Types of Diabetes

There are three types of diabetes mellitus, Type I (previously referred to as Insulin Dependent Diabetes Mellitus, IDDM), Type II (previously referred to as Non-insulin Dependent Diabetes Mellitus, NIDDM), and gestational diabetes that occurs during pregnancy.

Type I Diabetes

Type I diabetes represents approximately 5-10% of diabetic patients. It usually has a rapid onset and most frequently manifests in children and adolescents (juvenile onset). Type I diabetes is thought to result from the immune system mistakenly recognizing the insulin producing cells (beta-cells) in the pancreas as “foreign” and destroying them. Because the body cannot use the dietary glucose, the level in the blood is elevated, excess glucose is lost in the urine taking with it a large amount of water (resulting in frequent urination), and weakness, thirst and hunger result. Frequently weight loss is seen. The treatment for type I diabetes is insulin replacement.

A serious complication of type I diabetes is the development of ketoacidosis. As a result of cellular starvation, excessive fat breakdown causes the production of fatty acids that are converted into substances called ketone bodies. At high levels these substances are toxic. This condition most often occurs in adolescents that do not take their insulin as scheduled, but can also occur in the presence of infections or major forms of stress. There has also been concern that a large percentage of teenage girls with type I diabetes cut back on their insulin to promote weight loss. Proper use of insulin is vital for preventing short and long term complications.

Type II Diabetes

Worldwide, some 120 million Type II diabetics (adult onset) are able to produce insulin but the liver and muscle cells are resistant to its actions. Some type II diabetics can be effectively treated with diet alone, but many require oral medications. It is common for insulin to be needed as the disease progresses. Historically, this has been thought of as maturity onset diabetes because it tends to occur after age 50, but there has been a dramatic increase in the number of adolescents with the disease. This is thought to be due to increased obesity and decreased physical activity in this age group.

Gestational Diabetes

Gestational diabetes is diabetes that is first diagnosed during pregnancy. Hormones produced by the placenta oppose the action of insulin in order to provide food for the growing baby. In gestational diabetes, these hormones cause elevated blood glucose levels and can cause the baby to grow to a size larger than normal. This increases the risk for a difficult delivery. If diet alone is insufficient to provide blood sugar control, insulin is the treatment of choice. Some oral agents may be used during the 2nd or 3rd trimester, but they are not used during the 1st trimester since little is known about their effects on the developing baby at this critical stage.