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September 29, 2001

Diagnosis and Symptoms

Question from Frankfurt, Germany:

I am 31 years old, and I have recently been told by the physician that I have type 1 diabetes. How do they really differentiate between type 1 and type 2 diabetes?

Answer:

You have asked a loaded question. In theory, type�1 diabetes results from the autoimmune destruction of the insulin-producing cells called beta cells. Type�2 diabetes is associated with a more prominent genetic history in the family, insulin resistance, and obesity. Type 2 diabetes has generally been more of a problem in individuals over the age of 40, but the recent trend is for younger and younger individuals to develop it, and it is not uncommon to see individuals under age 20 with type 2 diabetes.

The general characteristics of type 1 diabetes include the development of DKA [diabetic ketoacidosis] (although not required), decreased insulin production in response to glucose challenge, and positive antibodies. In addition, patients with type 1 diabetes are usually thin. Patients with type 2 diabetes are obese, have a positive family history, make insulin (and often have elevated insulin levels), and do not have a history of positive antibodies or diabetic ketoacidosis.

JTL

[Editor’s comment: The reader should note that the patient’s age at the time of diagnosis is no longer considered relevant. The old terms “juvenile diabetes” and “adult diabetes” are out-of-date.

WWQ]