Diabetes: Understanding the Types and Risks as Knowledge Expands

While diabetes is commonly known to have three primary types — Type 1, Type 2, and gestational diabetes — experts are discovering that the boundaries between these forms are becoming less defined, with each type affecting people at various stages of life in distinct ways.

What is Diabetes?

Diabetes is a chronic condition where blood glucose, or sugar, remains elevated because the body can’t process it properly. Insulin, produced by the pancreas, plays a crucial role in moving glucose from the bloodstream into cells to be used as energy. When insulin production is insufficient or cells become resistant to it, blood sugar levels stay high, leading to a range of symptoms:

• Frequent urination and thirst due to the kidneys filtering out excess sugar.
• Extreme hunger because the body’s cells aren’t receiving glucose for energy.
• Unintended weight loss as the body starts breaking down muscle and fat for energy.
• Blurred vision caused by fluctuating fluid levels.
• Persistent fatigue as glucose, the main energy source, isn’t reaching cells.
• Slow-healing wounds and increased infections due to weakened immune function.
• Numbness or tingling in extremities, indicating nerve damage.

Long-term, high blood sugar levels can lead to serious health problems, including heart disease, stroke, kidney failure, and nerve damage.

Three Major Types of Diabetes

1. Type 1 Diabetes Type 1 diabetes is an autoimmune disorder in which the body’s immune system mistakenly attacks insulin-producing beta cells in the pancreas. This form of diabetes is less common, affecting about 1.6 million Americans. It typically develops in children or young adults, though it can emerge at any age. Individuals with Type 1 diabetes must take insulin to control blood sugar levels.
   • Subtypes of Type 1: Dr. Andrey Manov, an endocrinologist at MountainView Hospital, explains that Type 1 diabetes can be classified into Type 1a and Type 1b. Type 1a is autoimmune, while Type 1b, which is non-autoimmune, appears predominantly in certain ethnic groups, including those of Asian and sub-Saharan African descent. Some lesser-known forms, like LADA (latent autoimmune diabetes in adults), also exist and may initially appear similar to Type 2 diabetes.
   • Risk Factors and Symptoms: Type 1 diabetes has genetic links, so family history is a strong predictor. Symptoms often appear suddenly, which is why timely testing and diagnosis are crucial.
2. Gestational Diabetes Gestational diabetes occurs only during pregnancy and affects approximately 2-10% of pregnant individuals in the U.S. Doctors usually test for it between the 24th and 28th weeks. The condition arises when pregnancy-related hormones make cells more resistant to insulin, causing blood sugar to rise.
   • Risks to Mother and Child: Gestational diabetes can increase the risk of high birth weight, premature delivery, and respiratory distress for the baby. The mother is also at higher risk for developing Type 2 diabetes later.
   • Resolution and Monitoring: Gestational diabetes often resolves after childbirth, but both mother and child remain at increased risk of future diabetes. Dr. Manov advises regular testing post-pregnancy for early detection.
3. Type 2 Diabetes Type 2 diabetes is the most prevalent type, affecting over 34 million people in the U.S., though many cases are undiagnosed. Unlike Type 1, Type 2 diabetes typically develops slowly and is often linked to lifestyle factors, including a high-calorie diet, sedentary behavior, and obesity. It’s more common in people over 40, but cases are rising among younger individuals.
   • Mechanisms and Risk Factors: In Type 2 diabetes, the body either doesn’t produce enough insulin or becomes resistant to it. Risk factors include family history, ethnicity (higher among African American, Hispanic, Native American, and Pacific Islander groups), obesity, and age. Dr. Manov estimates that nearly 80-90 million Americans have prediabetes, a condition with elevated blood sugar that often precedes Type 2 diabetes.
   • Treatment and Management: Type 2 diabetes is usually managed through lifestyle modifications and medication. Dr. Manov recommends a Mediterranean diet, rich in whole foods like vegetables, fruits, lean proteins, and healthy fats, which helps regulate blood sugar levels. Exercise is also essential, as it increases insulin sensitivity and aids in weight management.
   • Complications and Prevention: Left untreated, Type 2 diabetes can lead to severe complications, including heart disease, nerve damage, and vision loss. However, studies such as the Diabetes Prevention Program have shown that weight loss, increased physical activity, and dietary changes can significantly lower the risk of developing Type 2 diabetes, particularly for those with prediabetes.

Lesser-Known Types and Emerging Research

As more research emerges, the distinctions between types of diabetes are blurring. Doctors are now exploring several subtypes and genetic markers that may explain variations in treatment response and disease progression.

Some conditions, such as MODY (Maturity Onset Diabetes of the Young) and neonatal diabetes, have genetic underpinnings that don’t fit into the typical Type 1 or Type 2 classifications. These forms are rarer and often present different management challenges.

Dr. Manov believes that as research continues, new insights will further personalize diabetes treatment. “There are many types of diabetes, and understanding your specific diagnosis is essential for choosing the right treatment plan,” he says.

Conclusion

The rise in diabetes cases underscores the importance of awareness, regular screening, and early intervention. “Diabetes is treatable, and Type 2 can even be preventable with the right diet, exercise, and weight control,” says Dr. Manov. For those with risk factors or symptoms, consulting a doctor early can lead to better management and quality of life.