with diabetic ketoacidosis. Diabetic ketoacidosis is a very dangerous and potentially deadly problem that patients with type 1 diabetes face. So patients with type 2 diabetes are not free of risk or danger either. But knowing that you have type 2 diabetes versus type 1 diabetes will give you a relative relief. When you have type 2 diabetes you have more time to work on your lifestyle, eat better, and exercise. You can start taking maybe 1 pill at first and then try to keep the number of medications to the least. There are many endocrinologists/diabetes doctors yet all are very busy. Our online diabetes doctors are always available and on your side. We provide on-Demand diabetes care.

What is relative insulin deficiency?

As we discussed above shortly, type II diabetics are relatively insulin deficient. Actually patients with type 2 diabetes have a lot of insulin compared to a person with no diabetes. However, the real problem with patients with type 2 versus type 1 diabetes is insulin resistance. When there is insulin resistance, our body requires much more insulin in order to do the same job. Insulin’s job is to help cells take the glucose in. However, due to the insulin resistance, those receptors stopped being responsive to the insulin. As a result, more insulin is necessary to overcome resistance. Eventually, our body starts giving up on insulin production and insulin resistance starts dominating.

Once insulin resistance is so high and insulin production is not enough diabetes happens. Again, patients with type 2 diabetes have a lot of insulin in their system. On the other hand, due to excessive insulin resistance, there is a high level of insulin may still not be enough. Diabetes happens when insulin is not enough anymore to keep blood sugars down. Our endocrinologists/ diabetes doctor will always be near you by communicating with you whenever you need it. Our goal is to guide you to stop diabetes.

Why do some overweight people develop diabetes but not others?

Although insulin resistance has a genetic component, the insulin production capacity also is genetically determined. As a result person, a may have the capacity to make enough insulin to overcome the same insulin resistance compared to person B. That brings us to the family history. If you have people in your family with diabetes you are going to be a high-risk patient for developing diabetes. Meaningly, if you become insulin resistant your body may not be able to keep up with the insulin you need to overcome the insulin resistance. An experienced endocrinologist can help you eliminate or reduce insulin resistance.

Why do patients with type 2 diabetes need insulin?

That is a good question. We said that type I versus type II diabetic patients are different in terms of their insulin needs. Patients with type 1 diabetes are totally insulin-dependent. Patients with type 2 diabetes are not insulin-dependent until later stages.

Moreover, diabetes is a progressive disease. Remission for diabetes is definitely possible by reducing demand. That demand is dietary sugar and our body weight. Most people can achieve diabetes remission if they can reduce the carbohydrates in their diet significantly or totally. On the other hand in the long-term due to the genetic insufficiency of making enough insulin and the return of insulin resistance diabetes may and will come back.

Like any other organ, our pancreas makes insulin also get older. As a result, insulin production capacity goes lower and lower. Even if insulin resistance did not get worse when insulin production goes down diabetes will still progress. This may not happen within a few years but it will happen in decades. Eventually, if it patient with diabetes live long enough he or she will become insulin-dependent. When someone with type 2 diabetes become insulin-dependent depend on many different factors. Their diet, diet, and exercise habits, the medication they are on and their genetic composition will determine the outcome.

Type 1 vs type 2 diabetes. Why cannot type I diabetic patients use medications that type II diabetics use?

That is a good fundamental question. The answer to this relies on the pathology of diabetes. Most medications that we use for type 2 diabetes work on beta cells. Since the majority of beta cells are dead, type 1 diabetes medications designed for type 2 diabetes will not be appropriate for patients with type 1 diabetes. Our diabetes doctors/endocrinologists may choose to use some medications off-label if they will that type 1 diabetic patient developed insulin resistance.
Insulin as the fundamental medicine will work for both type I and type 2 diabetes.

Why does DKA happen to patients with type 1 diabetes more frequently than type 2 diabetes?

Again, when we are talking about type I versus type 2 diabetes we are talking about a fundamental difference which is the presence or absence of insulin. When there is no insulin in the body our body starts making ketone bodies. Also, patients on the keto diet can also make ketone bodies. Yet, they still have some insulin in their system.

Patients with type 1 diabetes start making ketone bodies in an excessive manner due to prolonged lack of insulin. This prolonged lack of insulin could only be hours not days. The ketone bodies are acidic. They change body pH. PH of our body is very tightly regulated. Any minor changes in the pH can cause devastating consequences. So it is imperative for patients with type 1 diabetes to continue to take their insulin as instructed. Sometimes patients with type 1 diabetes may get sick. During sickness insulin requirements may change. During those times type I diabetics are at high risk for DKA.progress and be available at all times.

Are all type II diabetics overweight and all type I diabetics skinny?

Absolutely not. We just have general phenotypic features when we examined patients on the other hand that is not a rule. We see a lot of patients with type 1 diabetes who in time start gaining weight due to excess calories and insulin which eventually leads to insulin resistance.

Whereas, some patients with type 2 diabetes are not overweight however their insulin production capacity is much lower. So as a result, their insulin resistance that is lesser magnitude can still cause diabetes in those normal-weight patients. We sometimes diagnose them with type 1.5 diabetes. That is because they are not as insulin deficient as type I diabetics but they are also not as insulin resistant like type II diabetics. They are in between.ent progress and be available at all times.

Will I have thyroid disease or adrenal insufficiency if I have type 1 diabetes?

There is definitely an increased risk of Hashimoto’s thyroiditis, adrenal insufficiency, and celiac disease in patients with type 1 diabetes vs type 2 diabetes. As a result, our endocrinologist ( doctors who treat diabetes) do yearly screenings for these disorders to make sure we diagnose them before they become severe. On the other hand, type II diabetic patients compared to type I diabetic patients are not at high risk for autoimmune disorders. So no screenings are necessary for them.

Why is low blood sugars are more frequent in type 1 versus type 2 diabetes?

The more insulin patient is exposed to the higher the chance of low blood sugar. Remember, patients with type 1 diabetes are on insulin only. They take insulin injections 3-6 times a day. Taking long-acting insulin such as Tresiba, Toujeo, Levemir, Lantus, and short-acting insulin such as NovoLog, Humalog, Fiasp together increases the risk of low blood sugars. On most occasions, patients with type 2 diabetes are on basal insulin only or only on oral agents such as metformin. Even when type II diabetics are on multiple daily injections just like type I diabetics the chances of low blood sugar are still low due to their insulin resistance. Insulin resistance definitely reduces the risk of low blood sugar.

Now you have a good idea about type 1 diabetes versus type 2 diabetes. I would suggest checking sugarmds.com to now take control of your diabetes, reduce the number of medications, or even go into remission with diabetes. Our experienced endocrinologist( diabetes specialist) Dr. Ergin and his team will help you achieve your diabetes goals. Should you need medications or devices such as continuous glucose monitors, Dexcom G6, Freestyle libre, etc, we will advocate for you so you can get approval for these CGMs.

Author: Ahmet Ergin, MD, FACE, CDCES, ECNU

About the author: Dr. Ergin is an endocrinologist/diabetes specialist. He operates a large diabetes practice mostly in West Palm Beach, FL, and yet can see diabetic patients across the entire state of Florida via a unique telehealth platform which also allows him and his team to track patient progress and be available at all times.

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