What is the difference between type 1 and type 2 diabetes?

Before I went to medical school, diabetes was very confusing to me. There were kids in my school growing up who had diabetes and they had to take shots and prick their fingers, whereas the older people I knew with diabetes only had to take pills or no medication at all. I didn’t really understand diabetes or how people got it and I didn’t understand why some people needed to take shots while others did not.
In people with a normally functioning pancreas, the pancreas makes insulin when the blood sugar goes up after meals. Insulin allows sugar to enter the cells to be used as fuel. You need insulin to live because without it your blood sugar can get dangerously high and the sugar can’t get into your cells. If you have too much insulin, your blood sugar can get too low and you can go into a coma.
It turns out that type 1 and type 2 diabetes are very different medical conditions. In type 1 diabetes, the body loses the cells that make insulin (most often from an autoimmune problem where the body attacks those cells.) These cells don’t come back. People with type 1 diabetes have to take insulin in the form of shots for life. It is very important for people with type 1 diabetes to receive the exact amount of insulin that they need. Most of the time, they get the help of an endocrinologist to get this right. It can be difficult, but with care they can live a long and healthy life without complications. There is no way to avoid getting type 1 diabetes; it just happens to some people.

Type 2 diabetes arises when people’s bodies become resistant to insulin, meaning the insulin doesn’t work as well as it should. This can happen when people become overweight and they have an elevated insulin level over a period of time. Not everyone with type 2 diabetes is overweight; it is just an association. If this goes on too long, the cells stop producing insulin and people with type 2 diabetes have to take insulin shots just like people with type 1.

If diabetes is not well-controlled over the course of several years, people can have problems with their vision, heart, kidneys, and sensation in their feet. If this goes on too long, people can lose their sight, need dialysis, or have their feet amputated. So diabetes can be very serious!

One of the major reasons we pediatricians talk so much about healthy eating and activity is to avoid the really nasty complications of diabetes. Getting weight under control early in life gives kids the best shot to avoid type 2 diabetes. One of my passions is helping kids and families with weight-related issues. I think everyone deserves the best shot to live the healthiest life they can.