EPISODE 1: Diabetes Defined

This is “The Diabetes Discourse,” keeping you updated on diabetes care, management, and concerns. I’m Nicole Rivera, a student at the University of Florida and future diabetes educator.  I have also helped with research at the University of Florida’s Diabetes Institute. Today I’m gonna talk about the differences between the major forms of diabetes. Let’s begin with a story:

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In April of 2015, twelve year-old Karla Rivera is admitted to Joe DiMaggio’s Children’s Hospital in Hollywood, Florida. At the time of her admittance she is:

• Very athletic, participating in both soccer and lacrosse

• Proactive about fitness, health, and nutrition

• Extremely thin and 12 lbs underweight

• Recently feeling exhausted and constantly hungry and thirsty

After a few lab tests, Karla and her parents are shocked to hear that she has been diagnosed with a form of diabetes, Type 1 Diabetes (T1D).

 

This is not the patient profile that the public typically associates with the term “diabetes.” The term is usually associated with obesity, poor diet, lack of exercise, and genetics. Karla, my sister, was correctly diagnosed, and we would soon learn that “diabetes” wasn’t what we thought it to be.

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[Interlude]

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“Diabetes” is about as general a word as “allergy.” Just as there are many kinds of allergies, so too are there various forms of diabetes. There are over 10 forms diabetes, but I’ll name a few: 

 

So there is Type 1 and Type 2 diabetes, which are the two most prevalent forms of the disease. Type 1 is usually diagnosed in youth, and Type 2 is typically diagnosed in older patients. 

 

There is also Latent Autoimmune Diabetes in Adults or what we call LADA for short; LADA is similar to Type 1 Diabetes but is diagnosed in older populations. Maturity-Onset Diabetes of the Young or MODY is similar to Type 2 Diabetes but is diagnosed in young patients.

 

You may have heard of gestational diabetes, which is diabetes during pregnancy; it usually resolves after delivery and is very rarely permanent. Monogenic Diabetes is diabetes as a result of a genetic mutation; this form is rare, but easily treatable with oral medications. Finally, there is secondary diabetes, which has a variety of subforms. Simply put, secondary diabetes is diabetes as a result of some other stimulus or condition, whether it be the side effect of a medication or the result of another disease, such as cancer or pancreatitis.

Now of all the forms I’ve mentioned, only Type 2, Gestational, and Secondary diabetes can be fully cured, depending on the severity of the condition.

 

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As this podcast continues, notice that I will never refer to someone with diabetes as a “diabetic.” While the term is commonly used, it has sparked some controversy in recent years. Today the term can be considered offensive, as it identifies the patient by their disease, rather than who they are as a person. We would not call someone with a limp a “cripple” or “gimp,” its offensive and frankly dehumanizing. This same logic applies to the term “diabetic.” Patients with diabetes are called simply that: patients with diabetes, because there is so much more that characterizes a patient than just their condition.

 

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As I mentioned earlier, T1D and Type 2 Diabetes (T2D) are most common. But simply because the T1D and T2D share a common name does not mean that they are caused by the same things or treated the same way.  

 

The term “diabetes” simply refers to a variety of conditions that all share a common issue: improper glucose metabolism due to issues with insulin production or responsiveness. Now, insulin is a hormone produced by our pancreas and is responsible for allowing our cells to metabolize glucose. Without insulin, blood sugar levels cannot be controlled. 

 

Type 2 Diabetes is caused by obesity, poor diet, lack of exercise, and genetics, is generally what the public refers to as simply “diabetes.” In this condition, the body does not respond to insulin and may produced decreased amounts of insulin. It can be treated with oral medications, and in severe cases, insulin injections.

 

Type 1 Diabetes is an autoimmune disorder, in which the body’s immune cells attack the pancreas and ultimately results in no production of the hormone insulin. What causes this autoimmune response is still unknown; however, unlike T2D, research has proven that T1D is not correlated with poor diet, obesity, or lack of exercise. Those with T1D are completely reliant on insulin injections for treatment.

[Interlude]​

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During her week long stay in the hospital, Karla learned how to manage her T1D. She was given a prescription of analog insulin as treatment. But what was analog insulin and why was it so expensive?

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[Interlude]

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Once again, I’m Nicole and thank you for listening to “The Diabetes Discourse”. Be sure to listen in on the next episode by Samantha for a follow-up to this story.