Q: What is the difference between Type 1 diabetes and Type 2 diabetes?

Provided

A: Diabetes mellitus basically comes in two flavors: Type I diabetes also known as insulin dependent diabetes and juvenile diabetes and type II diabetes sometimes referred to as non-insulin dependent diabetes and adult onset diabetes. The names themselves can be misleading. Type II diabetes is by far the most common in the United States. Some reports suggest that at least 90% of the diabetics are type II. Generally speaking, type II diabetes is associated with truncal obesity or abdominal obesity. Notice I did not say obesity in general. Pear-shaped individuals are not quite as high a risk. Despite its name, type II diabetes often requires insulin in the management. Usually the patient will start on oral medicines and as the disease matures, many patients will go on to require insulin. Insulin is not necessarily a bad thing and should not be feared; it is just another treatment and often required in the later stages of type II diabetes. Type II patients also have cholesterol disorders with a low good cholesterol and a high triglyceride level.

Type II diabetes requires a strong genetic predisposition compounded with environmental factors such as obesity as discussed above. Type II diabetes can take years to develop in contrast to type I, which often appears more suddenly. Type I and type II diabetes share some complications. They both increase the risk of heart attack and stroke significantly. In fact, having diabetes puts you at the same risk of having a heart attach as a patient who has no heart disease, but no diabetes. So the management of both diseases is multifactorial requiring not only management of the blood sugar but more importantly, management of the high blood pressure that often accompanies the diabetes. That was a surprise to clinicians in the 90s when we learned that the blood pressure control was such an important part of reducing the risk of stroke and heart attack in diabetics. The goal blood pressure for diabetics is less than 130/over less than 80. The management also often incorporates medications to protect the kidneys and management of cholesterol disorders that come along with the diseases. The bottom line is that both diabetes types require complex management, juggling several medical balls, and when done effectively can drastically reduce the risk of stroke, heart attack, blindness, kidney failure and amputation.