Diabetes Crash Course
What's your type?
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Diabetes 101
I'm going to attempt to start at the beginning, i.e. what is diabetes, anyway?
There are three main flavours of diabetes:
type 1 (insulin-dependent, or “juvenile,” or T1D)
type 2 (non-insulin-dependent, or “adult-onset,” or T2D)
type 3 (gestational diabetes)
All of these are called "diabetes." Why? Because of their relation to the pancreas—the long, thin organ located behind your stomach. The pancreas plays a key part in the digestive process and metabolism, as it regulates sugar in the blood by secreting insulin (which lets cells change sugar into energy, which lowers blood sugar); glucagon (which breaks down a substance in the liver, known as glycogen, to raise blood sugar); and somatostatin (which regulates the production and release of both insulin and glucagon). This process is complex within an individual body and it makes things like blood sugar levels difficult to predict accurately.
Diabetes is not a simple equation of insulin and food. If it were, blood sugars would be a lot easier to manage. The pancreas produces insulin, but that is only a small part of its function as a digestive organ. The pancreas (or more accurately, a tiny part of the pancreas) is involved in a strange sort of balancing act, trying to deal with whatever the body eats or doesn't (because all food is broken down into sugar eventually, unless it’s stored as fat) and produce substances that allow the body to continue to function. The functioning of the pancreas was a mystery until insulin was discovered in 1922. These substances keep blood sugar balanced—not too high and not too low-- just right for the body to go on its merry way and function without having to think too much about it.
People who have type 1 diabetes (T1D) must take insulin through multiple injections or a pump to survive and most likely have a pancreas that produces no insulin at all. Without insulin, sugar hangs around in the blood stream, unable to enter the cells to produce energy, and therefore produces high blood sugar.
T1D used to be called “juvenile” because it usually occurs in people under 30 years of age, although it can occur at any time during a person’s life. It is caused when the immune system attacks the beta cells of the pancreas, which produce insulin. What is not known is why the immune system kicks into hyper-drive and attacks its own insulin-producing cells. That's the million dollar question, which is still unknown.
Type 1 Diabetes: Graham - JDRF
Type 2 (T2D) usually occurs in people over 40 years of age, hence the term “adult-onset,” and is usually hereditary and related to obesity. The pancreas does not produce enough insulin, or uses it ineffectively. People with T2D may be able to manage their condition with diet, exercise and/or medications, but some will also require insulin.
Type 3, known as gestational diabetes, is a temporary condition that occurs during pregnancy, and may stick around after delivery. It is not caused by a lack of insulin, but by hormones produced pregnancy that makes insulin less effective, also known as "insulin resistance." T1D can occur at any age, so an adult may be diagnosed with “juvenile diabetes.” T2D is now an epidemic among young Native populations in Canada, which many believe to be caused by obesity and changing diets.1 Gestational diabetes is transitional, developing during pregnancy and disappearing after the baby is born. It’s not a lifetime condition like T1D, or a progressive condition like T2D.
Diabetes affects all types of people. People with T1D like me are the minority, comprising about 10 percent of all people with diabetes, while T2D accounts for the other 90 percent of North Americans that have diabetes.
Part of this is a language issue. It matters. It gets lost in translation. In other words, the term “diabetic” is often used to describe both a child with T1D who requires insulin on a daily basis and an adult with T2D who must take medication and follow a diet. This is one of the main difficulties in defining the condition, and it can contribute to misconceptions. Diabetes Australia looks at it this way:
Evidence shows 1 in 2 people find the label unacceptable and 1 in 4 find it harmful. People with diabetes are free to use whatever words they wish. Other people – whether they are working in healthcare, media, research, industry or anywhere – have a responsibility to engage all people affected by diabetes in positive, constructive ways. Labelling a person as ‘diabetic’ runs the risk of causing offense or alienating that person. People are rarely offended by being referred to as a person. This is just one small part of why our language matters. It is so much more than whether we use the words ‘diabetic’ or ‘person with diabetes’. 2
More about this later. Below are the symptoms and risk factors that are used to diagnose diabetes.
Diabetes Symptoms 3
All of the following symptoms are used to diagnose diabetes. If you have any of the following persistent and unexplainable symptoms, visit your physician:
Excessive thirst
Frequent urination
Weight loss
Dry mouth
Drowsiness/lethargy
Blurred vision
Fruity-smelling breath
Risk Factors for Diabetes
For T1D:
Race and ethnicity (specifically people of Aboriginal, African, and Latin American descent)
A family history of diabetes
Exposure to an environmental trigger such as a virus (thought to stimulate an immune system attack against the beta cells of the pancreas). There has been some evidence that COVID-19 might trigger T1D in some people.4
For T2D:
A family history of diabetes
Age (usually over 40 years old)
Obesity
Sedentary lifestyle
Race and ethnicity (specifically people of Aboriginal, African, and Latin American descent)
A previous diagnosis of impaired glucose tolerance
Cheran K, Murthy C, Bornemann EA, Kamma HK, Alabbas M, Elashahab M, Abid N, Manaye S, Venugopal S. The Growing Epidemic of Diabetes Among the Indigenous Population of Canada: A Systematic Review. Cureus. 2023 Mar 15;15(3):e36173. doi: 10.7759/cureus.36173. PMID: 37065334; PMCID: PMC10103803.
Speight J., Skinner T.C., Dunning T., Black T., Kilov G., Lee C., Scibilia R., G. Johnson (2021) Our language matters: Improving communication with and about people with diabetes. A position statement by Diabetes Australia. Diabetes Research and Clinical Practice, p. 173. https://doi.org/10.1016/j.diabres.2021.108655
JDRF statistics: https://jdrf.ca/t1d-basics/signs-symptoms
Wang Y, Guo H, Wang G, Zhai J, Du B. (2023) COVID-19 as a Trigger for Type 1 Diabetes, J Clin Endocrinol Metab., 108 (9), pp. 2176-2183.