Diabetes Mellitus: Type 1 and Type 2 Differences

Type 1 Diabetes

Type 2 Diabetes

Key Characteristics

• Juvenile onset
• Autoimmune attack on pancreas: No insulin production
• (Autoimmune destruction of Beta cells)
• (Process is subclinical until insulin levels are insufficient to manage plasma glucose)

Treatment

• Insulin administration to prevent ketoacidosis
• Insulin pumps

Key Characteristics

• Adulthood onset, often associated with obesity
• Insulin resistance: Insulin is less effective, leading to increased insulin production
• (The body's cells are not responding, leading to overproduction of insulin)

Treatment

• Lifestyle modifications: Exercise, Weight loss

Clinical Features

Hyperglycemia Symptoms:

• Glycosuria (Osmotic diuresis)
• Severe dehydration (weakness, fatigue, mental alteration)
• Weight loss
• Nausea and vomiting
• Blurred vision
• Increased susceptibility to bacterial and fungal infections

Severe Cases: Diabetic Ketoacidosis (DKA) as a complication.

Complications

Acute Complications:

• DKA (Nausea, Vomiting, Abdominal pain)

Chronic Complications:

Vascular Complications:

Microvascular:

• Retinopathy (eye disease)
• Neuropathy (Sensory and motor polyneuropathy)
• Nephropathy
• Impaired skin healing

Macrovascular:

• Coronary Artery Disease (CAD)
• Peripheral Artery Disease (PAD)
• Cardiovascular Disease (CVD)

Non-Vascular Complications:

• Gastrointestinal issues
• Genitourinary issues
• Dermatological conditions
• Infectious diseases
• Cataracts
• Glaucoma

Clinical Features

Hyperglycemia Symptoms:

Can be asymptomatic in many cases.

• Glycosuria (Osmotic diuresis)
• Severe dehydration (weakness, fatigue, mental alteration)
• Weight loss
• Nausea and vomiting
• Blurred vision
• Increased susceptibility to bacterial and fungal infections

Similar to Type 1, except DKA is rare.

Diagnosis

1. Clinical Features (Signs and Symptoms)
2. Blood Glucose Level (Fasting Plasma Glucose (FPG) + Oral Glucose Tolerance Test (OGTT)) - Refer to table below
3. Plasma Glucose or HbA1c (Glycated Hemoglobin: Hemoglobin binds to glucose instead of oxygen)
4. Presence of antibodies against Beta cells

Treatment

Dietary Management:

• Caloric content
• Nutrient balance in daily meals

Exercise

Insulin Therapy:

• Injections or pumps

Treatment

Dietary Management:

• (80% of patients are obese)

Exercise

Pharmacological Treatment:

• Metformin (Increases cellular insulin sensitivity, decreases hepatic gluconeogenesis)

Contraindications:

• Renal disease
• Liver disease
• Lung disease

(May cause acidemia)

Dual Therapy:

• Metformin + (another anti-glycemic agent)

(Not recommended in cases of liver, kidney, or lung disease due to risk of acidosis)

Fasting Plasma Glucose (FPG)

Non-Fasting Plasma Glucose (Anytime)

Oral Glucose Tolerance Test (OGTT)

(Glucose administered, blood clearance assessed)

HbA1c

(Proportion of hemoglobin with glucose attached)

Normal: <100 mg/dL

Pre-diabetes: 100-125 mg/dL

Diabetes: >126 mg/dL

Diabetes: >200 mg/dL

Pre-diabetes: 140-199 mg/dL

Diabetes: >200 mg/dL

Pre-diabetes: 5.7-6.4%

Diabetes: >6.5%