The Different Types of Diabetes
More than 100 million U.S. adults are now living with diabetes or prediabetes. Whether it is you or a loved one that lives with diabetes, we're here to help. Through our education services, resources and top of the line diabetes supplies that we carry, we can help you manage diabetes better and more effectively. Get started by learning about the different types below or get in touch if you have questions.
Get in Touch
Diabetes Defined
First, let's define diabetes.
- When you have a meal or a snack, some of the foods you eat - called carbohydrates - break down into sugar and go into your bloodstream.
- Think of your bloodstream as your highway system, and the blood sugar needs to travel where it is needed - your muscles, all of your organs and everywhere it can be used for energy.
- However, the sugar needs to be transported or carried, and what carries it to its many destinations is insulin. So, think of insulin as your UPS, FedEx or Post Office carrier. It is made by the pancreas, which sits right by the stomach.
- When things are normal, the pancreas makes the right amount of insulin all of the time, and blood sugar levels stay in the normal range.
- However, without insulin, the sugar just sits in the bloodstream, and the level of sugar goes higher and higher. This is Type 1 diabetes.
- Type 2 diabetes may be caused by too little insulin, but more often is due to insulin resistance - meaning your body is not using the insulin your pancreas produces. The UPS/FedEx/Post Office folks are trying to do their work, but your body is fighting them. High blood sugar is the result and, over time, a diagnosis of type 2 diabetes.
Pre-diabetes, also known as borderline diabetes, is indicated by a fasting blood sugar between 100-125 mg/dl or an A1c between 5.6-6.5%. If left unchecked, pre-diabetes can develop into type 2 diabetes. These higher than normal blood sugars are the result of insulin resistance — the pancreas producing insulin to lower blood sugar, but the body resists it. High blood sugar is the result.
Pre-diabetes is almost always caused by the usual suspects, such as:
- Having family members with diabetes
- Being overweight
- Not getting enough exercise
Pre-diabetes can also be due to having gestational diabetes (diabetes while pregnant).
Lifestyle Changes
This is the good part! Landmark research, including the Diabetes Prevention Program (DPP), has shown diabetes can be prevented, even in people at high risk.
Doing these two things can make a big difference:
- Exercise at least 150 minutes per week. Most of the subjects in the DPP walked 30 minutes, five days a week.
- Get to comfortable body weight and stay there. The subjects in the DPP lost an average of 7 percent of their weight. For example, a 200-pound person lost 14 pounds, and a 300-pound person lost 21 pounds. This is a modest reduction in weight, but it reduced insulin resistance contributing to the above-normal blood sugars.
Insurance & Financial Questions
As of this writing, pre-diabetes is not recognized by most health plans, so requesting coverage for a blood sugar monitor, medication or diabetes education will most likely be denied. However, you can use this as even more reason to get your exercise program in gear and lose any excess, unhealthy weight!
Type 1 diabetes accounts for only 5 - 10 percent of all cases and used to be called juvenile diabetes. Three-quarters of people who develop type 1 are under the age of 18, and most others are under 40 years old, but older adults can develop it as well.
Many people think of type 1 diabetes as the more serious kind, because injecting insulin is the only treatment, but its type 2 counterpart can lead to the same long-term problems we all want to prevent. Another common distinction between the two forms of diabetes is the lack of insulin resistance in persons with type 1; in fact, most people with type 1 diabetes are quite sensitive to insulin and require smaller doses. However, overweight and obese people often experience insulin resistance, regardless of their form of diabetes.
What Causes It
The exact cause of type 1 diabetes is unknown. Most experts believe it is an autoimmune disorder, meaning it occurs when the immune system mistakenly attacks and destroys healthy body tissue. With type 1, an infection or some other trigger causes the body to destroy the cells in the pancreas that make insulin. This kind of disorder can be passed down through families. In fact, in most cases of type 1 diabetes, people inherit risk factors from both parents. Such factors appear to be more common in Caucasian people, who have the highest rate of type 1 diabetes.
Moreover, many people at risk do not develop type 1 diabetes. Consequently, researchers want to know what the environmental triggers of this are. One might be related to cold weather, as type 1 diabetes develops more often in winter than summer and is more common in cold climates. Another trigger might be viruses, as a virus that mildly affects most people may trigger type 1 diabetes in others. Early diet may also play a role. Type 1 diabetes is less common in people who were breastfed and in those who first ate solid foods at later ages.
Finally, in many people, the pathway to developing type 1 diabetes appears to take years. In studies that followed relatives of people with type 1 diabetes, researchers found that relatives who later developed diabetes had certain autoantibodies in their blood for years.
How You Know You Have It
Type 1 diabetes has a sudden onset, meaning, it presents with obvious signs usually over a period of a few days. Contrast that with type 2 diabetes, which may not be diagnosed for 8-10 years. However, like type 2, these are the most common symptoms:
- Blurry vision
- Excessive hunger
- Excessive thirst
- Frequent urination
- Tingling or numbness in your feet or fingers
- Unexplained weight loss
- Unusual infections, such as skin or yeast infection
- Unusual tiredness
The symptoms above may go unnoticed, or you and your family may attribute them to something else. So, if blood sugar continues to rise, you may experience these signs:
- Deep, rapid breathing
- Dry skin and mouth
- Flushed face
- Fruity breath odor
- Nausea or vomiting, and inability to keep down fluids
- Stomach pain
These are symptoms of a deadly complication of acute high blood sugar called diabetes ketoacidosis. This calls for emergency treatment to lower your blood sugar and stabilize your fluid and electrolyte balance.
Your doctor will confirm the diagnosis of type 1 diabetes by one of these blood tests:
- A1c > 6.5% (A1c tests blood sugar control over the past 2-3 months)
- Fasting blood sugar > 126 mg/dl
- Random blood sugar > 200 mg/dl
What You Can Do
Type 1 diabetes is a chronic disease with no known cure. However, you can live a long, happy life with diabetes. Research has shown your risk of problems greatly decreases by getting your blood sugar in good control and keeping it there!
Once you are diagnosed, ask your doctor to refer you to a diabetes educator at your hospital. Here is what you will learn:
- How and when to check your blood sugar, and what the numbers tell you.
- How and when to give yourself insulin and understand how the types of insulin your doctor prescribed work.
- How to manage your blood sugar when you are sick, and when to call your doctor if your blood sugar runs high.
- How to prevent complications, such as blindness, amputation, kidney failure and heart disease and stroke.
- Planning your meals and snacks. Counting carbohydrate grams or servings is essential.
- Starting an exercise routine, working up to 150 minutes a week.
- What to do if you have low blood sugar (called hypoglycemia).
- When to check for ketones in your urine. This may be when blood sugar is higher than 240 mg/dl, or when you are ill, especially with vomiting.
- Working with your doctor to have your A1c checked every 3-6 months, and to keep blood pressure and cholesterol on target. Also, to make sure you receive all of the care you need - annual eye exam, flu vaccine and regular dental visits.
Insurance & Financial Questions
With your doctor's prescription, your insurance company should cover your meter and supplies to check your blood sugar, your insulin and your pen needles or syringes. It may also cover an insulin pump and supplies. For the lowest copay, call the customer service number to ask if there is a particular brand of meter or insulin device you should use.
With your doctor's referral, diabetes education at your hospital's diabetes center should also be a covered benefit but call your health plan's customer service number to make sure, and to see what your out-of-pocket costs will be.
Diabetes Products
Patients with type 1 diabetes are treated with insulin daily and administer it with a syringe, insulin pen or insulin pump. Additionally, they may use a Continuous Glucose Monitoring System (CGMS) to monitor their blood glucose constantly. All patients test their blood glucose levels multiple times daily.
Type 2 diabetes is the most common form of diabetes, accounting for 90-95 percent of all cases. It used to be called adult-onset diabetes, but, unfortunately, both children and adults develop this kind of diabetes. Many people think of it as the kind of diabetes that does not require insulin. However, about half of people with type 2 diabetes will eventually need insulin. This is because the pancreas produces less and less insulin over time, so it must be injected to meet the body's needs.
What Causes It
The causes of type 2 diabetes are not completely understood, but it almost always starts with insulin resistance. So, what contributes to this insulin resistance? Here are some of the most common risk factors:
- Family history of diabetes
- Growing older - your risk increases as you age
- History of gestational diabetes
- Lack of exercise
- Member of a high-risk ethnic group, such as:
- African American
- Asian American or Pacific Islander
- Hispanic American
- Native American
- Overweight or obese
How You Know You Have It
Type 2 diabetes usually develops over the years, so you may or may not experience these so-called classic symptoms:
- Blurry vision
- Excessive hunger
- Excessive thirst
- Frequent urination
- Unexplained weight loss
- Unusual infections, such as skin or yeast infection
- Unusual tiredness
Your doctor can diagnose diabetes by one of these blood tests:
- A1c > 6.5% (A1c tests blood sugar control over the past 2-3 months)
- Fasting blood sugar > 126 mg/dl
- Random blood sugar > 200 mg/dl
What You Can Do
Type 2 diabetes is a chronic disease that can cause serious health problems. However, you can still live a long, happy life with diabetes. Research has shown your risk of problems greatly decreases by getting your blood sugar in good control and keeping it there!
Once you are diagnosed, ask your doctor to refer you to a diabetes educator at your hospital. Here is what you will learn:
- How and when to check your blood sugar, and what the numbers tell you.
- How and when to take your medications, how they work, and what side effects you may experience; if necessary, how to inject insulin.
- How to manage your blood sugar when you are sick, and when to call your doctor if your blood sugar runs high.
- How to prevent complications, such as blindness, amputation, kidney failure and heart disease and stroke.
- Planning your meals and snacks. Counting carbohydrate grams or servings, and smart portion control are essential.
- Starting an exercise routine, working up to 150 minutes a week.
- What to do if you have low blood sugar (called hypoglycemia).
- Working with your doctor to have your A1c checked every 3-6 months, and to keep blood pressure and cholesterol on target. Also, to make sure you receive all of the care you need - annual eye exam, flu vaccine and regular dental visits.
Insurance & Financial Questions
With your doctor's prescription, your insurance company should cover your meter and supplies to check your blood sugar. For the lowest copay, call the customer service number to ask if there is a particular brand you should use.
With your doctor's referral, diabetes education at your hospital's diabetes center should also be a covered benefit but call your health plan's customer service number to make sure, and to see what your out-of-pocket costs will be.
Type 2 Products
Patients with type 2 diabetes may or may not be treated with insulin and sometimes take oral medications to lower their blood glucose levels. If they use insulin for a period of time, it is administered with a syringe or insulin pen. Some patients may also use an insulin pump to control their diabetes. Most type 2 patients test their blood glucose levels at least once daily if they do not use insulin and three times daily if they use insulin.
Gestational Diabetes (GDM) is diabetes that develops while you are pregnant. Gestational diabetes is still diabetes, which means your blood sugar levels are abnormally high. Excess sugar crosses the placenta and can make your baby grow too large and lead to problems with your pregnancy and delivery.
The following guidelines for diagnosing GDM were revised in 2011 by the American Diabetes Association:
- Screen in the first trimester if a woman has risk factors for type 2 diabetes
- In pregnant women not known to have diabetes, screen for GDM at 24 - 28 weeks of gestation, using a 75-gram 2-hour glucose (sugar) tolerance test. A diagnosis of GDM is made when any of the following glucose values are exceeded:
- Fasting > 92 mg/dl
- 1 hour > 180 mg/dl
- 2 hour > 153 mg/dl
What Causes It
The causes of gestational diabetes have not been determined, but the many hormonal changes during pregnancy contribute to what is called insulin resistance - which is your body not using the insulin that your pancreas produces.
Here are the risk factors that contribute to insulin resistance and the development of gestational diabetes:
- Family history of diabetes
- Member of a high-risk ethnic group, such as:
- African American
- Asian American or Pacific Islander
- Hispanic American
- Native American
- Older than age 25
- Overweight or obese
- Personal birth weight greater than 9 pounds
- Polycystic ovarian syndrome
- Previous delivery of baby greater than 9 pounds or delivery with complications
How You Know You Have It
You may have signs, such as unusual tiredness or thirst, but you probably won't know until your doctor orders a glucose tolerance test.
What You Can Do
As soon as you are informed you have gestational diabetes, ask your doctor to immediately refer you to a diabetes educator at your hospital. The complications of GDM do not have to happen, especially if you learn all you need to know to have a safe, healthy pregnancy and delivery.
Here is what you will learn from a diabetes educator:
- How and when to check your blood sugar, and what the numbers tell you
- How to prevent developing type 2 diabetes in the future, including the benefits of breastfeeding for you and your baby
- Planning your meals and snacks
- Starting an exercise routine
- If necessary, how to take medication or inject insulin
The American Diabetes Association recommends that, to ensure you have gestational diabetes, and not type 2 diabetes, ask your doctor to check your blood sugar 6 - 12 weeks after you have your baby and every 3 years after that.
Insurance & Financial Questions
With your doctor's prescription, your insurance company should cover your meter and supplies to check your blood sugar. For the lowest co-pay, call the customer service number to ask if there is a particular brand you should use.
With your doctor's referral, diabetes education at your hospital's diabetes center should also be a covered benefit but call your health plan's customer service number to make sure, and to see what your out-of-pocket costs will be.
Diabetes Welcome Manual Link
T1D Exchange is an organization striving to accelerate research to improve outcomes in people living with type 1 diabetes. The website offers three main divisions: an online community, a clinical registry of data and research and a study databank.
The diverse type 1 diabetes community is designed to accelerate research and amplify the voices of those living with T1D and those serving as caretakers. Its clinic registry has become the most credible and published T1D data set in the nation.
Finally, T1D Exchange offers a wealth of ongoing and concluded studies into diabetes treatment and potential cures. For example, it has researched factors associated with discontinuation of pump and CGM Data show that the use of an insulin pump and/or continuous glucose monitors (CGM) improve glycemic control.
The College Diabetes Network (CDN) is a 501c3 non-profit organization whose mission is to provide innovative peer-based programs that connect and empower students and young professionals to thrive with diabetes. The group operates on three pillars of programming: tools, network, and an ecosystem.
The following are tests and exams that are recommended at every visit to your doctor:
- Blood pressure
- Weight
- Brief foot inspection
The following are the lab tests that are recommended and how often you should get them done:
- A1C – Every 3-6 months.
- Microalbuminuria (a urine test to check kidney health) – Once a year.
- Blood Cholesterol (measures "good" cholesterol, "bad" cholesterol and triglycerides in the blood) – Once a year.
Coverage – Services of outpatient preferred lab providers are covered at 100 percent. Non-preferred labs and labs in doctors' offices may require a copay. - Eye Exams – Dilated Eye Exam (checks health and condition of blood vessels inside eye) – Once a year.
Coverage – Screening like those for glaucoma are usually covered at 100 percent. Dilated diabetes eye exams may have a specialist co-pay that varies depending on your medical plan. - Foot Exams – Complete foot exam with filament test, determines adequate blood circulation and if nerves and skin in your feet are healthy – once a year.
Coverage – Services of a podiatrist are usually a covered benefit with your plan, but may have a copay. Ask your Primary Care Physician if he or she can assist you with this exam. - Dental Exams – Exam of teeth and gums – every six months.
Coverage – Limited dental benefits include one cleaning, filling and general exam each year. Check your benefits to determine if you have coverage for this exam. - Recommended Vaccinations – Flu shot at the beginning of flu season every fall.
- Pneumococcal Vaccination – As recommended by your physician
