Diabetes: The differences

between types 1 and 2

Last updated Mon 25 March 2019
By Hannah Nichols
Reviewed by Deborah Weatherspoon, PhD, RN, CRNA

1. Causes

2. Risk factors

3. Symptoms

4. Diagnosis

5. Treatment and prevention

6. Outlook

Type 1 and type 2 diabetes both occur when the body cannot properly store and use
glucose, which is essential for energy. Sugar, or glucose, collects in the blood and
does not reach the cells that need it, which can lead to serious complications.
Type 1 diabetes usually appears first in children and adolescents, but it can occur in
older people, too. The immune system attacks the pancreatic beta cells so that they
can no longer produce insulin. There is no way to prevent type 1 diabetes, and it is
often hereditary. Around 5 percent of people with diabetes have type 1, according to
the Centers for Disease Control and Prevention (CDC).

Type 2 diabetes is more likely to appear as people age, but many children are now
starting to develop it. In this type, the pancreas produces insulin, but the body cannot
use it effectively. Lifestyle factors appear to play a role in its development. According
to the CDC, around 90–95 percent of people with diabetes have this type.

Both types of diabetes can lead to complications, such as cardiovascular disease,

kidney disease, vision loss, neurological conditions, and damage to blood vessels
and organs.
The CDC estimate that over 30 million people in the United States probably have
diabetes, but 25 percent of them do not know they have it.

Another type is gestational diabetes. This occurs in pregnancy and typically resolves
after childbirth, but some people then develop type 2 diabetes later in life.

This article will look at the differences and similarities between type 1 and type 2
diabetes.

Causes
Type 1 and type 2 have different causes, but they both involve insulin.

Insulin is a type of hormone. The pancreas produces it to regulate the way blood
sugar becomes energy.

Type 1 diabetes
Type 1 diabetes often affects young people.

In this type, scientists believe that the immune system mistakenly attacks the
pancreatic beta cells, which produce insulin. They do not know what causes this to
happen, but childhood infections may play a role.

The immune system destroys these cells, which means that the body can no longer
make enough insulin to regulate blood glucose levels. A person with type 1 diabetes
will need to use supplemental insulin from the time they receive the diagnosis and for
the rest of their life.

Type 1 often affects children and young adults, but it can happen later in life. It can
start suddenly, and it tends to worsen quickly.
 Risk factors include:

 having a family history of diabetes

 being born with certain genetic features that affect the way the body produces or
uses insulin

 some medical conditions, such as cystic fibrosis or hemochromatosis

 possibly, exposure to some infections or viruses, such as mumps or

rubella cytomegalovirus

What is the truth about type 2 diabetes?

Type 2 diabetes is a serious and prevalent disease, but numerous myths surround this
condition. Find out more here
READ NOW

Type 2 diabetes
In type 2 diabetes, the body's cells start to resist the effects of insulin. In time, the
body stops producing enough insulin, so it can no longer use glucose effectively.

This means glucose cannot enter the cells. Instead, it builds up in the blood.

This is called insulin resistance.

It can happen when the person always or often has high blood glucose. When the
body's cells are overexposed to insulin, they become less responsive to it, or maybe
they no longer respond at all.
 Symptoms may take years to appear. People may use medications, diet, and
exercise from the early stages to reduce the risk or slow the disease.

In the early stages, a person with type 2 diabetes does not need supplemental
insulin. As the disease progresses, however, they may need it to manage their blood
glucose levels in order to stay healthy.

Risk factors for type 2 diabetes include:

 having a family member with type 2 diabetes

 having obesity

 smoking

 following an unhealthful diet

 a lack of exercise

 the use of some medications, including some anti-seizure drugs and some
medications for HIV
People from certain ethnic groups are more likely to develop type 2 diabetes. These
include Black and Hispanic people, Native American Indians and Native Alaskans,
Pacific Islanders, and some people of Asian origin, according to the CDC.

Risk factors
Genetic and environmental factors may trigger both type 1 and type 2 diabetes, but
many people may be able to avoid type 2 by making healthful lifestyle choices.

Research has also suggested that some other environmental factors might play a
role.

Vitamin D
Studies have suggested that vitamin D may help prevent both type 1 and type 2 diabetes.

Low levels of vitamin D may play a role in the development of both type 1 and type 2
diabetes, according to some studies.

A review published in 2017 suggests that when a person lacks vitamin D, certain
processes in the body, such as immune function and insulin sensitivity, do not work
as well as they should. According to scientists, this may increase a person's risk of
diabetes.

The primary source of vitamin D is exposure to sunshine. Food sources include oily
fish and fortified dairy products.
Breastfeeding
Some researchers have suggested that giving an infant only breastmilk, even for a
short time, might help prevent type 1 diabetes in the future.

A review published in 2012 concluded that there might be "weak protective

associations" between exclusively breastfeeding and type 1 diabetes. However, there
was not enough evidence to prove that a link exists.

Symptoms
A person with diabetes may experience symptoms and complications due to
inadequate levels of blood sugar.

Other aspects of metabolic syndrome also occur alongside type 2 diabetes, including
obesity, high blood pressure, and cardiovascular disease. Inflammation appears to
play a role.

The chart below outlines the symptoms and complications of type 1 and type 2
diabetes before and at the onset of the condition.

Type 1 Type 2

Before onset BMI within a healthy range (19–24.9) BMI above the healthy range (25 or over)

Appearance over several weeks of:

Development over several years of:
increased thirst and urination
increased thirst and urination
increased hunger
increased hunger
blurry vision
blurry vision
At onset tiredness and fatigue
tiredness and fatigue
numbness or tingling in hands and feet
numbness or tingling in hands or feet
sores or wounds that take a long time to
sores or wounds that take a long time to heal
heal
unexplained weight loss
unexplained weight loss

Risk of: Risk of:

Complications cardiovascular disease, including a risk cardiovascular disease, including a risk of heart
of heart attack and stroke attack and stroke
kidney disease and kidney failure kidney disease and kidney failure
 eye problems and vision loss eye problems and vision loss
nerve damage nerve damage
problems with wound healing problems with wound healing, which can lead
ketoacidosis to gangrene and the need for an amputation
ketoacidosis

Hyperglycemia
If a person's blood sugar is too high, they may experience the signs and symptoms of
hyperglycemia and long-term complications, such as vision loss, cardiovascular
disease, and organ failure.

According to the American Diabetes Association (ADA), when a person has

hyperglycemia, they may experience the following:

 frequent urination

 increased thirst
This can lead to ketoacidosis, a potentially life-threatening condition that needs
urgent medical attention.

Symptoms include:

 difficulty breathing

 a fruity smell on the breath

 nausea and vomiting

 a dry mouth

 coma
Click here to learn more about hyperglycemia.

Hypoglycemia
 People with diabetes need to test their blood sugar levels regularly.

Hypoglycemia is when blood sugar levels are too low. This can result in diabetes if
the person uses more insulin or drugs that cause the body to produce insulin than
they need.

Early symptoms include:

 sweating, chills, and a pale face

 feeling shaky, nervous, and anxious

 rapid heartbeat
 feeling dizzy and lightheaded

 nausea

 feeling weak and tired

 headache

 tingling
A person should take a glucose tablet, a candy, or a sweet drink to relieve the
symptoms and prevent the problem from getting worse. Follow this with a protein-
based food, such as peanut butter.

Without treatment, the person may experience:

 seizures

 loss of consciousness

 coma
This can be life-threatening and needs immediate medical attention.

A person with diabetes should carry a medical ID so that others will know what to do
if a problem occurs.

Find out more here about hypoglycemia.

Diagnosis
The onset of type 1 diabetes tends to be sudden. If symptoms are present, the
person should see a doctor as soon as possible.

A person with prediabetes, which is the earliest stage of type 2 diabetes, and the
early stages of type 2 will have no symptoms, but a routine blood test will show that
blood sugar levels are high.

People with obesity and other risk factors for type 2 diabetes should have regular
checks to ensure that their glucose levels are healthy. If tests show they are high, the
person can take action to delay or prevent diabetes and its complications.

The following tests can assess for type 1 or type 2 diabetes, but they may not all be
useful for both types:
 A1C test, which doctors also call the hemoglobin A1c, HbA1c, or glycohemoglobin
test

 Fasting plasma glucose (FPG) test

 Oral glucose tolerance test (OGTT)

 Random plasma glucose (RPG) test

Depending on the results, the doctor may diagnose diabetes or prediabetes.

The following table shows what type of results indicate diabetes:

FPG OGTT RPG

A1C (%)
(milligrams per deciliter (mg/dl) (mg/dl) (mg/dl)

Diabetes 6.5% or above 126 or over 200 or over 200 or over

Prediabetes 5.7–6.4% 100–125 140–199

Normal below 5.7% below 100 below 140 below 200

The ADA recommend regular screening for type 2 diabetes in people aged 45
years and above, or earlier for those with risk factors.

People can check their own blood glucose levels at home. Testing kits are available
for purchase online.

Treatment and prevention

There is no cure for diabetes, but treatment can help people to manage it and
prevent it from getting worse. Here are some points about treating and managing
diabetes.

Type 1 Type 2
 Currently no cure, but lifetime treatment
Currently no cure, but measures can slow
can manage symptoms.
progression and manage symptoms.
Possible cure In time, gene therapy, regenerative
Gastric bypass may reduce symptoms in
medicine using stem cells, or pancreatic
people with severe obesity.
islet transplantation may become an option.

Metformin can reduce the amount of sugar

the liver produces.
SGLT2 inhibitors, DP-4 inhibitors, or
alpha-glucosidase inhibitors (AGIs) can
reduce blood sugar levels.
Meglitinides or sulfonylureas can increase
Daily insulin injections or using an insulin insulin levels.
Treatment with pump can provide insulin as needed Thiazolidinediones (TZDs) can increase
insulin and other through the day and night. sensitivity to insulin.
drugs Other drugs, such as pramlintide, can stop Glucagon-like peptide-1 (GLP-1) agonists
glucose levels from rising too far. can increase insulin and reduce sugar
levels.
Amylin analogs can reduce blood sugar by
slowing digestion.
Additional drugs for people at high risk of
cardiovascular disease and atherosclerosis.
Insulin in some cases.

Follow the treatment plan and the doctor's

Follow the treatment plan and medical
instructions regarding insulin and glucose
advice. Healthful diet
testing.
Regular exercise
Follow an active, healthful lifestyle to
Lifestyle Managing blood pressure and high
reduce the risk of cardiovascular disease
treatments cholesterol levels
and other health issues.
Avoiding smoking
Pay attention to glucose levels when
Knowing the signs of adverse effects and
exercising.
complications.
Managing blood pressure and
high cholesterol levels.

Know the signs of possible complications

to be ready to take action.
Follow the treatment plan and know the Wear a medical ID.
signs of hypo and hyperglycemia and the Take measures to avoid infections.
complications of diabetes. Check for wounds and seek early
Avoiding
Wear a medical ID. treatment.
complications
Take measures to avoid infections Have regular eye tests.
Have regular eye tests Follow a healthful diet and take exercise
Check for wounds and seek early treatment to manage cholesterol levels and high
blood pressure and reduce cardiovascular
risk.
 Follow a healthful diet with regular
It is not yet possible to prevent type 1 exercise. Avoid or quit smoking.
Prevention
diabetes. Follow a doctor's instructions if they
diagnose prediabetes.

Scientists have been investigating whether immunosuppressant drugs — effective in

treating conditions such as multiple sclerosis (MS) and rheumatoid arthritis — might
help prevent or reverse type 1 diabetes. However, results so far have been
inconclusive.

There is no cure for type 2 diabetes, although gastric bypass surgery, lifestyle, and
medication treatment can result in remission.

Find out more here about non-insulin drugs for type 2 diabetes.

Outlook
Diabetes is a serious condition.

It is not currently possible for a person to prevent type 1, but insulin and other drugs
can help people to manage their symptoms and live a normal life.

While there may be a hereditary link for both types of diabetes, people can both
reduce the risk and manage the progress of type 2 diabetes dramatically by following
a healthful lifestyle with regular exercise.

Anyone with a diagnosis of prediabetes should also make healthful lifestyle choices,
as this can reduce or eliminate the risk of type 2 diabetes developing.

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