Understanding the differences between type 1 and type 2 diabetes

Diabetes is often spoken about as one condition but type 1 and type 2 diabetes differ in their causes and some of the treatment options. As a health professional, understanding these differences is essential to providing clients living with diabetes with personalised, effective, and empathetic care.

The key distinctions

Type 1 diabetes is an autoimmune condition where the body destroys insulin-producing beta cells in the pancreas. As the pancreas does not produce insulin, glucose cannot enter the cells to be used for energy. Instead, it builds up in the bloodstream, causing hyperglycaemia (high blood glucose levels), and over time forces the body to break down fat for energy, producing ketones. A build up of ketones, combined with hyperglycaemia, can lead to a serious complication known as diabetes ketoacidosis.

Type 1 diabetes:

• often starts in childhood or adolescence, but can also present in adults
• requires people to have lifelong insulin therapy
• has no known cause but has known triggers such as a viral infection
• currently has no prevention or cure, although studies into delaying onset continue.

In contrast, type 2 diabetes, which accounts for around 90% of diagnoses, is a metabolic disorder that anyone can develop. In people with type 2 diabetes, the pancreas does not make enough insulin or the insulin it makes doesn’t work well (insulin resistance), leading to hyperglycaemia.

Type 2 diabetes:

• usually starts in adults over 45, although it’s increasingly diagnosed in younger people
• can be managed using lifestyle interventions, but often glucose-lowering medications or insulin are needed
• has some known risk factors
• has no cure.

Diagnosis and misconceptions

Diagnosing diabetes and differentiating between the types involves considering features such as:

• age at onset
• body mass index
• family history
• the speed of onset
• presence of ketones
• autoantibody testing results.

Avoid assumptions based on weight or age. Some young people develop type 2 diabetes, and some adults develop autoimmune diabetes (also known as LADA: Latent Autoimmune Diabetes in Adults).

Treatment needs

People with type 1 diabetes must use insulin daily, either through multiple injections or an insulin pump, often combined with a continuous glucose monitor.

Education is vital, especially at diagnosis, to guide people in managing:

• insulin adjustments (insulin sensitivity, correction factor)
• hypoglycaemia treatment
• healthy eating (including carbohydrate counting)
• physical activity
• sick days (sick day management planning, including ketone checking)
• their emotional wellbeing.

The health care team of a client with type 1 diabetes may include:

• an endocrinologist
• a credentialled diabetes educator
• a dietitian
• a psychologist
• a podiatrist
• a pharmacist
• an optometrist/opthamologist
• a dentist
• an exercise physiologist

Caring for people with type 2 diabetes varies depending on disease progression and individual needs. Many people manage their diabetes through:

• healthy eating
• physical activity
• weight management
• medication

Various health professionals, including those mentioned above, can support healthy lifestyle changes and general health monitoring. GPs can prescribe glucose-lowering medications or insulin, if needed.

Common ground

Despite their differences, both types of diabetes cause hyperglycaemia. Both types require regular blood glucose monitoring to guide treatment and prevent complications. 

They also share early symptoms, such as:

• excessive thirst
• frequent urination
• unexplained weight changes
• blurred vision
• fatigue
• slow healing or frequent infections.

These symptoms tend to much more pronounced in type 1 diabetes, and not identifying symptoms early can lead to the need for emergency hospital admission.

The long-term risks of both types are similar, including:

• heart disease
• kidney disease
• vision problems.

Clients with both type 1 and type 2 diabetes must also monitor their blood pressure, cholesterol, cardiovascular, and kidney health.

Ongoing education, regular screening, and prevention strategies can help reduce these risks.  

A team approach

People with both type 1 and type 2 diabetes benefit from a multidisciplinary, informed, and empathetic care team. By understanding the differences and similarities between these conditions, health professionals can empower their patients to manage their diabetes with confidence.