Type and Type Diabetes

The two main forms of diabetes are called type 1 and type 2 diabetes. Although they have different causes and, to a great extent, affect different categories of people, they share three main features.

First, type 1 and type 2 diabetes are both characterized by metabolic abnormalities that include high levels of blood sugar in the circulation, as well as increased levels of other nutrient breakdown products that are released from their storage sites. See Table 1.1. Second, decreased insulin secretion or a decreased sensitivity to insulin action is the reason for these metabolic abnormalities. In the case of type 1 diabetes, the body makes no or very little insulin because the insulin-secreting islets have been harmed or destroyed. In type 2 diabetes, the body cannot meet the increased insulin demands brought on by a condition called insulin resistance.

table i.i How We Diagnose Diabetes

Test

Diabetes* level

Prediabetes level

Fasting plasma glucose

Plasma glucose (sugar) is measured after an overnight (8-hour) fast.

>126 mg/dL

1OO-125 mg/dL

Oral glucose tolerance test

After fasting overnight, the patient drinks a solution with 75 grams of glucose. Plasma glucose is measured 2 hours later.

>2OO mg/dL

14O-199 mg/dL

Random plasma glucose**

Plasma sugar is measured at any time of day

> 2OO mg/dL

*To make a diagnosis of diabetes, abnormal results should be confirmed with repeat testing. **Diabetes can be diagnosed in the presence of typical symptoms.

*To make a diagnosis of diabetes, abnormal results should be confirmed with repeat testing. **Diabetes can be diagnosed in the presence of typical symptoms.

Third, both types of diabetes can result in long-term complications that affect the small vessels of the eyes, kidneys, and nervous system. These complications are related to the high levels of blood sugar that are sustained over time and can result in serious damage such as blindness, kidney failure, foot ulcers and amputations, and the dysfunction of other organs. Both types of diabetes also substantially increase the risk of developing heart disease and stroke. In the short term, very high blood sugars, if not treated, can lead to severe dehydration and can cause confusion, coma, and even death.

Even with their shared features, the two types of diabetes are quite different in many respects. Type 1 diabetes characteristically occurs in children and young adults (it was once called juvenile-onset diabetes) and requires treatment with insulin for survival (type 1 also used to be called insulin-dependent diabetes). In type 1 diabetes, the body's immune system attacks the pancreas. This autoimmune attack destroys the beta cells, leaving them unable to make insulin.

The causes of type 1 diabetes are not fully understood. We don't know what triggers the immune system to start attacking the pancreas, although certain inherited genes can make you more vulnerable. However we do know that type 1 diabetes is not primarily caused by lifestyle, being overweight, or obesity; however, controlling body weight and exercising regularly are important parts of the treatment. Maintaining blood-sugar levels as close to the nondiabetic range as possible is critical to avoid long-term complications.

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