By- Dr. Jonathan Wood
My work with children and teens with Type I Diabetes Mellitus and its life-threatening acute complications has led me to realize there is quite a bit of confusion about what diabetes is and what the differences are between the two main types. This is important stuff.

The confusion is understandable. We use the same word to describe 2 different diseases. Related, yes, but really quite different. Type II or Adult Onset diabetes used to be a disease of older people and generally of overweight people. While it was always a fairly common disease, it has become much much more common in recent years. Many debate the reason for the increased incidence of Type II diabetes, but certainly it is related to some degree to the increased incidence of obesity in the US. And, as we see more and more young obese people, including many children, Type II diabetes has started to occur in younger and younger people. You see where I'm going here - - the terms Juvenile Onset and Adult Onset no longer apply and the crossover has fueled the confusion.

Both Type I and Type II diabetes result in high blood glucose or blood "sugar". That said, the way this happens and the consequences of this is somewhat different in the two diseases.

What are the underlying problems in these 2 diseases?

Type I Diabetes: lack of insulin. The pancreas stops making insulin.

Insulin is critical to the body's ability to manage and use the fuel glucose. Without insulin, paradoxically, the body tissues can't "see" all the glucose accumulating in the bloodstream. They therefore turn to different pathways to produce fuel, which causes acute and often severe illness.

Type II Diabetes: resistance to insulin. There is insulin, but the body doesn't recognize it.

The body makes insulin, but the tissues can't "see" the insulin properly. The tissues are partially resistant to the effect of insulin and hence the blood sugar rises.

The long-term consequences of high blood glucose (sugar) are largely the same in both diseases. (e.g. eyesight problems, kidney problems, peripheral nerve problems, increased infections)
But, additionally, the complete absence of insulin in the Type I diabetics creates a scenario for life-threatening acute problems if day-to-day insulin management isn't well understood and maintained carefully. This is generally not the case in Type II diabetes.

If you have diabetes or a family member with diabetes, learn about their type of diabetes. If you have a young child or teen or grandchild or niece or nephew with diabetes, it is probably Type I. It needs to be well understood to safely provide for that child or teenager.

If someone has Type I Diabetes, they need to have insulin given to them at all times. Learn about this! Most of the insulin given is to allow them to handle ingested foods, but a common misconception is that "if they don't eat anything, they don't need insulin". This is a dangerous misconception. Yes, if they are sick or vomiting and not eating, a Type I diabetic needs less insulin, but they still need insulin. To give none is to risk the life-threatening complication of ketoacidosis. The rules governing this important situation are called "sick day rules" - - learn about them.

Type I diabetics can lead full and productive lives. They can do all the things that other children can do, but they need to be safe and have family members that understand their disease.

A good online review of all this can be found on Wikipedia: http://en.wikipedia.org/wiki/Diabetes_mellitus

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