The main difference is type 1 is autoimmune and type 2 is not
Medically reviewed by Do-Eun Lee, MD
Type 1 diabetes is an autoimmune condition in which the immune system attacks and destroys the insulin-producing cells in the pancreas. Type 2 diabetes is a chronic condition that develops slowly over time due to several risk factors. While the two conditions have similarities, there are some differences in how they are managed.
This article explores and compares type 1 and type 2 diabetes, including who is most affected, how the conditions affect insulin and the pancreas, symptoms, and treatment. It also discusses managing the conditions with monitoring, diet, and medications.
Facts About Type 1 vs. Type 2 Diabetes
While both type 1 and type 2 diabetes result in high blood glucose (sugar) levels, differences exist in how they develop and in treating and managing the diseases. Getting an accurate diagnosis from a healthcare provider will help ensure you receive proper care and treatment.
People Aren’t Born With Type 1 or Type 2 Diabetes
Diabetes is not a condition with which you are born. Some people are born with certain genes that make them more likely to develop diabetes. However, many people with these genes never go on to develop diabetes.
An environmental trigger, such as a virus, may play a role in causing type 1 diabetes to develop. While infants under 6 months can develop type 1 diabetes, it is very rare.
On the other hand, family history, lifestyle habits, and environment may influence the development of type 2 diabetes. It also is diagnosed more often in certain ethnic or racial populations in the United States.
One Isn’t “Worse” Than the Other
While there may be differences in treatment, one type of diabetes isn’t “worse” than the other. Both are chronic medical conditions that require daily self-management. If not managed properly, both types can lead to serious health consequences, such as:
Heart disease and stroke
Gum disease and other dental problems
Sexual and bladder problems
Risk Factors for Type 1 and Type 2 Diabetes
Researchers haven't pinpointed an exact cause of type 1 diabetes. However, they have found that someone is more likely to develop type 1 diabetes if they have the following risk factors:
Have an immediate family member with type 1 diabetes
Have certain autoantibodies in their blood (immune proteins directed against the body's tissues)
Had certain viral infections
Had certain environmental triggers
Type 2 diabetes is associated with several factors, including certain lifestyle habits and genetics. These include:
Family history of type 2 diabetes (in a parent or sibling)
Had gestational diabetes (diabetes developing during pregnancy)
Are 45 years or older
Do not exercise regularly
Have overweight or obesity
In the United States, type 2 diabetes is more often diagnosed in these ethnicities: Black, Latinx, American Indian, Alaska Native, Pacific Islanders, or Asian.
Is Type 1 or Type 2 Diabetes More Serious?
Both type 1 and type 2 diabetes are serious conditions and require careful and thoughtful management.
However, some people consider type 1 diabetes to be more serious because it is an autoimmune condition. In addition, all people with type 1 diabetes require insulin in order to survive, whereas not all people with type 2 diabetes need to take insulin as part of their treatment plan.
Nevertheless, you cannot base the seriousness of someone’s disease simply on the medication they take or don’t take.
It’s important to keep in mind that even though some people consider type 2 diabetes to be less serious than type 1 diabetes, this does not mean people with type 2 diabetes can be lax in following their treatment plan or fall back into old lifestyle habits. Unmanaged type 2 diabetes can quickly become very serious.
Insulin and Pancreas in Type 1 vs. Type 2 Diabetes
Type 1 diabetes, previously known as juvenile diabetes or insulin-dependent diabetes, is an autoimmune condition in which the immune system attacks and destroys the insulin-producing cells in the pancreas. As a result, the body is no longer able to make insulin.
Insulin is a hormone that helps decrease blood glucose levels. It allows cells to take glucose out of the blood and into the cells to produce energy.
Type 2 diabetes is a chronic condition that develops slowly over time. With type 2 diabetes, your body doesn't use insulin properly, called insulin resistance. Over time, this results in high blood sugar levels.
If insulin resistance persists, people with type 2 diabetes can also develop deficiencies in insulin production and require insulin replacement as part of their treatment plan.
Typical Age of Diagnosis
While both type 1 and type 2 diabetes can be diagnosed at any age, they are typically diagnosed during different life stages.
Type 1 Diabetes
Type 1 diabetes is more commonly diagnosed in children, teens, and young adults. Most type 1 diabetes diagnoses occur between the ages of 4 to 7 years and 10 to 14 years. However, research suggests that more than half of all new type 1 diabetes diagnoses are in adults.
Types 2 Diabetes
Type 2 diabetes is most often diagnosed in middle-aged adults and older, though more and more younger people are developing type 2 diabetes.
Your risk of developing type 2 diabetes increases with age, particularly after age 45. Most type 2 diabetes diagnoses occur between the ages of 45 and 64.
Identifying Symptoms: How Does Type 1 vs. Type 2 Diabetes Feel?
The symptoms that occur with type 1 and type 2 diabetes are due to high blood glucose levels and are very similar. However, a big difference between type 1 and type 2 diabetes symptoms is how quickly they appear.
Type 1 diabetes symptoms tend to come on suddenly, while symptoms of type 2 diabetes usually develop slowly over time. Sometimes, people with type 2 diabetes don’t notice any symptoms or not until blood sugar levels are extremely high.
Common symptoms of both type 1 and type 2 diabetes include:
Frequent urination (unusual bed wetting in children is common with type 1)
Dry, itchy skin
Cuts, wounds, or bruises that don’t heal or heal slowly
Unexplained weight loss (more common with type 1)
How Treatment Differs for Type 1 vs. Type 2 Diabetes
Because of the different causes and treatments for type 1 and type 2 diabetes, it is critical to receive a proper diagnosis. While the aim for diabetes treatment (to stabilize blood glucose levels) may be similar, the treatments for type 1 vs. type 2 diabetes can be very different.
Treatment for Type 1 Diabetes
Because their body can no longer make insulin, people with type 1 diabetes require exogenous (from outside the body) insulin to survive. Insulin can be administered via syringe or pen injection, insulin pump, or insulin inhaler. Other injectable medications are also available for people with type 1 diabetes.
An artificial pancreas, or automated insulin-delivery system, is a newer treatment option available for people with type 1 diabetes. An artificial pancreas is a three-part wearable system that works together to mimic how a healthy pancreas controls blood glucose in the body.
Can Type 1 Diabetes Be Prevented?
Researchers have long been investigating ways to help cure or prevent the development of type 1 diabetes. In November 2022, the Food and Drug Administration (FDA) approved a medication to delay the onset of type 1 diabetes.
Tzield (teplizumab), is given intravenously once daily for 14 consecutive days. It is approved for use in people with stage 2 type 1 diabetes (having dysglycemia—in which blood sugar levels are either too high or too low—and before they have symptoms) to help delay the progression of the disease to stage 3 type 1 diabetes (present with dysglycemia and have symptoms).
Treatment for Type 2 Diabetes
People with type 2 diabetes often still produce some insulin in their body. Because of this, only some people with type 2 diabetes use insulin as part of their treatment plan.
Oral medications (pills) or medication injections are commonly prescribed to people with type 2 diabetes. Currently, only people with type 2 diabetes can use pills to manage their diabetes.
Besides insulin, several different classes (types) of medications are used for type 2 diabetes. These work in different ways to help lower blood glucose levels. They include:
Alpha-glucosidase inhibitors, such as Precose (acarbose)
Biguanides, such as Glucophage (metformin)
Bile acid sequestrants, such as Colestid (colestipol) or Welchol (colesevelam)
Dopamine-2 agonists, such as Cycloset (bromocriptine)
DPP-4 inhibitors. such as Janumet (sitagliptin), Jentadueto (linagliptin), Kazano (alogliptin), or Kombiglyze (saxagliptin),
Meglitinides. such as Prandin (repaglinide)
SGLT2 inhibitors. as Glyxambi (empagliflozin). Invokana (canagliflozin), or Xigduo (dapagliflozin)
Sulfonylureas. such as Glucotrol (glipizide)
Thiazolidinediones (TZDs), such as Actos (pioglitazone) or Avandia (rosiglitazone)
Oral combination therapy, such as Trijardy XR (empagliflozin/linagliptin/metformin hydrochloride extended-release)
Aside from medication and blood glucose monitoring, lifestyle habits are a big part of self-management with type 2 diabetes, such as:
Regular physical activity
Making healthy food choices
Managing your blood pressure
Keeping your cholesterol in normal ranges
Losing weight, if needed
Can Diabetes be Reversed?
Currently, there is no known cure for type 1 diabetes. However, maintaining healthy blood glucose levels can prevent or delay diabetes-related complications.
On the other hand, weight-loss (bariatric) surgery is used by some people with obesity and type 2 diabetes to help them lose weight and improve blood glucose levels. All of the different types of weight-loss surgery make changes to your digestive tract.
Some people with type 2 diabetes who have undergone weight-loss surgery have had their blood glucose levels return to normal and no longer need to use diabetes medications, putting their diabetes in remission. However, risks are associated with weight-loss surgery.
How long the improved blood glucose levels last varies from person to person. The amount of weight lost, how long a person has had diabetes, and whether they used insulin also influence blood glucose level improvement.
Research is underway to determine if weight-loss surgery is an option for people with obesity and type 1 diabetes to help manage their blood glucose levels.
How to Monitor Glucose Levels
Keeping blood glucose levels in your target range(s) is the most important part of diabetes management, regardless if you have type 1 or type 2 diabetes.
As part of daily self-management, blood glucose levels can be monitored in several different ways. One of the most common ways is to use a glucometer (blood glucose meter). A glucometer is a small, portable device that measures the amount of glucose in your blood.
First, test strips are inserted into the glucometer. Next, using a lancet and/or lancing device, you prick the tip of your finger. You then place a small drop of blood on the test strip. The device displays the results within seconds.
Type 1 Diabetes
Recommended testing times include:
Before and after eating (meals and snacks)
Before and after exercise
Possibly during the night
If you get sick, you may need to test more frequently.
However, many people with type 1 diabetes use a wearable continuous glucose monitor (CGM) that automatically and frequently checks their blood glucose levels throughout the day.
Type 2 Diabetes
If you have type 2 diabetes, how often you check your blood sugar can depend on how severe your symptoms are and what medications you use to manage your condition.
Some people with type 2 diabetes may not need to check their blood glucose levels daily, while others have CGM devices to monitor their blood glucose levels throughout the day frequently.
If unsure when or how often to check your blood glucose levels, consult a healthcare provider to set up a diabetes treatment and management plan.
Role of Diet in Type 1 vs. Type 2 Diabetes
As with anyone, a healthy diet is important for people with type 1 diabetes. People with type 1 diabetes often have to count carbohydrates in what they eat and drink to know the correct dosage for their insulin.
People with type 2 diabetes also need to follow a healthy eating pattern. Shifting your eating pattern to include more whole fruits, vegetables, whole grains, lean protein, and healthy fats, and less refined grains, saturated fats, and added sugars can help improve blood sugar levels.
If someone with type 2 diabetes is not taking a fast-acting insulin, they may not need to count carbohydrates. Nevertheless, it’s important for anyone with diabetes to know what foods and beverages contain carbohydrates.
Paying attention to how your body responds to different carbohydrate-containing foods and beverages with respect to blood glucose levels after eating is an important aspect of diabetes self-management.
Ways to Manage Each Type of Diabetes
Along with frequently monitoring blood glucose levels, a balanced eating pattern, and regular physical activity are important for people with type 1 diabetes to help manage their condition. Keeping other aspects of health in normal ranges is important, too, such as blood pressure and cholesterol levels.
With many risk factors for type 2 diabetes being modifiable, there are ways to help prevent or delay complications of type 2 diabetes. Along with a healthy diet, these include:
Lose weight, if needed
Manage your blood pressure
Keep your cholesterol in the normal range
Medications, if needed
Every person with diabetes should have regular health visits with the different providers on their healthcare team, which may include a:
Primary care provider
Foot doctor (podiatrist)
Eye doctor (ophthalmologist)
Registered dietitian nutritionist
Type 1 and type 2 diabetes are chronic medical conditions in which people need to self-manage their blood glucose levels. Type 1 diabetes is an autoimmune condition, while type 2 diabetes is largely related to lifestyle habits and family history.
Type 1 diabetes is more commonly diagnosed in children and teens. Type 2 diabetes is usually diagnosed in adults. However, anyone of any age can be diagnosed with either type of diabetes.
People with type 1 diabetes require insulin as part of their treatment plan, while people with type 2 diabetes might control their diabetes with diet, exercise, and/or medications. Type 1 diabetes has no known prevention or cure. Type 2 diabetes may be prevented or delayed with lifestyle modifications and/or medications.
Read the original article on Verywell Health.