In patients with type 1 diabetes, their bodies don’t produce insulin. You need insulin to survive. Patients with type 1 diabetes need to take insulin for the rest of their lives. Unfortunately, we don’t have an easy way to give insulin so most people with type 1 diabetes are best treated with 3 or 4 injections of insulin a day or with an insulin pump. An insulin pump is a medical device that continuously infuses insulin into the body. Those are the only approved treatments right now for type 1 diabetes.
In classic type 1 diabetes, people have just stopped making insulin. Their pancreas (the organ that makes insulin) doesn’t work anymore. That’s usually an autoimmune problem – it’s something that people are born with and we don’t know what causes it or how to prevent it. An autoimmune destruction of the cells that make insulin cause the person to be insulin-deficient and that’s what causes type 1 diabetes.
Unfortunately, there are no strategies now to prevent type 1 diabetes. A lot of research has been done in this area but we still haven’t found anything that will prevent type 1 diabetes.
Many people with diabetes need to check their blood sugar on a regular basis because it allows us to identify trends and adjust medications to improve blood sugars. It really depends on the medications you’re taking whether or not you need to check your blood sugar. For example, there are a lot of medications for type 2 diabetes where you probably never have to check your blood sugar at all. Whether your blood sugar is checked needs to be individualized – you need to talk to your diabetes provider to figure out if it would help you at all. On the other hand, people who are taking insulin do need to check their blood sugar because there are a lot of different doses of insulin and we just can’t adjust those doses without having some information about what the blood sugar is doing. If you’re only taking one injection of insulin a day (like many people with type 2 diabetes) you might be okay just checking your blood sugar once or twice a day. On the other hand, people with type 1 diabetes who are taking 3 or 4 injections a day or using a pump, it might be necessary for you to check your blood sugar 4, 5, or even more times a day. It really depends on what treatment you have, whether or not you should check your blood sugar.
When someone has diabetes, what that means is that their blood sugar is too high – that’s what defines diabetes. Really, though, diabetes is a spectrum of disease because there’s a lot of ways to get blood sugar that’s too high. On the one hand, we have classic type 2 diabetes where people are making plenty of insulin (the hormone that controls blood sugar) but they don’t respond to it very well. They’re resistant to it, so they have high blood sugar. On the other end of the spectrum, you have type 1 diabetes. In that type of diabetes, people are making no insulin at all. They are very sensitive to it and respond to it but they don’t make it, so they have diabetes. In between these two spectrums, you have a lot of other things that contribute to the development of high blood sugar. You have certain medications that cause diabetes, certain illnesses and other medical problems that can cause it – so there’s a lot of overlap sometimes between the conditions and you can’t always tell if it’s type 1 or type 2.
Both type 1 and type 2 diabetes run in families – there is definitely a genetic component to both of them. This is particularly strong in type 2 diabetes because people with type 2 diabetes typically have a lot of relatives who have diabetes as well. People with type 1 diabetes may not have as many relatives with diabetes. In type 2, since it’s an asymptomatic condition, it’s really important to be tested because if you have a relative with diabetes, your risk is much increased. People with relatives who have diabetes need to be tested for type 2 diabetes.
Classic type 1 diabetes is an autoimmune problems, so people with type 1 diabetes very frequently have other autoimmune problems such as thyroid problems, early ovarian failure, and sometimes certain kinds of anemia or hepatitis. So when people have type 1 diabetes, we look for those other conditions as well. In type 2 diabetes, it’s also associated with other classic abnormalities. Sometimes with type 2 diabetes, we talk about the metabolic syndrome or the insulin-resistant syndrome. The classic features of the insulin-resistant syndrome are all of the risk factors for diabetes: hypertension, abnormal cholesterol, heart disease, and being overweight. All of those things go with type 2 diabetes – so if a person has one of those conditions, we look for the other ones.
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