Diabetes Type 1 and Type 2
EDP column by Dr Ketan Dhatariya

“I have had tablet controlled diabetes for 6 years, and have now been put onto insulin. Does this mean I have gone from type 2 diabetes to type 1?”

Diabetes is a condition associated with high blood glucose (sugar) levels. There are 2 main types. Type 1 is due to the immune system destroying the insulin producing cells in the pancreas.  This usually occurs in younger people – often (but not always) under the age of about 25 years old. Type 1 diabetes used to be called ‘juvenile onset diabetes’, or ‘insulin dependent diabetes’. Neither of these is strictly true because the condition can occur in older individuals, and also people with type 2 diabetes can also become insulin dependent, as I will come on to.

Insulin is the hormone that lowers blood glucose levels. In people with type 1, there is none being produced, and so insulin treatment is mandatory. If there is no insulin on board, such as if doses are missed, then the person can become very unwell very quickly and may need to be in hospital in a few hours. However, in the other main type of diabetes, Type 2, it is not a lack of insulin that is the problem, but the fact that the cells do not respond to the insulin that is produced.

Type 2 used to be called ‘adult onset diabetes’ or ‘non-insulin dependent diabetes’, but again, neither of these is true, because in Norfolk and across the world, there are several children and young people who have the condition. In addition, as you allude to in your question, after a while, it may be that the tablets that are used to treat type 1 diabetes are no longer enough to control the condition, and so insulin is needed to supplement the body’s’ own supply. In this case, it is not then called type 1 diabetes, but ‘type 2 diabetes on insulin’

Type 2 diabetes often gets worse with time, and because the targets for ‘good control’ are very strict, it is often necessary to increase the doses of the tablets, and the number of types of tablets to control the diabetes. These can control the diabetes for several years, but if things continue to get worse, then insulin may be necessary. Don’t think of going onto insulin as a ‘failure’. It is another form of medication added in to achieve good diabetes control, and to try and prevent the long term complications from occurring.

As always, if you do not understand why you are being given a particular medication, then ask your doctor, nurse or pharmacist to explain them to you.

For more information about Diabetes click these links: