Do you have trouble differentiating between type 1 diabetes (T1D) and type 2 diabetes (T2D)? You’re not alone!
Because of their similar name, the media often uses the word diabetes alone to refer to both conditions—T1D and T2D—lending to the idea that they are one and the same. This lack of accuracy and knowledge in the general population has led to stereotypes and misconceptions about diabetes that reinforce the confusion between the two types.
The media and public health messages sometimes convey the idea that diabetes is the result of a “lack of personal responsibility,” including an unhealthy lifestyle, lack of exercise and excess weight. This is completely false for T1D, and largely untrue for T2D.
However, while there are obvious differences between the different types of diabetes, pitting them against each other can also contribute to the stigma experienced by people living with diabetes (e.g., thinking that people living with T2D are responsible for the onset of diabetes as opposed to people living with T1D, or that living with T2D is easier than living with T1D).
So, what is the truth? What are the differences between T1D and T2D? Let’s take a look.
What is diabetes?
To understand how diabetes works, we first need to understand how the body works without diabetes.
Without diabetes
The pancreas is the organ in the human body that produces a hormone called insulin.
Insulin is like a key that unlocks the door to the cells, allowing glucose (sugar in the blood) to provide the body with the energy it needs to function.
With diabetes
The body is unable to produce enough insulin or use it properly. So, sugar in the blood cannot be used properly to provide energy to the body.
Sugar accumulates in the blood, and the body eventually releases it in urine.
Differences between the two types
There are different types of diabetes depending on the cause of the sugar build-up in the blood. The most common are T1D and T2D.
T2D is the most common form of diabetes, accounting for 90% of cases, while T1D accounts for about 7% of cases.
Since T2D is the most common type of diabetes, most people often mistakenly think of all diabetes cases as being type 2. However, the profile of people affected, the causes and the treatments are very different from one type of diabetes to another.
Origin
Type 1
The immune system goes after the wrong target and attacks the cells in the pancreas that produce insulin. The body no longer produces insulin. This is called an autoimmune disease.
Type 2
Glucose cannot effectively enter the cells. This phenomenon is called insulin resistance, as if the “key” was damaged. The pancreas has to work harder to produce more insulin. Over time, it produces less and less insulin, as if it were running out.
Risk factors
Type 1
The causes are largely unknown, but often involve a genetic predisposition and a triggering factor (e.g., viral infection, stress).
Type 2
- Genetic predisposition
- Socio-economic and environmental factors (e.g., lack of nutrition information, high costs associated with physical activity)
- Excess weight, especially excess abdominal fat
- Diet high in saturated fatty acids and animal products, low in plant-based fiber
- Hypertension
- Sedentary lifestyle
- Gestational diabetes
Age
Type 1
Often appears before the age of 20, but can be diagnosed at any age
Type 2
Often appears after the age of 40, but affects increasingly younger populations
Prevention
Type 2
When possible, improved diet and increased physical activity have both been shown to be good prevention measures.
Treatment
Type 1
Insulin administration
Type 2
Lifestyle changes and, if insufficient, oral and/or injectable medication, which may include insulin
Are there any other types of diabetes?
There are multiple types of diabetes that can be caused by other conditions (e.g., gestational diabetes and certain pancreatic diseases such as diabetes secondary to cystic fibrosis). Over time, certain types of diabetes that were previously called T1D or T2D were identified thanks to new diagnostic methods.
Here are a few examples:
- LADA (Latent Autoimmune Diabetes in Adults) (link in French only), also called “slow or late onset type 1 diabetes.” It appears later in life (after 30 years of age) than classic T1D, and the destruction of insulin-producing cells happens more slowly than in the classic form of T1D. This type of diabetes accounts for about 8% of BETTER registry participants who live with type 1 diabetes.
- MODY (Maturity Onset Diabetes of the Youth) is a rare form of diabetes with a known genetic origin. It occurs early in life (childhood or adolescence), but is not related to an autoimmune process as is the case with T1D. It is an anomaly in the regulation of insulin secretion.
Beware of the risk of stigmatization
In a recent U.S. study, 76% of participants living with T1D reported experiencing stigma related to their diabetes. Similar numbers were reported among 14- to 24-year-olds living with T1D in Canada. This stigma (e.g., blaming, stereotypes, exclusion, rejection) was explained in part by the confusion between the different types of diabetes, which leads to a build-up of negative stereotypes. Thinking that a person with T1D is irresponsible when they eat dessert or thinking that people living with diabetes are not allowed to eat sugary foods are among these stereotypes. People with T1D sometimes experience stigma related to T2D because of the misconception that T1D and T2D are one and the same.
It’s important to note that even though T2D often involves lifestyle changes, people living with T2D should not be discriminated against or stigmatized. People with T2D also get derogatory comments or unsolicited advice about their health and appearance.
As you can see, there are many different types of diabetes, and although they have similar names, they are also very different. People living with diabetes may experience stigmatization due to misconceptions or even confusion between the different types. That’s why getting information from reliable sources (e.g., from the person living with diabetes) is crucial to understand the differences between the various types of diabetes.
References :
- Edwin A.M. Gale; The Discovery of Type 1 Diabetes. Diabetes 1 February 2001; 50 (2): 217–226. https://doi.org/10.2337/diabetes.50.2.217
- American Diabetes Association. “2. Classification and Diagnosis of Diabetes.” Diabetes care vol. 40,Suppl 1 (2017): S11-S24. doi:10.2337/dc17-S005
- LIU, N. F., et al., (2017), «Stigma in People with Type 1 or Type 2 Diabetes», Clinical Diabetes, 35(1), 27-34.
- SPEIGHT, J., T. C. Skinner, K. J. Rose, R. Scibilia et A. J. Boulton (2020), «Oh sugar! How diabetes campaigns can be damaging to the cause they aim to serve», The Lancet Diabetes and Endocrinology, 8(7), 566-567.
- BRAZEAU, A. S., M. Nakhla, M. Wright, C. Panagiotopoulos, D. Pacaud, M. Henderson, E. Rahme, D. DaCosta et K. Dasgupta, «Stigma and its association with glycemic control and hypoglycemia in adolescents and young adults with type 1 diabetes : Cross-sectional study», JMIR, 2018; 20 (4): e151.
- BROWNE, Jessica L., et al., «“I’m not a druggie, I’m just a diabetic”: a qualitative study of stigma from the perspective of adults with type 1 diabetes», BMJ, open vol. 4,7 e005625. 23 juillet 2014, doi :10.1136/bmjopen-2014-005625.
Written by: Sarah Haag RN. BSc.
Reviewed by:
- Amélie Roy-Fleming Dt.P., EAD, M.Sc.
- Rémi Rabasa-Lhoret, MD, PhD
- Anne-Sophie Brazeau RD, PhD
- Jacques Pelletier, Claude Laforest, Marie-Christine Payette, Sonia Fontaine, Laurence Secours, patient-partners of the BETTER project
Linguistic revision by: Marie-Christine Payette
