Main Types of Diabetes: Type 1, Type 2, and Gestational Diabetes (2023)

Around 11.3% of the US population has diabetes, according to the Diabetes Research Institute. It’s not a far stretch to say you probably know someone who’s living with such a chronic condition.

That’s why everyone needs to have a better understanding of the different types of diabetes, treatment strategies, and prevention of complications. Follow along as we lay down the basics to help you lead a healthier life and better manage such a condition.

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Diabetes is a condition that affects how your body cells utilize simple sugars to produce energy. Most of the food we consume is broken down into simple sugars, which are then dumped into the bloodstream.

Once the blood glucose levels get higher than a specific threshold, the pancreas senses such a rise and produces insulin in response.

Insulin is needed for our cells to take up simple sugar from the bloodstream into the cells themselves. People with diabetes have high blood sugar levels for a variety of reasons:

• This can be attributed to a defective pancreas that is unable to produce enough insulin.

• The pancreas can produce perfectly fine insulin, but the cells can’t seem to have the necessary means to interact with it. In other words, our body cells can have what is known as insulin resistance.

In terms of complications, they arise from chronically high levels of blood sugar. This ranges from heart and kidney issues to visual impairment. The good news is that all such problems can be easily avoided by keeping blood sugar levels in check and following diabetes management protocols.

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A variety of intertwining factors influence the development of diabetes. Genetics, environmental factors, age, and lifestyle habits are all contributing factors to developing different types of diabetes.

It’s worth noting that most people diagnosed with diabetes can have one of three main types: type 1, type 2, and gestational diabetes. Let’s explore the differences between the three types in terms of causes and different presentations.

We’ve already touched on how one of the mechanisms behind diabetes is the inability of the body to produce enough insulin. This is exactly what happens in type 1 diabetes! It’s inherently an autoimmune condition where the immune system goes rogue and starts attacking insulin-producing cells in the pancreas.

The body still deals with food in the same way and gives out glucose into the bloodstream. However, without insulin to help the cells utilize the wandering sugars, your blood retains too much glucose. Such imbalance is responsible for most of the symptoms associated with type 1 diabetes.

Type 1 diabetes develops early in life. That’s why young adults and teens make up the majority of the cases presenting with the condition.

The exact reason why such an autoimmune reaction is present in some people and not others is still not entirely clear. However, we know that genetics govern such an immune reaction, which explains why diabetes type 1 runs in families.

Diabetes type 1 affects a variety of systems. It commonly presents with the following signs and symptoms:

• Increased frequency of urination that can wake you up at night.

• Constant feeling of thirst as a compensatory measure to make up for the increased blood glucose levels.

• Weight loss that can’t be explained by another cause.

• Blurry vision due to damaged blood vessels in the retina.

• Mood swings as higher blood sugar levels are associated with anger and sadness, while lower levels go along with nervousness and anxiety.

• Chronic fatigue is reported in type 1 diabetes patients, even those with controlled blood sugar levels.

According to the reports by the Centers for Disease Control and Prevention (CDC), 90 to 95% of all patients with diabetes are diagnosed with type 2. Here, the body can’t utilize insulin properly and, therefore, can’t keep blood sugar levels down within the normal range.

The condition develops gradually over the years and is highly influenced by lifestyle factors. For instance, abdominal obesity and lack of physical activity are key contributors to the condition.

It’s also worth noting that some diseases, like polycystic ovaries, are associated with insulin resistance. In such cases, the cells lose their ability to take up glucose and metabolize it to produce energy.

Since type 2 diabetes develops slowly over time, the symptoms might not be noticeable, especially in the early stages of the disease. Being aware of diabetes symptoms ensures there is no delay in seeking medical evaluation.

You’ll notice that type 1 and type 2 share the majority of the symptoms. However, there are some unique signs reported with type 2 that are worth highlighting. Keep an eye out for such signs and symptoms, and consult your physician whenever you’re in doubt.

• Increased feeling of thirst associated with frequent urination.

• Fatigue and generalized weakness.

• Due to the fact that the body can’t utilize glucose efficiently, diabetes patients have persistent hunger.

• Delayed wound healing, which increases the risk of wound infection.

• A unique sign of type 2 diabetes is the development of darkened skin patches, especially in the areas of skin folds. Such a condition is related to insulin resistance.

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Let’s switch gears to the third common type of diabetes that exclusively affects pregnant women. Gestational diabetes develops during pregnancy in a woman who has never had diabetes before.

The condition is usually diagnosed between 24 to 28 weeks of pregnancy. Although the exact mechanism for gestational diabetes isn't fully understood, there are some factors related to pregnancy that contribute to the condition.

For instance, pregnancy is associated with hormonal imbalances that interfere with insulin’s action. The placenta produces a hormone known as human placental lactogen (HPL) that creates a state of insulin resistance, where the circulating insulin is no longer effective in lowering blood sugar levels.

As a compensatory measure, the pancreas starts to produce more insulin than usual. With such a sustained workload, the pancreatic cells become exhausted and unable to produce insulin anymore.

Risk factors such as advanced maternal age, genetic predisposition, and being overweight all contribute to the development of gestational diabetes.

It’s worth noting that all the symptoms of gestational diabetes usually resolve after childbirth. Although the blood sugar levels normalize following birth, such mothers need to follow a healthy lifestyle as they're more susceptible to type 2 diabetes later in life.

In terms of disease presentation, it comes as no surprise that such a form of diabetes shares the same symptoms as its other two counterparts. Here are the signs and symptoms to look out for during pregnancy:

• Unusual thirst is associated with frequent urination.

• Easy fatigability and weakness.

• During the early stages of pregnancy, women with gestational diabetes experience increased nausea and vomiting.

Bear in mind that gestational diabetes might not present with any symptoms at all. That’s why screening for the condition is part of routine prenatal care. All women are tested between 24 to 28 weeks of pregnancy for elevated blood sugar levels.

Earlier screening is also advised for women with increased risk, like a history of gestational diabetes with a previous pregnancy, a high body mass index, or insulin resistance conditions.

With the most common types out of the way, let’s explore some other presentations of diabetes.

• Latent autoimmune diabetes: Just like type 1 diabetes, the underlying mechanism here has to do with an autoimmune reaction. The main difference comes in the age of presentation. Latent autoimmune diabetes presents much later in life. The average age at diagnosis is over 30 years.

• Maturity onset diabetes: Another name for such a condition is monogenic diabetes, as it’s related to a single gene mutation. Here, patients inherit a defective gene that affects their ability to produce insulin. This variant of diabetes usually runs in families where the body’s cells retain such a genetic mutation from one generation to the next.

• Neonatal diabetes: Newborns can rarely develop diabetes within the first six months of life. This is another form of monogenic diabetes. It’s worth noting that the condition can be transient or permanent. In the former, diabetes completely resolves after a few months, while in the latter, it becomes a lifelong condition.

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Diabetes cases are easily diagnosed by checking their blood sugar levels. Here are the three blood tests used to make a diagnosis:

• Fasting blood sugar level: Food intake leads to fluctuation in insulin levels and, in turn, blood glucose levels. So for this test to be accurate, you will have to fast for at least eight hours. Here, healthcare providers try to establish a baseline and see where the blood glucose levels are sitting.

• Random blood sugar level: This test doesn’t require fasting. You can get such a test at any time of the day, regardless of when you had your last meal.

• A1c test: This test is also known as the glycated hemoglobin test, where you get a snapshot of the extent of your disease control over the past two or three months.

According to the Australian Centre for Disease Control (ACDC), management plans can vary depending on the type of diabetes, the severity of the presentation, and the presence of complications.

Diabetes affects almost all organ systems, and it has a spectrum of presentations that might vary from one person to another. That’s why healthcare professionals are now adopting personalized treatment to accommodate the different variants of the disease.

Regular blood glucose level monitoring is key to assessing the response to treatment and giving cues on how to adjust the current protocol for better disease control. Managing diabetes usually involves one or more of the following:

• Oral medications: Patients diagnosed with type 2 or gestational diabetes can start on oral medications to lower their blood glucose levels. The rationale here is that the pancreas is still capable of producing insulin to some extent, so the medications are meant to augment the secreted hormone.

• Insulin: In type 1 diabetes, the insulin-producing cells are no longer functioning. That’s why such patients require external synthetic insulin to carry out the role of the missing hormone. In advanced cases of type 2 diabetes, oral treatment is no longer effective, and such patients need insulin injections as well.

• Lifestyle modification: A key aspect of managing diabetes is fostering a healthy lifestyle. This includes maintaining a good level of physical activity and following healthy diet plans. Keeping track of the carbohydrates you consume in your diet is critical, as the amount of carbs influence the dose of insulin needed.

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Uncontrolled diabetes is a life-threatening condition that presents many health problems. This includes kidney disease, increased risk of death from heart attack, and nerve damage.

You can avoid such a condition and its potential complications by sticking with the following simple steps:

• Maintaining a healthy body weight

• Regular exercise for at least 30 minutes a day, five days a week

• Avoid smoking and alcohol

• Get sufficient sleep

Some diabetes risk factors are modifiable, while others, like genetic predisposition, are not. Nevertheless, leading a healthy life can halt the progress of autoimmune and genetic diabetes to ensure the condition doesn’t present with complications.

You can also check the UK National Health Service (NHS) prevention program for a more comprehensive health plan.

Different types of diabetes have unique underlying mechanisms. Type 2 diabetes is the most common type of the disease, and yet it’s related to modifiable risk factors like obesity and lack of physical activity. This shows how much lifestyle modification plays a critical role in the prevention of the disease.

Meanwhile, type 1 is seen more in young adults and is highly influenced by family history. Lastly, gestational diabetes is related to pregnancy and resolves completely after childbirth.

Make sure you schedule regular visits with your healthcare providers for effective disease control and early monitoring of complications.