Types of diabetes
Please read on for more information on each of these types of diabetes, or select the headers above to get taken straight through to that specific section.
Living with diabetes is NOT easy
Diabetes requires daily self-management and if diabetes-related complications develop, diabetes can have a significant impact on quality of life and can reduce life expectancy. While there is currently no cure for diabetes, you can live an enjoyable life by learning about the condition and effectively managing it.
Carolien is a very experienced Credentialled Diabetes Educator, she can help you understand better how diabetes can impact on your life and what you can do to minimise this impact. Carolien is also a Clinical Somatic Psychotherapist, a type of counsellor, and can help you or your family members with a range of concerns, ranging from diabetes-related stress, to anxiety, burnout, depression and diabetes distress.
Did you know your dog or cat can get diabetes too?
Type 1 diabetes
If the body’s immune system destroys the insulin-producing beta cells in the pancreas one can develop Type 1 diabetes. Type 1 diabetes (T1D) is an auto-immune condition and this type of diabetes accounts for 10-15% of all people with diabetes. In the past T1D used to be called Juvenile Diabetes as it tends to be diagnosed mostly in younger people, under the age of 40. However, we now know that it can in fact appear at any age; hence we moved away from the old term.
Type 1 diabetes also used to be called ‘insulin dependent diabetes mellitus’, or IDDM, as people with this condition will have to rely on daily insulin injections in order to survive.
T1D can be triggered by environmental factors such as viruses, diet or chemicals in people who have a genetic predisposition. As mentioned, type 1 diabetes is an auto-immune condition, this means that the body’s own defence mechanism attacks and kills off the insulin producing cells in the body. It is most certainly not “self-inflicted’, as some people seem to think.
People with type 1 diabetes must inject themselves with insulin, usually several times a day, to replace the insulin their body can no longer produce. They also need to be very mindful of their food intake and exercise regime, to manage blood glucose levels and avoid diabetes related complications.
Type 2 diabetes
Type 2 Diabetes Mellitus (T2D) is the more common form of diabetes, affecting around 85% of people with diabetes worldwide. It is characterised by insulin resistance (when the insulin that your body produces does not work properly – affecting the quality of the insulin) and/or insulin deficiency (when there is not enough active insulin being produced by your body – the quantity is affected), and is strongly genetic in origin.
Although lifestyle factors such as excess weight, inactivity, high blood pressure and poor diet are also major risk factors for the development of type 2 diabetes, they are not a cause as such.
Type 2 used to be referred to as ‘mature-onset diabetes’, as it tends to be diagnosed more commonly in older people (over the age of 40) and becomes more and more common with age. In Australia the incidence of type 2 diabetes is around 25% in those over the age of 75.
As obesity is becoming more common place, even in children, type 2 diabetes is also becoming more common, even at an earlier age; hence we moved away from the term ‘maturity-onset diabetes’.
Type 2 Diabetes was once also referred to as ‘Non-Insulin Dependent Diabetes Mellitus’ or ‘NIDDM’, as patients often do well on oral agents (tablets) and hence do not always need insulin treatment, at least not for the first few years. The term NIDDM was done away with in the 90’s as it became evident that many people with type 2 diabetes will need insulin treatment in the long-term, if they live long enough with the condition. A person with type 2 diabetes can therefore become insulin requiring, although the type of diabetes itself doesn’t really change.
Not everyone who develops type 2 diabetes develops symptoms, or these symptoms may not show for many years, and hence regular screening for type 2 diabetes through your General Practitioner (GP, or family doctor) is strongly recommended. Particularly for people over the age of 50 and those of certain ethnic backgrounds (in Australia this is in particular Aboriginal or Torres Strait Islander peoples, and those from the Middle East, India and Asia).
Gestational Diabetes, or GDM for short, has been defined as “a carbohydrate intolerance of variable severity with the first onset or diagnosis during the current pregnancy” (1) and is usually and traditionally diagnosed through an oral glucose tolerance test.
Risk factors
Risk factors for GDM include: having a family history of diabetes, increasing maternal age, obesity, a poor obstetric history (in other words: a history of miscarriages, ectopic pregnancy, or abortions), having polycystic ovarian syndrome (PCOS) and certain ethnic groups.
It is estimated that between 5.5 and 8.8% of pregnant women in Australia will develop GDM.
Management of GDM
Women with GDM will be prescribed a diet with restricted carbohydrate intake. It is generally recommended to have more frequent, smaller meals with carbohydrate portions spread out across the day to help stabilise and maintain glucose levels. Women with gestational diabetes are usually asked to have a smaller breakfast, lunch, and dinner and to include some morning tea, afternoon tea and supper in between their main meals.
Women with gestational diabetes are also asked to do regular physical activity, to help burn off excess glucose. Guidelines may vary slightly from one area to another, but mostly women are asked to do 150 minutes per week (or 30 minutes daily) of moderate intensity physical activity. For most women this means going for a daily walk, in addition to their regular daily activities.
Good glycaemic (blood glucose) management is very important for the foetus (unborn baby) as high blood glucose levels can cause complications in the newborn baby. These complications can include jaundice (a yellowing of the skin due to a struggling liver, requiring phototherapy), hypoglycaemia (a low blood glucose level), shoulder dystocia (dislocation) and macrosomia (a big baby).
Women with gestational diabetes are asked to check their blood glucose levels regularly so that their progress can be reviewed.
In approximately one third of women with gestational diabetes, diet and exercise alone is not enough to maintain blood glucose levels in the target range and hence insulin treatment may be required. In Australia tablets are generally not used in pregnancy as most tablets would cross the placenta and they are often not strong enough to provide the required level of glucose management. Insulin is a much safer option as insulin will not cross the placenta and side-effects are minimal.
After the birth
While the carbohydrate ‘intolerance’ mostly returns to normal after the birth, the mother has a significant risk of developing type 2 diabetes later in life, while the baby is more likely to develop obesity and impaired glucose tolerance and/or diabetes later in its life. Self-care and dietary changes are essential in the prevention of diabetes down the track for both mother and child.
To find out more about gestational diabetes talk to Carolien. She has helped women with GDM for over 25 years and she understands the concerns you may have. In a consultation with Carolien you can discuss how GDM might impact you or your baby, what you can do to minimise risks, learn more about carbohydrates and how they affect blood glucose levels and what type of physical activity may be beneficial for you. She can also provide you with a free blood glucose monitor to help you check your levels. The National Diabetes Services Scheme (NDSS) also has a fabulous website with loads of useful information.
References:
(1) ADIPS Consensus Guidelines for the Testing and Diagnosis of Gestational Diabetes Mellitus in Australia. Nankervis A, McIntyre HD, Moses R, Ross GP, Callaway L, Porter C, Jeffries W, Boonnan C, De Vries B, McElduff A for the Australasian Diabetes in Pregnancy Society.: VERSION 2:3/5/13
Other types of diabetes
There are actually other types of diabetes, in addition to the ones mentioned above.
For example, some people develop diabetes following surgery on their pancreas. Some people develop diabetes in response to medications, such as steroid treatment. Some develop diabetes in response to certain types of anti-rejection medications, needed following an organ transplant.
There is a type of diabetes called Latent Auto-immune Diabetes in Adults (LADA) and there is a type of diabetes called Maturity Onset Diabetes in the Young (MODY).
Some people may be misdiagnosed with one type of diabetes or develop another type on top of their “original form of diabetes”.
So to say that there are “only” the 3 types of diabetes, as outlined above, would be remis of me. I have therefore decided that I will dedicate a whole chapter to each type of diabetes in a book. It will take me some time to get this researched and written, so please bear with me. If you are interested in being the first to hear about it when my book is available, please use the button below to express your interest.