Understanding and living with type 1 and type 2 diabetes
Understanding the difference between the two types of diabetes doesn’t need to be complicated. Avoiding type 2 diabetes starts with a healthy lifestyle, but the signs of either type can be spotted early with good screening.
In 2017, over 7% of Canadians had diagnosed diabetes, but according to Diabetes Canada data, over 20% of the Canadian population is at risk of developing the disease.
Diabetes is linked to insulin, a hormone produced by your pancreas, which processes sugar, carbohydrates and other foods to give you the energy you need to live on a daily basis. With insufficient insulin, you may end up with too much sugar (glucose) in your bloodstream, leading to a variety of serious, chronic symptoms.
Whether you have type 1 or type 2 diabetes, the symptoms are the same, but you can give yourself the best chance of avoiding type 2 diabetes by making well-informed lifestyle decisions.
What are the symptoms?
Undiagnosed diabetes can present as an acute condition mostly in children, where type 1 diabetes may first present as a hyperglycemic coma in the emergency ward. Undiagnosed adult diabetes (type 2) is a chronic condition that will very rarely present as a medical emergency.
If you have diabetes, you may experience one or more of the following symptoms: you are often thirsty (more than usual), you urinate a lot, you find that you have lost or gained weight without a specific cause, you lack energy and your vision is affected.
A few symptoms that may indicate diabetic neuropathy would be a good reason to consult with your doctor for testing:
A cut or sore on your foot that is infected or won't heal
Burning, tingling, weakness or pain in your hands or feet that interferes with daily activities or sleep
Changes in digestion, urination or sexual function
Long term health impacts
Diabetes-related complications are generally caused by the presence of too much glucose in the blood. Over the long term, if blood glucose levels remain high, you may develop serious health problems and some of your organs may become damaged. Whether you have type 1 or type 2 diabetes, the symptoms can be the same. Since diabetes and other chronic diseases have several risk factors in common, according to Health Canada, 36.5% of adult Canadians with diabetes indicated they were also suffering from at least two other serious chronic diseases. People with diabetes are three times more likely to be hospitalized with cardiovascular disease than people without diabetes, 12 times more likely to be hospitalized for terminal kidney failure and nearly 20 times more likely to be hospitalized for the amputation of a lower limb (not caused by trauma).
Diabetes can lead to progressive deterioration of your vision and can also lead to cataracts and glaucoma, or even vision loss.
Neuropathy is a type of nerve damage that can often occur with diabetes, as high blood sugar and poor circulation injure nerves throughout your body, most often in your legs and feet. It develops within the first 10 years of diabetes in 40 to 50% of patients. There are a wide range of symptoms and indicators of neuropathy on which your doctor can advise.
Sensitivity to Infections
High blood glucose levels and weakening of the immune system sometimes caused by the disease make diabetics more likely to develop periodic infections that are difficult to cure, such as infections of the skin, gums, respiratory tract, vagina or bladder. Diabetes can also slow the healing process more generally.
Kidney Disease (nephropathy)
Because diabetes causes vascular problems, the small blood vessels in the kidneys can be affected, leading to progressive kidney deterioration ranging from kidney failure to irreversible kidney disease requiring maintenance dialysis. Hypertension is also a major contributor to kidney disease. In 2009, diabetes was the leading cause of 34% of new terminal kidney failure cases in Canada.
Cardiovascular disease is 2 to 4 times more common in diabetics than in the general population. High glucose levels contribute to accidental blood clotting and increase the risk of clogging blood vessels near the heart (infarction) or the brain (stroke).
Diabetes is also often linked to other complications such as sleep apnea, musculoskeletal disorders and erectile dysfunction.
What’s the difference between type 1 and type 2 diabetes?
Although it is easy to confuse the two types of diabetes (type 1 and 2) since their symptoms are the same, their respective causes are very different.
Type 1 diabetes is an autoimmune disease that represents about 10% of all diabetes cases. It happens when your body is no longer able to produce insulin because the cells that make it have been destroyed by your immune system as part of an auto-immune disorder. Consequently, your insulin levels go down and consequently the sugar levels in your blood go up. There is nothing you can do with regards to lifestyle to prevent type 1 diabetes – it is not caused by factors related to your diet or physical activity. It is usually diagnosed in children and young people, but only very rarely in people over the age of 40.
The risk factors for type 1 diabetes are not properly understood yet. Studies have shown that genetic predisposition can influence its development, but it is not the only cause of the disease. Some environmental factors may also trigger the autoimmune response.
Type 2 diabetes accounts for 90% of diabetes cases and typically develops during adulthood. It is caused by insufficient insulin production in your pancreas, or by resistance of the cells to the insulin produced.
According to Health Canada, the causes of type 2 diabetes are complex and no single risk factor can explain its progression. Ageing, obesity, physical inactivity, certain ethnic origins and a family history of diabetes (or gestational diabetes for women) are all important risk factors.
Prevention and Prescription
There are no known lifestyle factors related to type 1 diabetes – it is an autoimmune disease for which there are no clear preventative measures to be taken.
By maintaining a healthy lifestyle and making choices that focus on your everyday wellbeing, you can significantly decrease your risk of developing type 2 diabetes, or pre-diabetes. It doesn’t need to be difficult! Here are five simple guidelines you can follow.
Eat 5 to 10 servings of fruit and vegetables per day.
Increase your fibre intake.
Reduce your fat and salt intake.
Limit your alcohol consumption.
Make sure to engage in regular physical activity
Be active at least 30 minutes per day, every day, with significant activity such as brisk walking.
Choose activities that promote strength, endurance and flexibility.
Find activities you like and that you can do as a family.
Do not smoke
If you smoke, it’s never too late to stop.
Avoid second-hand smoke.
Reduce your stress
Get sufficient sleep and rest.
Be active – physical activity is a great way to reduce stress.
Manage your blood pressure, cholesterol and glucose levels.
Following the above advice about maintaining a healthy weight is a great start. High blood pressure can be controlled by using less table salt, limiting alcohol, tobacco and caffeine intake, and monitoring your blood pressure at home. Consult a medical professional for further advice.
When should I be screened for diabetes?
An unhealthy weight, poor fitness or eating habits, a high waist circumference, high blood pressure, or a family history of type 2 diabetes are all good indicators of the risk of developing type 2 diabetes.
We test for diabetes by assessing glycemia, which is simply the level of glucose present in the blood. There are a few different tests you can undergo. In the absence of symptomatic high glucose levels, a single result in the diabetic range should be confirmed by another test or repeat testing on another day. Diabetes can also be screened in the non-fasting state using a random glucose level and/or glycated hemoglobin (HbA1c).
Fasting Glucose Level
This test assesses blood sugar levels following 8 hours with no caloric intake.
2 hour glucose level in a Glucose Tolerance Test
This test is done on a fasting basis. You will be asked to drink a liquid that contains 75g of sugar. Your glucose level will be checked after a 2-hour period.
Random glucose level
This test assesses blood glucose level at any time of the day without regard to the interval since the last meal.
Glycated Haemoglobin Test (HbA1C)
HbA1c, or glycated haemoglobin, is a particular form of hemoglobin on which a glucose molecule has been attached, providing a proportional link between HbA1c and blood glucose levels.
The blood level measurement of glycated haemoglobin gives an idea of the average blood glucose level over the past two to three months. Its dosage is used in the diagnosis of diabetes and for monitoring the glycemic balance and thus evaluate and adapt diabetes treatment.
What are glucose levels that would indicate diabetes?
Type 2 diabetes
Between 6.1 and 6.9 mmol/L (fasting glucose anomaly)
7.0 mmol/L or higher
Glycated haemoglobin (HbA1C)
Between 6.0 and 6.4 mmol/L
6.5 mmol/L or higher
Hyperglycemia (oral tolerance test) glycemia, 2 hours after drinking a liquid containing 75 g glucose
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Living with diabetes
If tests indicate you have either pre-diabetes or diabetes of either type, consult with medical professionals to make a treatment plan appropriate for you, as specific care varies with your specific condition. Though type 1 diabetes is a non-curable disease (apart from transplant) that requires insulin in 100% of cases, type 2 diabetes may be much more easily treated and controlled with oral drugs and lifestyle changes. Only about 25% of type 2 diabetic patients will require insulin.