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Type 1 and Type 2 Diabetes: What’s the Difference?

Carol Baldwin

Last updated: October 20, 2016 7:19 pm

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“Over 23 million people in the United States have diabetes,” says the American Kidney Fund, a nonprofit group. The group is concerned about the growing number of people affected by diabetes, because diabetes is the leading cause of kidney disease. 1

What is Diabetes?

Diabetes is a metabolic disease characterized by the body’s reduced ability to produce insulin, which results in increased levels of glucose (sugar) in the blood.

There are several types of diabetes. The two primary types are type 1, often called juvenile diabetes and type 2, often called adult-onset diabetes.

These two types of diabetes share a common set of symptoms. Symptoms include: fatigue, irritability, frequent urination, excessive thirst or hunger, unexplained weight loss, and blurred vision. 2

While diabetes can affect almost anyone at any age, there are some discernable risk factors:

  • Being over 45 years old
  • Being African American, Hispanic American, Native American or Asian American (type 2 diabetes)
  • Being Caucasian American (type 1 diabetes)
  • Being overweight or obese, having high blood pressure
  • Having a family history of diabetes 3

The American Diabetes Association (ADA) notes that as similar as these two types of diabetes are, they have different causes. Regardless of the cause, according to the ADA, “… two factors are important in both [types].You inherit a predisposition to the disease then something in your environment triggers it.” 4

Type 1 Diabetes

Type 1 diabetes affects only 5 to 10 percent of diabetics, and usually affects people under the age of 20. 5 Typically, type 1 diabetics inherit risk factors from both parents. 6

In this type of diabetes, the body does not make any insulin. Insulin is a hormone manufactured in the pancreas, which is needed to help move glucose (sugar) – the primary source of fuel the body uses for energy – into cells. 7

People with this type of diabetes are insulin-dependent. They must inject insulin into their bodies on a regular basis.

Type 1 diabetes is an autoimmune disease, meaning that the body’s immune system has turned on the body. In the case of type 1 diabetes, the body has attacked its own pancreatic cells responsible for producing insulin. The ADA says, “In experiments that followed relatives of people with type 1 diabetes, researchers found that most of those who later got diabetes had certain autoantibodies in their blood for years before.” While antibodies are proteins that kill bacteria or viruses, autoantibodies attack the body’s own tissues. 8

DKA Diagnosis

One of the most life-threatening complications of diabetes is the development of diabetic ketoacidosis (DKA), the result of a serious chemical imbalance in the body. DKA occurs when cells in the body cannot get enough glucose because there is not enough insulin. 9

When sugar cannot enter your cells, it remains in the blood. The kidneys will then try to remove the excess sugar from the blood and express it through urine. While this is occurring, the body turns to fat reserves as an alternative source of energy. As fat is broken down for energy it releases a byproduct known as ketones into the body, which can then build up in the blood, making it more acidic. 10

While DKA can happen in both types of diabetes, it happens more frequently in type 1 diabetics. The U.S. Food and Drug Administration (FDA) says, “DKA most commonly occurs in patients with type 1 diabetes and is usually accompanied by high blood sugar levels.” 11

Treatment of DKA frequently requires hospitalization, and a DKA diagnosis is made through blood and urine tests. 12

Type 2 Diabetes

In type 2 diabetes, the body produces some insulin, however, it does not produce it in sufficient amounts, or if it does, the body cannot utilize the insulin that it makes. 13

Additionally, type 2 diabetes is associated with aging, obesity, family history, physical inactivity and is more prevalent among people of certain ethnicities. The vast majority of people with this form of diabetes are overweight. 14

However, the ADA says that there is a genetic predisposition to type 2 diabetes, as well. The ADA further explains, “Type 2 diabetes has a stronger link to family history and lineage than type 1, although it too depends on environmental factors.” 15

The ADA notes, “Some scientists believe that a child’s risk is greater when the parent with type 2 diabetes is the mother. If both you and your partner have type 2 diabetes, your child’s risk is about 1 in 2.” 16

Type 2 Diabetes and SGLT2 Inhibitors

Along with diet and exercise, treatment for type 2 diabetes may require medications to regulate blood sugar levels. Newer drugs that may be used in the treatment of type 2 diabetes include sodium glucose cotransporter-2 (SGLT2) inhibitors.  SGLT2 inhibitors include: Invokana (canagliflozin), Farxiga (dapagliflozin), Jardiance (empagliflozin), Invokamet (canagliflozin and metformin), Xigduo XR (dapagliflozin and metformin extended-release), and Glyxambi (empagliflozin and linagliptin).

SGLT2 inhibitors are designed to suppress SGLT2, a protein found in the kidney’s proximal tubules. When uninhibited, SGLT2 prevents the excretion of glucose through urine by causing the kidneys to reabsorb it into the bloodstream. SGLT2 inhibitors discourage this reuptake of glucose in the kidneys, causing it to be expelled in urine. 17

DKA has been reported in type 2 diabetics taking SGLT2 inhibitors.  The FDA and other regulatory agencies have issued safety alerts regarding the risks of DKA and SGLT2 inhibitors.

The FDA’s May 15, 2015 Safety Announcement was prompted by adverse events reports in which people taking SGLT2 inhibitors developed DKA. Many had only slightly elevated blood sugar levels, which the FDA noted as being atypical for DKA. 18

In addition, Health Canada, the health regulatory body equivalent to the FDA for Canada, found a “link between events of acute kidney injury and the use of” two separate SGLTS inhibitors, “Invokana and Forxiga [Farxiga in the U.S.].” 19

If you or a loved one takes these drugs, you may be at greater risk for DKA or renal complications.

  1. American Kidney Fund, Diabetes and Kidney Disease. (2015). Diabetes and Kidney Disease. http://www.kidneyfund.org/are-you-at-risk/risk-factors/diabetes/. Accessed October 23, 2015. 

  2. American Kidney Fund, Diabetes and Kidney Disease. (2015). Diabetes and Kidney Disease. http://www.kidneyfund.org/are-you-at-risk/risk-factors/diabetes/.
    Accessed October 23, 2015. 

  3. American Diabetes Association, Diabetes Basics. (2015). Genetics of Diabetes. http://www.diabetes.org/diabetes-basics/genetics-of-diabetes.html. Accessed October 23, 2015. American Kidney Fund, Diabetes and Kidney Disease. (2015). Diabetes and Kidney Disease. http://www.kidneyfund.org/are-you-at-risk/risk-factors/diabetes/. Accessed October 23, 2015. 

  4. American Diabetes Association, Diabetes Basics. (2015). Genetics of Diabetes. http://www.diabetes.org/diabetes-basics/genetics-of-diabetes.html. Accessed October 23, 2015. 

  5. WebMD, Diabetes Health Center. (2015). Diabetes Overview. http://www.webmd.com/diabetes/diabetes-overview. Accessed October 23, 2015 

  6. American Diabetes Association, Diabetes Basics. (2015). Genetics of Diabetes. http://www.diabetes.org/diabetes-basics/genetics-of-diabetes.html. Accessed October 23, 2015 

  7. WebMD, Diabetes Health Center (2015). Diabetes Overview. http://www.webmd.com/diabetes/diabetes-overview?page=2. Accessed October 23, 2015. 

  8. American Diabetes Association, Diabetes Basics. (2015). Genetics of Diabetes. http://www.diabetes.org/diabetes-basics/genetics-of-diabetes.html. Accessed October 23, 2015. 

  9. American Diabetes Association, DKA (Ketoacidosis) & Ketones. (2015). http://www.diabetes.org/living-with-diabetes/complications/ketoacidosis-dka.html. Accessed October 23, 2015.  

  10. American Diabetes Association, DKA (Ketoacidosis) & Ketones. (2015). http://www.diabetes.org/living-with-diabetes/complications/ketoacidosis-dka.html. Accessed October 23, 2015. 

  11. U.S. Food and Drug Administration, Drug Safety and Availability. (May 2015). FDA Drug Safety Communication: FDA warns that SGLT2 Inhibitors for diabetes may result in serious condition of too much acid in the blood. http://www.fda.gov/Drugs/DrugSafety/ucm446845.htm. Accessed October 23, 2015 

  12. American Diabetes Association, DKA (Ketoacidosis) & Ketones. (2015). http://www.diabetes.org/living-with-diabetes/complications/ketoacidosis-dka.html. Accessed October 23, 2015. 

  13. WebMD, Diabetes Health Center (2015). Diabetes Overview. http://www.webmd.com/diabetes/diabetes-overview?page=2. Accessed October 23, 2015 

  14. WebMD, Diabetes Health Center (2015). Diabetes Overview. http://www.webmd.com/diabetes/diabetes-overview?page=2. Accessed October 23, 2015. 

  15. American Diabetes Association, Diabetes Basics. (2015). Genetics of Diabetes. http://www.diabetes.org/diabetes-basics/genetics-of-diabetes.html. Accessed October 23, 2015. 

  16. American Diabetes Association, Diabetes Basics. (2015). Genetics of Diabetes. http://www.diabetes.org/diabetes-basics/genetics-of-diabetes.html. Accessed October 23, 2015. 

  17. Kelsey Burr et al, “A Case Report of Ketoacidosis Associated with Canagliflozin (Invokana),” presented at the Endocrine Society 97th Annual Meeting and Expo, March 7, 2015. http://press.endocrine.org/doi/abs/10.1210/endo-meetings.2015.dgm.5.sat-595. Accessed October 30, 2015. 

  18. U.S. Food and Drug Administration, Drug Safety and Availability. (May 2015). FDA Drug Safety Communication: FDA warns that SGLT2 Inhibitors for diabetes may result in serious condition of too much acid in the blood. http://www.fda.gov/Drugs/DrugSafety/ucm446845.htm. Accessed October 23, 2015.
    Health Canada, Forxiga, Invokana: Health Canada begins safety review of diabetes drugs known as SGLT2 inhibitors and risk of ketoacidosis. http://healthycanadians.gc.ca/recall-alert-rappel-avis/hc-sc/2015/53892a-eng.php. Accessed October 23, 2015.
    European Medicines Agency, SGLT2 inhibitors. http://www.ema.europa.eu/ema/index.jsp?curl=pages/medicines/human/referrals/SGLT2_inhibitors/human_referral_prac_000052.jsp&mid=WC0b01ac05805c516f. Accessed October 23, 2015.
     

  19. Health Canada, Summary Safety Review – Sodium Glucose Cotransporter 2 (SGLT2) Inhibitors INVOKANA (canagliflozin) and FORXIGA (dapagliflozin) – Evaluation of a Potential Risk of Acute Kidney Injury. http://www.hc-sc.gc.ca/dhp-mps/medeff/reviews-examens/sglt2-eng.php Accessed October 23, 2015.