What are the types of diabetes?

Most important to managing the disease is to know as much about it as you can. The first thing to know is what kind of diabetes you have. There are three types:

Type 1 Diabetes:

This type of diabetes used to be called 'juvenile diabetes' or 'insulin-dependent diabetes.' Type 1 diabetes accounts for about 5 to 10 percent of all diagnosed diabetes, so it's less common than type 2. It's an autoimmune disease, which means that your immune system (the body's system for fighting infection) has gone haywire and is destroying the cells in your pancreas that produce insulin.

Without insulin, your body can't use sugar and fat broken down from the food you eat. When sugar can't get into your cells, your blood sugar rises and it's this high blood sugar level that damages your body. A person with type 1 diabetes can't make insulin. If you have this disease, you have to take insulin in order to live. Type 1 diabetes develops most often in children or young adults but can occur at any age. It can come on suddenly, often after an illness. There is no cure for type 1 diabetes, but because of new knowledge about the disease and new medical advances, good self-care is now possible. A person with diabetes can live a healthy life and avoid or experience few complications from the disease. Diabetes of any kind is a disorder that prevents the body from using food properly. Normally, the body gets its major source of energy from glucose, a simple sugar that comes from foods high in simple carbohydrates (e.g., table sugar or other sweeteners such as honey, molasses, jams, and jellies, soft drinks, and cookies), or from the breakdown of complex carbohydrates such as starches (e.g., bread, potatoes, and pasta). After sugars and starches are digested in the stomach, they enter the blood stream in the form of glucose* (figure 1). The glucose in the blood stream becomes a potential source of energy for the entire body, similar to the way in which gasoline in a service station pump is a potential source of energy for your car. But, just as someone must pump the gas into the car, the body requires some assistance to get glucose from the blood stream to the muscles and other tissues of the body. In the body, that assistance comes from a hormone called insulin. Insulin is manufactured by the pancreas, a gland that lies behind the stomach. Without insulin, glucose cannot get into the cells of the body where it is used as fuel. Instead, glucose accumulates in the blood to high levels and is excreted or spilled into the urine through the kidneys.

Characteristics of type 1 diabetes:

• Most common in children
• Quick onset with thirst, frequent urination, weight loss developing and worsening over days to weeks
• Usually no known family history
• No major risk factors; risk is increased if there is a strong family history
• Insulin shots required to control diabetes
• Blood glucose levels are sensitive to small changes in diet, exercise, and insulin dose

Type 2 Diabetes:

Type 2 diabetes used to be called 'non-insulin-dependent diabetes mellitus' or adult-onset diabetes. It differs from type 1 diabetes in that the body makes some insulin, but not enough; also, the body can't use the insulin efficiently.

Type 2 diabetes is the most common type of diabetes, accounting for 90 to 95 percent of all diabetes. It usually develops after the age of 40. However, in the late 1990's, its incidence increased among young people. Experts are trying to determine why that is happening; they think it may be related to the increased incidence of obesity and sedentary lifestyles among young people in the US.

About 80 percent of those with type 2 diabetes are overweight. It is more common among people who are older, sedentary or obese, or have a family history of the disease. It may reappear in women who had gestational diabetes. It is more common among people of Asian, Hispanic, African or Native American ancestry.

Type 2 diabetes is a progressive disease that can cause significant, severe complications such as heart disease, kidney disease, blindness and loss of limbs through amputation. Treatment differs at various stages of the condition. In its early stages, many people with type 2 diabetes can control their blood glucose levels by losing weight, eating properly and exercising. Many may subsequently need oral medication, and some people with type 2 diabetes may eventually need insulin shots to control their diabetes and avoid the disease's serious complications.

Even though there is no cure for diabetes, proper treatment and glucose control enable people with type 2 diabetes to live normal, productive lives.

A major advance for people at risk of developing type 2 diabetes - such as family members of those with the condition - occurred recently when it was shown that diet and exercise can prevent or delay type 2 diabetes. People at high risk, who already had early signs of impaired glucose tolerance, significantly reduced their risk by losing only 5-7 percent of their body weight and performing moderate physical activity for 30 minutes/day. Taking the diabetes medication metformin also reduced the risk.

Characteristics of Type 2 Diabetes:

• Most common in adults, although more younger people are developing this type
• Usually slow onset with thirst, frequent urination, weight loss developing over weeks to months
• Usually runs in families
• Most people who get this type are overweight or obese
• Treatment usually begins with diet and exercise, progressing to use of oral medications and later to insulin as the disease advances
• Blood glucose levels may improve with weight loss, change in diet and increased exercise
• May be prevented or delayed in high-risk individuals by moderate weight loss and exercise

Gestational Diabetes:

Some women, about 3 to 5 percent of all pregnant women, get this form of diabetes during pregnancy. It usually ends when the baby is born, but some women who have gestational diabetes go on to develop diabetes when they get older. Some studies have reported that almost 40 percent of women who have gestational diabetes will go on to develop type 2 diabetes. So, if you have had gestational diabetes, you need to see your doctor every year and ask to be screened for type 2 diabetes.

Gestational diabetes usually doesn't cause birth defects, but one of the problems is the possibility of having a baby that is considerably larger than normal. There is also the risk that the baby might have low blood sugar right after it's born.

Gestational diabetes happens when the body doesn't make enough insulin and resists the action of insulin because of hormones. The condition develops about midway through the pregnancy. Although most women with this condition are treated with diet, some women may need insulin. The problem can't be treated with pills because the medication can harm the baby.