Diabetes Health Center

Type 1 in a Type 2 World

Andrea Kolligian has learned that she's likely to get well-meaning comments if she eats a donut.

"Can you eat that? Are you sure you can eat that?" a friend or coworker will ask.

Kolligian, an administrative assistant at the Dana-Farber Cancer Institute in Boston, was diagnosed with type 1 diabetes when she was a teenager, and has been taking insulin ever since. But like many people with type I diabetes, she's learned that the growing prevalence of the type 2 form of the disease, which is often linked to weight and lifestyle, makes for a lot of misunderstandings about her own health.

"People assume that you have type 2. They ask if you've lost a lot of weight, or they'll say, ‘But you don't look fat!'" she says.

In fact, the many myths and misconceptions about type 1 vs. type 2 have even sparked a movement to have type I diabetes renamed. A Facebook group, called "Rename Type I," now has 861 members and has compiled suggestions for new names ranging from IDS (Islet Destruction Syndrome) to ABCD (Autoimmune Beta Cell Degeneration) or just plain Pancreatic Failure.

Similarities and Differences

About 25 million people in the United States -- more than 8% of the population -- have diabetes. About 95% of them have type 2 diabetes, while only about 5% have type 1.

Many of the public health messages about lifestyle strategies for people with diabetes don't distinguish between type 1 and type 2 diabetes. Weight, nutrition, and exercise matter for both types of diabetes, but people with type 1 diabetes need more than that to control their diabetes.

"They just say ‘diabetes,' which can be confusing," says Jessica Markowitz, PhD, a clinical psychologist who runs a support group for young adults with type 1 diabetes at the Joslin Diabetes Center in Boston.

Both forms of diabetes involve problems with insulin, a hormone that the body needs to use blood sugar for energy.

Type 1 diabetes, which used to be called juvenile diabetes because it is more often diagnosed in children and young adults, occurs when the body's immune system attacks the cells of the pancreas that make insulin. People with type 1 must take insulin therapy to survive.

In type 2 diabetes, the pancreas still makes insulin, but the body cannot use it properly. The pancreas responds by making more, until it eventually loses its ability to generate the hormone. People with type 2 may eventually have to take insulin, but early on in the disease, they usually take oral medications only and can sometimes control it with diet and other lifestyle changes alone.

Type 2 has a strong genetic component, and obesity and poor diet often play a role in developing the disease. It was once known as adult-onset diabetes, but as the childhood obesity epidemic increased, more and more children began to develop type II, so the name was changed.