If you have diabetes and someone asks, “What’s your type?” you probably don’t answer by describing your perfect date. Because you know they’re not interested in whether you like spontaneous adventurers or cuddly couch potatoes—they want to know your type of diabetes. But that’s a difficult question to answer.
The first challenge is that there are a lot of misconceptions. If you say type 2, someone might jump to the conclusion that your diabetes is your own fault or that you could fix it yourself if you would just “try harder.” If you say type 1, then someone might worry that you can’t ever have sugar and freak out that you have to use needles. No one needs that kind of stress, and it’s frustrating to be categorized by a single number when diabetes, any type, affects each person differently. Given that about 1 in 10 Americans has diabetes, it’s time we all had at least a basic understanding of the different types.
But type 1 and type 2 don’t address the full spectrum of diabetes. What about type 1.5? What about MODY? Below is a rundown of the types and their general attributes.
1. Type 1
Once called “Sweet Urine Disease” back before doctors were able to differentiate between the types, type 1 diabetes is an autoimmune disease that causes the body’s own immune system to attack insulin-producing beta cells in a person’s pancreas. Without functioning beta cells, a person cannot secrete the hormone insulin. This is a problem because insulin carries glucose (or sugar) from the bloodstream into the body’s cells. Without insulin to carry glucose to the cells, someone will have extremely low energy and be forced to burn 100% fat for fuel. No, that’s not a good thing. When the body burns only fat, the by-product of fat burning, ketones, builds up too quickly in the bloodstream. Excessive ketone levels in the blood are poisonous and will cause ketoacidosis, a potentially deadly condition.
Those with type 1 will need to inject insulin so that their body can properly process glucose. Unfortunately, even with insulin injections type 1 diabetics will still deal with fluctuating blood sugar levels that can lead to other serious complications. They will need to closely manage their levels for the rest of their lives, and diabetes can lead to serious complications, including neuropathy. Approximately 1.25 million Americans have type 1 diabetes.
Type 1 is usually diagnosed in children and young adults, but it can develop later in life.
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2. Type 2
Type 2 represents about 90-95% of all diabetes cases. It typically develops later in life and is usually linked to lifestyle factors.
A person with type 2 diabetes can produce insulin, but their body’s cells have developed a resistance to it and they can no longer properly absorb glucose. The body reacts to this resistance by producing more insulin, but eventually the pancreas starts to wear out from overuse and a person faces both insulin resistance and decreased insulin production. A person with type 2 will have fluctuating blood sugar levels and many of the same risks and symptoms as a type 1. However, type 2 can sometimes be managed with diet and exercise changes alone, and may even be reversed through drastic lifestyle changes in some cases. However, every body is different. Many people with type 2 will need medication or even insulin injections.
While it’s rare for someone with type 1 to have a type 1 parent, risk for type 2 diabetes is associated with family history. Because it’s also associated with lifestyle factors, type 2 diabetes is more prevalent in those living in poverty.
3. Type 1.5
When you aren’t quite type 1 and you aren’t quite type 2, you may be type 1.5. No, it’s not made up. Diabetes type 1.5, sometimes called LADA (latent autoimmune diabetes in adults) is an autoimmune disorder like type 1 but develops later in life like type 2. Because of the slow onset of type 1.5, the condition is usually not insulin dependent right away because the body still produces some insulin. Type 1.5/LADA is often mistaken for type 2 because it develops later in life, and many people discover they have type 1.5 after trying treatments for type 2 without any positive results.
People with type 1.5 may respond positively to diet changes and increased exercise, but the slow destruction of beta cells will continue, and blood sugar management will eventually require insulin.