Differences Between The Types Of Diabetes: Type 1 Diabetes A

Differences Between The Types Of Diabetestype 1 Diabetes Also Called

Differences between the Types of Diabetes Type 1 diabetes, also called juvenile diabetes, is characterized by low or absent insulin production, predominantly affecting children. Patients depend on insulin injections to regulate glucose metabolism and prevent complications like diabetic ketoacidosis. Its etiology is believed to be immune-mediated or idiopathic, with genetic susceptibility linked to Human leukocyte antigen (HLA) class II. Despite the genetic factors, most children with type 1 diabetes have no family history, and environmental factors such as viral infections—including mumps and enteroviruses—may trigger autoimmune destruction of pancreatic beta cells leading to pancreatic failure (Pasi & Ravi, 2022).

Conversely, type 2 diabetes, previously termed adult-onset diabetes, now increasingly diagnosed in children, is strongly associated with obesity and family history. It is characterized by a combination of impaired insulin secretion and insulin resistance. The disease progresses gradually, beginning with cellular insulin resistance. During early stages, pancreatic beta cells compensate by secreting more insulin to maintain normal blood glucose levels. Over time, beta cell function declines, leading to inadequate insulin secretion relative to the body's needs, and hyperglycemia becomes evident. The disease severity intensifies as insulin secretion diminishes further (Taylor, Yazdi & Beitelshees, 2021).

Gestational diabetes mellitus (GDM) occurs during pregnancy and is defined by any degree of glucose intolerance first recognized during gestation. It arises from metabolic changes during pregnancy that cause insulin resistance, leading to maternal hyperglycemia. Factors contributing to GDM include obesity, family history, prediabetes, increased maternal age, and ethnicity. Blood glucose levels typically return to normal postpartum; however, persistent hyperglycemia mandates diagnosis and treatment as type 2 diabetes (Choudhury & Rajeswari, 2021).

Pharmacologically, metformin is a first-line drug used to treat type 2 diabetes. It belongs to the biguanide class and has been proven to reduce blood glucose levels by activating AMP-activated protein kinase, inhibiting hepatic glucose production, and modifying gut glucose absorption. Importantly, metformin does not stimulate insulin secretion, thereby minimizing the risk of hypoglycemia when used alone. It also has a role in reducing the risk of developing diabetes and promotes moderate weight loss (Flory & Lipska, 2019).

Metformin's mechanism involves decreasing hepatic gluconeogenesis primarily, with some actions occurring in the gut, which reduces intestinal glucose absorption. It is not metabolized but excreted unchanged via the kidneys, highlighting the importance of renal function monitoring, especially in patients with impaired kidney function. Available in immediate-release and extended-release formulations, starting doses are typically low (500 mg daily) and titrated based on individual tolerance and glycemic response. Common side effects include gastrointestinal disturbances like nausea and diarrhea. Contraindications include renal impairment, acute heart failure, hepatic failure, and conditions predisposing to lactic acidosis (Rosenthal & Burchum, 2021; Flory & Lipska, 2019).

Effective management of type 2 diabetes with metformin involves combining pharmacologic therapy with lifestyle modifications, including healthy dietary choices emphasizing low glycemic index foods, high fiber intake, and regular physical activity. Early intervention upon diagnosis is critical to prevent short- and long-term complications. Short-term effects of uncontrolled diabetes include hyperglycemia-related symptoms such as polydipsia, polyuria, blurred vision, fatigue, and headache. Long-term sequelae encompass diabetic nephropathy—the leading cause of end-stage renal disease—along with macrovascular complications like atherosclerosis, myocardial infarction, and stroke. Additionally, diabetic retinopathy, neuropathy, non-alcoholic fatty liver disease, and even pulmonary fibrosis are linked to chronic hyperglycemia (Demir et al., 2021).

In conclusion, understanding the distinctions among the various types of diabetes is essential for targeted management and prevention strategies. Type 1 diabetes primarily involves autoimmune destruction of pancreatic beta cells, necessitating insulin therapy. Type 2 diabetes involves insulin resistance and relative insulin deficiency, where medications like metformin play a pivotal role. Gestational diabetes, when managed appropriately, often resolves postpartum but requires monitoring due to increased future risks. Pharmacologic treatments, particularly metformin, along with lifestyle interventions, remain central in controlling blood glucose and reducing diabetes-related morbidity and mortality (Taylor, Yazdi & Beitelshees, 2021; Pasi & Ravi, 2022).

References

• Choudhury, A., & Rajeswari, V. D. (2021). Gestational diabetes: A metabolic and reproductive disorder. Biomedicine and Pharmacotherapy, 143.
• Demir, S., Nawroth, P. P., Herzig, S., & Ustunel, B. E. (2021). Emerging targets in type 2 diabetes and diabetic complications. Advanced Science, 8.
• Flory, J., & Lipska, K. (2019). Metformin 2019. Journal of American Medical Association.
• Pasi, R., & Ravi, K. S. (2022). Type 1 diabetes mellitus in pediatric age group: A rising endemic. Journal of Family Medicine and Primary Care, 11(1), 27-31.
• Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.). Elsevier.
• Taylor, S. I., Yazdi, Z. S., & Beitelshees, A. L. (2021). Pharmacological treatment of hyperglycemia in type 2 diabetes. The Journal of Clinical Investigation, 131(2). https://doi.org/10.1172/JCI142243