Introduction

Before we dive in let’s make sure we are clear on the physiology of diabetes itself.

 

Diabetes is, at its most basic, the presence of elevated blood sugar.

However that is where the simplicity stops, there are commonly two discussed forms of diabetes (but in reality there are dozens of causal factors.)

For the sake of today’s discussion we will refer to them by two categories, (as a side note, as a person with diabetes and clinician it pains me to do this because there is not enough discussion about the many forms of diabetes, so I encourage you to seek further education on this topic outside of today’s course) .

But I digress.

Type 1 Diabetes

Under this umbrella we will put all the pathologies that lead to a loss of the body’s ability to make sufficient insulin for supporting life. This may be auto immune in nature, but it also may be surgical, a result of injury or trauma to the insulin making organ, the pancreas. Or it may be caused as a complication of another illness such as Cystic Fibrosis or a side effect of medications like high dose steroids.

Whatever the cause, these patients can not produce their own insulin in a great enough quantity to stay alive. Without exogenous insulin these patients will go into DKA and die.

 

The second subset we will lump everyone else into is commonly referred to as Type 2 diabetes.

These patients are able to produce insulin, often in large quantities, however for whatever reason their body can not produce sufficient insulin to keep blood sugars in a healthy range. These patients may be managed with adjustments in diet, exercise, lifestyle, oral medications, injectables, insulin, or most likely some combination of these therapies.

Type 2 diabetes may be related to metabolic factors like weight or activity level, but also may have strong genetic, hormonal, pharmacological or other physiologic causes as well.

 

 

As we can see in this image insulin acts as a key to unlock glucose uptake channels in the cells that get glucose form the blood stream into the cells.

In type 1 we just don’t have enough insulin keys to open the doors to glucose lingers in the blood stream to unhealthy levels, and in type 2 diabetes we have a lot of keys, but the locks are not sensitive to them so it takes more and more insulin to get the channels to respond and allow glucose in.

Again there are a number of diverse causes and additional factors in causing elevated blood sugars but these two factors cover the bulk of diabetes causes and focuses of treatment.

But you can see that someone with type 1 diabetes and type 2 diabetes may manage their disease in very different ways. But the resulting imbalance of blood glucose and burden of treatment leads to very similar complication risk profiles in both persons with types 1 and 2.