Type 1 vs. Type 2 Diabetes: Differences and Similarities

by Ginger Vieira Health Writer & Patient Advocate

Regardless of which type of diabetes you have, it can be difficult to understand what is happening to your body. Despite having very similar symptoms and medical risks, the two primary types of diabetes are actually very different when you look closely at what’s going on inside the body. Learn more about the main differences and similarities between type 1 and type 2 diabetes.

What causes diabetes?

TYPE 1: Type 1 diabetes is an autoimmune disease which means it’s caused when your own immune system attacks the part of the pancreas responsible for producing insulin: the islet cells (or also known as the pancreatic beta cells).

Researchers still aren’t sure exactly why the body gets so confused and perceives these cells as a foreign body worth attacking, but they do know stressful events or severe illness can be a common trigger for those who are predisposed to developing the disease.

In other words, the following list is not what causes the disease but what simply triggers the onset in a person’s body who was born with the predisposition to develop type 1 diabetes:

  • The flu or other severe bout with a virus

  • A divorce

  • An extremely stressful or unhealthy job

  • The traumatic loss of a loved one

  • Severe inflammation within the body from any variety of causes

  • Pregnancy and/or childbirth

These are examples of stressful (either emotionally or physically) events that have been known to occur right before the onset of a person’s type 1 diabetes symptoms and diagnosis.

Eventually, a person with type 1 diabetes will produce essentially no insulin.

TYPE 2: While the media has portrayed type 2 diabetes as a disease caused by eating too many doughnuts, that’s hardly the full or accurate story. The cause of type 2 diabetes is a bit of a mystery, much like the question of “Which came first: the chicken or the egg?”

While people diagnosed with type 2 diabetes are often overweight or obese at the time of diagnosis, in many cases that person’s insulin resistance and lack of sufficient insulin production or sufficient insulin efficacy is what may have contributed largely to their weight-gain.

As their blood sugars rise from increasing difficulty producing and using insulin, insulin resistance rises too with the gradual weight-gain. To make matters worse, the resulting high blood sugars easily cause a person to severely crave more sugar and more food in general which inevitably adds more fuel to the fire.

For some people with type 2 diabetes, an awareness of a family history means that taking steps to be very mindful of your diet and exercise habits can help to prevent a diagnosis but this isn’t true for all.

People with type 2 diabetes will always produce some insulin but it’s either an insufficient amount to meet the body’s demands, or their body is struggling to properly make use of the insulin produced.

What are the symptoms of diabetes?

TYPE 1 & TYPE 2: Most symptoms are the same between the two primary types of diabetes.

  • extreme thirst

  • frequent need to urinate

  • craving sugar

  • sour-fruity smelling breath

  • blurry vision

  • extreme fatigue and tiredness

  • urinary tract infections

  • yeast infections (in men or women)

  • dry mouth

  • weight-loss (type 1s)

  • weight-gain (type 2s)

  • numbness and tingling in the toes, feet, or fingers

  • difficulty with wounds healing or becoming easily infected (type 2s)

TYPE 1: The symptoms of type 1 diabetes usually come on very quickly compared to type 2. In children, the symptoms can become very severe over just a couple of weeks. In adults, the onset can be a bit more gradual, increasing in severity over the course of a few months.

Undiagnosed patients with type 1 diabetes can develop DKA (diabetic ketoacidosis). This condition occurs when blood sugar levels are extremely high and insulin production is at zero or extremely low. The symptoms of DKA are all of the symptoms listed above as well as vomiting and loss of consciousness. It can result in death if left untreated.

If you have diagnosed type 1 diabetes and are vomiting and unable to even keep water down, you need to visit an emergency room immediately.

TYPE 2: The symptoms of type 2 diabetes are generally very gradual, even over the course of years as the body struggles more and more to produce or properly use its own insulin.

Patients with type 2 diabetes cannot develop DKA because there is always insulin present. While they absolutely develop ketones, the severity of those ketones never reaches a level of DKA.

How is diabetes diagnosed?

Diagnosing diabetes is very straight-forward for both types, but type 1 diabetes comes on so quickly that patients generally get to the hospital quickly. Type 2 diabetes, however, comes on so slowly that it can easily go undiagnosed for years if you aren’t going to your primary care doctor regularly for check-ups.

TYPE 1: Type 1 diabetes is easy to diagnose once a doctor has a chance to test your urine and prick your finger for a blood sample, but the symptoms can easily be overlooked for the flu, so it’s important to always have your child or yourself as an adult tested for type 1 diabetes at that time as well.

Testing the urine for ketones and the blood for a blood glucose reading is very fast and easy at the doctor’s office or in an emergency room.

Type 1 diabetes used to be considered a disease that was always diagnosed during childhood but the rates of adult diagnoses has climbed dramatically, and is very common now.

An uninformed doctor may dismiss a type 1 diagnosis just because of the patient’s age, and misdiagnose them as a type 2. In this case, the patient can ask for an autoantibodies test to clearly determine which type they have.)

TYPE 2: Type 2 diabetes is also straight-forward to diagnose based on an A1c test and a blood glucose test, but there are a couple of stages.

  • Pre-diabetes: A1c above 5.6 percent

  • Type 2 diabetes: A1c above 6.5 percent

  • Pre-diabetes: fasting blood sugar above 100 mg/dL

  • Type 2 diabetes: fasting blood sugar above 126 mg/dL

Occasionally, an adult is misdiagnosed with type 2 diabetes when they actually have developed LADA (the slow onset of type 1 diabetes).

How is diabetes treated?

TYPE 1: A person diagnosed with type 1 diabetes will need to begin taking insulin immediately. Depending on the severity of ketone levels, a short stay in the hospital may be necessary to get saline through an IV to flush out the ketones, rehydrate the body, and stabilize fully before heading home.

Type 1 diabetes requires constant, 24/7 attention to the balancing act of food, activity, insulin, and some non-insulin diabetes medications.

Other variables such as hormones, stress, weight-gain or weight-loss, age and growth, and menstruation all impact blood sugar levels and insulin needs. Perfection is neither expected nor reasonable to demand of any patient with type 1 diabetes, but encouraging patients to do the best they can with the medications, technology, and knowledge available today is crucial.

Thanks to many advancements in technology, people with type 1 diabetes have a variety of choices when it comes to how they take their insulin with pumps, pods, and insulin pens.

Every person living with type 1 diabetes needs their own glucose meter to check your blood sugar at least 4x per day. Many patients today are also using continuous glucose monitors (CGMs).

TYPE 2: Treating type 2 diabetes comes with many more medication options than type 1 diabetes because not all type 2 patients will need to start taking insulin.

  • Some patients can improve their blood sugars without medication by improving nutrition and exercise habits and losing weight.

  • Some patients will take non-insulin oral medications like glucophage (Metformin) to help their body make better use of the insulin they produce, help their pancreas produce more insulin, and reduce the amount of glucose released from the liver.

  • Some patients will take non-insulin injectable medications that help their body make better use of the insulin they produce, help their pancreas produce more insulin, and reduce the amount of glucose released from the liver.

  • Some patients will need to take insulin.

  • All patients, even those taking medications, should focus on improving daily habits around nutrition and exercise to naturally improve their sensitivity to insulin.

Patients with type 2 diabetes should also check their blood sugar every day as guided by their doctor, along with A1c tests at their doctor’s office every 3 to 6 months.

Is there a cure for diabetes?

TYPE 1: There is currently no cure for type 1 diabetes. If you are related to a person with type 1 diabetes but you have not developed type 1 diabetes yourself, consider participating in TrialNet’s ongoing research to monitor any potential production of autoantibodies which develop long before a diagnosis would occur.

TYPE 2: While it isn’t considered a cure, many patients with type 2 diabetes are able reverse their insulin resistance and high blood sugars through changes in how they eat, how often they exercise, and by losing weight. If they maintain that weight-loss and those changes in nutrition and activity level, they are managing their diabetes naturally, and maintaining non-diabetic blood sugar levels, or nearly non-diabetic blood sugar levels.

Some patients with type 2 diabetes will require medications and/or insulin for the rest of their lives depending on the cause of their diabetes in the first place. If insulin production or amylin production is impaired, they may always need the help of medications to maintain healthy blood sugar levels.

Every person with type 2 diabetes brings their own set of genetics, predispositions, and challenges. Be sure that you have a healthcare team that supports you and helps you to learn about your many medication options while also working to improve habits around food and exercise.

What are the risks and complications of diabetes?

Chronic high blood sugars lead to complications in all types of diabetes.

In a nutshell: the higher your blood sugars are, the more damage occurs to the nerve-endings in your fingers, toes, eyes, and kidneys, along with increased inflammation and stress throughout your body.

Perfection isn’t necessary to live a long, healthy life with diabetes. Working with your healthcare team to find the right balance of medications and changes in diet and exercise to achieve the best blood sugar levels for you requires patience, persistence, and a great deal of self-discipline. Don’t give up!

How should a person with diabetes eat?

Paying close attention to your diet and exercise habits in life with type 1 and type 2 diabetes is a tremendous part of living well with diabetes.

While there is a great deal of confusion and controversy over whether people with diabetes should eat low-carb diets, low-fat diets, plant-based diets, or ketogenic diets, the one thing everyone can agree on is: mostly whole foods that you prepared yourself.

A diet full of processed crackers, cookies, breads, candy, soda, chips and other processed junk isn’t good for anyone, especially for people with diabetes.

Focus on increasing the amount of whole, real food in your diet, learning to cook more meals for yourself, and reducing your consumption of processed food with long lists of ingredients that are not real food.

Ginger Vieira
Meet Our Writer
Ginger Vieira

Ginger Vieira has lived with Type 1 diabetes and Celiac disease since 1999, and fibromyalgia since 2014. She is the author of Pregnancy with Type 1 Diabetes, Dealing with Diabetes Burnout, Emotional Eating with Diabetes, and Your Diabetes Science Experiment. Ginger contributes regularly for Diabetes Strong, Healthline, HealthCentral, DiabetesDaily, EverydayHealth, and her YouTube channel. Her background includes a B.S. in professional writing, certifications in cognitive coaching, Ashtanga yoga, and personal training, with several records in drug-free powerlifting. She lives in Vermont with her husband, their two daughters, and their dog, Pedro.