Type 1 diabetes’ evil twin                                       

            Type 1 diabetes was known in the time of Hippocrates, some 2500 years ago. They even knew that one of its main characteristics was the presence of sugar in the urine. Throughout the Middle Ages, physicians actually tasted patients’ urine to identify the sweet taste. I am certainly grateful that we have better ways of making the diagnosis. The large amount of sugar that passes through the kidneys causes an excessive output of urine; the term diabetes means “siphon” in Greek.

            Called juvenile, early onset or childhood diabetes because most of its victims are young, the disease seems to be triggered by a viral infection in susceptible persons. In a misdirected response to the infection, the body produces antibodies that destroy cells in the pancreas that manufacture insulin. Without the daily replacement of insulin by injection, patients seldom survive for more than a few weeks or months.

            Type 2 diabetes, once known as adult onset diabetes, is not an identical twin of type 1. These patients have adequate insulin but their body is unable to use it, a condition known as insulin resistance. Physicians use numerous drugs in an attempt to help the body to utilize insulin but the pancreas eventually stops production of this hormone and insulin injections become necessary.  

            Both types of diabetes lead to the malformation of small blood vessels so the organs most affected by complications of these diseases include the eyes and the kidneys. Nerves and blood vessels in the feet are damaged and the result is often gangrene and amputation.

            Obesity is a major factor in type 2 diabetes and it makes this disease the evil twin of type 1. Almost all persons with type 2 diabetes have an excess of body fat even if they appear to be of normal weight. To no one’s surprise, type 2 diabetics are afflicted with the complications of obesity: heart disease and stroke. These complications occur at about twice the frequency of type 1 diabetes and they lead to a mortality rate which is also much higher.

            There is little that one can do to avoid type 1 diabetes but type 2 diabetes is almost 100 percent preventable. Less than a century ago there was no type 2 diabetes in Native Americans; it is now their second leading cause of death. The rest of us are not far behind.

            It’s time to slay the evil twin.