[Tamarante]

I get confused so here is my question.

Which one is worse, Type 1 or Type 2 and what is the difference? My husband was diagnosed with diabetes and almost went into a diabetic coma when he was 19 years old. He is now on pills twice a day and not on insulin. I thought I understood...he tells me he doesn't have type 1 or 2...I belive he has two and we don't see the doctor until Thursday and I never thought to ask her which one he has so if someone can help me out today I'd appreciate it.

Thanks!

[DeusXM]

Firstly, there isn't a 'worse' form of diabetes. Each form of the condition has its own specific set of challenges and it's largely in the eye of the beholder as to which is worse or better.

Anyway, T1 and T2 are basically 2 completely different conditions with one similar symptom - an inability to regulate BGs.

T1 is caused by an autoimmune reaction which destroys the insulin producing cells in the body. It is more common in younger people. Because T1s produce no insulin at all, they require insulin injections - T1 cannot be treated by tablets.

T2 is a condition where the body still produces insulin, but is unable to use it properly. It is more common in older people and there is evidence to suggest it can be influenced by lifestyle choices although this is something of a contentious subject. T2s tend to treat their condition through diet, exercise and sometimes tablets. Lower carb diets reduce the overall amount of glucose that ends up in the blood, exercise increases sensitivity to the insulin they produce themselves, and tablets can either block the dumping of glucose into the blood by the liver or increase sensitivity to insulin.

As for which is worse...

T1s are more likely to suffer from hypoglycaemia and diabetic ketoacedosis (also known as DKA or [incorrectly] as 'diabetic coma' if allowed to progress). However, T1s also have considerably more freedom in their lives. Although injections are a necessity, because T1s tend to have no problems using insulin once it's in their systems, they can eat whatever they like provided they calculate the correct amount of insulin.

T2s are less likely to suffer from extremes of blood sugar and thus avoid some of the more immediate problems that face T1s. However because they have insulin resistance, exercise and diet play a far greater role in treatment and some people may find this restrictive compared to what they are used to. T2s also appear to be more at risk from CHD/CVD, strokes and other 'complications' from diabetes. This can be explained by the fact that T2s tend to go undiagnosed for a few years (meaning there is a build up of damage) and if the lifestyle 'cause' is to be believed, it can be guessed that they may have been at greater risk anyway.

Your husband's story is confusing. Given his age and that he went into 'diabetic coma', he would sound like a classic T1. However if he is on tablets then that would suggest T2. What are his BG readings like? How long has he been diagnosed for?

To further complicate this, there is also a T1.5, which is sorta a mix of T1 and T2. T1.5 (also known as Latent Autoimmune Diabetes in Adults - LADA) is a bit like T1 in that it is an autoimmune reaction, but also like T2 in that people with T1.5 still produce insulin but need to increase their insulin sensitivity to make better use of their diminished insulin production. It is possible that your husband has T1.5. Without any more information I'm afraid I can't give you more definitive answers. So you should definitely ask the doctor on Thursday. Understanding which type of diabetes you're dealing with has a major bearing on the treatment plan.

Hope that helps.

[princesslinda]

Hi Tamarante: First, THERE ARE NO DUMB QUESTIONS!!!! Dumb is not asking questions.

Type I diabetes is an auto-immune disease where the body destroys insulin-producing cells. T1's must take insulin.

Type II diabetes is often called "adult onset." T2's usually are insulin resistant (meaning they produce a lot of insulin, but their cells don't absorb it properly) or insulin deficienct (not making enough insulin). Many (though not all) T2's are overweight when diagnosed. Many T2's are able to treat their diabetes with oral medications, though some start on insulin sooner than others. Not sure that one is worse than the other, they are both challenging in their own ways.

Not sure how old your husband is now, but if he has been taking oral meds since he was 19, why does he not feel he has diabetes? Does he get regular medical checkups and blood work?

I believe you mentioned in a previous post that he didn't watch his diet very well. Does he check his blood sugar regularly? It sounds like he's not able to exercise if he is having a lot of leg pain.

Will he be seeing a internist or an endocrinologist (doctor specializing in disease such as diabetes)? Perhaps you could have the doctor he'll be seeing give you both information on diabetes education classes. These might be very helpful in motivating him to take better care of himself.

Good thing he has you in his corner.

[Tamarante]

Originally Posted by DeusXM

Your husband's story is confusing. Given his age and that he went into 'diabetic coma', he would sound like a classic T1. However if he is on tablets then that would suggest T2. What are his BG readings like? How long has he been diagnosed for?

Thank you! It's helps.

My mother in law told me that my husband passed out at age 19 and they rushed him to the ER. The ER doctor tested his sugar and it was extremely high. He could have gone into coma and died if she hadn't gotten him to the ER in time. That is the story.

Today, he is not on insulin and he takes Avandament twice per day. He's 32 years old and his readings are around 250 per day and that's down from the 450's he was at a year ago because of foot infection from a callus that went bad and surgery (long story). His doctor will take the history test (I forgot the name of it) to see what his levels has been and I'm sure she will be changing his meds again because 250 is still very high.

I believe he has type 2 from what you just explained. Is it not possible for him to slip into diabetic coma if his sugars measure extremely high? I'm confused again.

Also, he does have a problem with controlling what he eats (stubborn, but I will keep nagging and cooking good foods), but he is not able to exercise or walk much right now.

[Tamarante]

Originally Posted by princesslinda

Hi Tamarante: First, THERE ARE NO DUMB QUESTIONS!!!! Dumb is not asking questions.

Thank you for saying that. I've been with my husband for a long time and I find that Diabetes is very complicated for me to understand still. It seems like the older he gets the more Diabetes becomes more of an issue around my house. It's scary.

Originally Posted by princesslinda

Not sure how old your husband is now, but if he has been taking oral meds since he was 19, why does he not feel he has diabetes? Does he get regular medical checkups and blood work?

Here is the thing. He's 32 today, but back when he was diagnosed he was not given any medications because his doctor said that he could control it be good diet and exercise which was fine and it worked. After we started dating he was still fine. We then got married and that was about 6 years later and that's when he started getting unusual symptoms. I always knew him to be active but then he became tired all the time and he is such a wonderful man inside and out and he was having very bad mood swings and then headaches and then bad acid reflux (that's now another problematic issue now) and the list went on and on.

Three years ago he was put on medications and he stuck with that and he does take his sugar everyday and he was fine after that. Last year (he works on his feet A LOT) he got a small callus and he though nothing of it and it just grew and grew and got infected and all **** broke loose. The last year has been really bad for us...he is still out of work and is in therapy for his foot at the moment. He has a bone infection now and surgery is setup for next month and that was what was keeping his sugar levels high since his surgery. His wounds heal very very slow because of the sugar levels. It's a long story...but I hope you understand it.

One thing affects another and then another and it seems endless at this point.

Originally Posted by princesslinda

I believe you mentioned in a previous post that he didn't watch his diet very well. Does he check his blood sugar regularly? It sounds like he's not able to exercise if he is having a lot of leg pain.

Will he be seeing a internist or an endocrinologist (doctor specializing in disease such as diabetes)? Perhaps you could have the doctor he'll be seeing give you both information on diabetes education classes. These might be very helpful in motivating him to take better care of himself.

Good thing he has you in his corner.

Yes, he checks his sugar regulary and keeps track. No, he's not able to exercise at this point. Walking the dog a block and back takes a lot of him. I'm currently searching for another Endocrinologist because the one he has now, I feel, he's not doing a good job and is relying on my husband's primary doctor to figure out all of the answers.

Also, my husband has been to classes. He just needs to take it upon himself and get himself better. I will keep pushing and pushing and pushing...some say I'm just stressing him out but usually when I push I get results afterwhile.

Thanks to you too!

[notme]

Hi Tamarante and welcome to the forums.

Your husband is a type two. Even if he is put on insulin, his type would remain the same. He would be a type two, with his treatment as insulin instead of tablets.

Blood sugar that is too high can do damage as you well know. It does not matter what type of diabetes you have for that damage to happen. The complications for a type one or a type two are the same.

Exercise is key. I understand it is very hard for him, but he must start out slowly and continue to do more as he feels he can. Diet is extremely important. Your husband has had diabetes for thirteen years and the damage will start showing itself if he doesn't start doing the basics. Low carb diet and moderate exercise is important.

You can only lead a horse to water. Now maybe you can lead your husband to the internet and let him start researching. See if he will come to the forums and talk with the knowledgeable people here. Many of us were helped by talking with others in the same boat.

Good luck and we hope to see him here soon.

[LancetChick]

If he doesn't get his blood sugars under control, he will continue to get worse. Daily blood sugars in the 250 range is asking for serious trouble. If he does get his blood sugars under tight control, on the other hand, he may be able to reverse whatever damage has been done, and he'll feel like a different person. If I had to walk around with blood sugars that high, I'd be depressed, lethargic, slow to heal, and I probably wouldn't have the energy to care about anything. I'm not a type 2, but I hope someone else can give you some references to good books that will explain how to really take control of your blood sugar when you're type 2. The benefits of doing so can be felt very quickly, and far outweigh the work involved (for type 1 anyway, and I imagine that's true for type 2 as well).

[princesslinda]

I think if you husband had been to all the classes, it's just a matter of him being willing to sacrifice some of the things he enjoys for the benefit of his health. I can't imagine how bad the poor man must feel with all his health issues right now, especially at such a young age.

If he's unwilling to eat the healthy foods you are preparing for him, there's really not much you can do except continue cooking healthy food and hope he'll come around. I'm sure he feels like **** right now. I remember feeling so bad before diagnosis, but I didn't actually realize how bad I felt until I started feeling normal again after my blood sugars were controlled.

With his #'s that high, it's no wonder his foot wound has had problems healing. He's risking eye damage, nerve damage, heart damage and a whole list of problems neither of you want to have to deal with. My heart goes out to you as his wife and caregiver. I KNOW where you're coming from.

My mother was a diabetic from age 28. She knew she had diabetes, but she didn't want to have to eat differently than she ever had. She let herself get more and more overweight and took her medicines (pills) when she felt like it. One day she noticed a sore on her big toe that wouldn't heal. She spent many days in the hospital for IV antibiotics and debridements before she finally had it amputated to above her knee in her late 40's. She had really bad retinopathy that rendered her unable to drive and she died at age 54 of renal failure. That's what can happen when someone refuses to do what they need to do to control their blood sugar.

Have his doctors talked with him about insulin? Sounds like this might be the best way to get his blood sugars to a good level quickly and allow his foot to heal. Hang in there, keep on cooking healthy meals and encouraging him to do all he can do to feel better.

[DeusXM]

I believe he has type 2 from what you just explained. Is it not possible for him to slip into diabetic coma if his sugars measure extremely high? I'm confused again.

I would be inclined to agree with you - if he was a T1 he would be having even more problems right now than he would be, although as has been noted, 250 is still 'too high' for normal function. Indeed this elevated BG has probably contributed significantly to his foot problems - high BGs impair the healing process which is why all people with diabetes should pay close attention to their feet.

As for diabetic coma - I may be wrong on this but my gut feeling is it's highly unlikely. Diabetic coma isn't really caused by high BGs. High BGs are a preliminary symptom. Diabetic coma is caused by a process called diabetic ketoacedosis (DKA), which happens when the body doesn't have enough insulin to transport glucose to the muscles. This process produces ketones, which is what causes the problem. T2s generally still produce some insulin, so it is highly likely that your husband is producing enough to meet his basic energy needs but not enough to clear all the excess glucose from his blood. However his high BGs may not cause coma but will cause progressive long-term damage unless they're brought down.

Given his current situation I would suggest reducing the total carbs in his diet, and either an increase in medication or perhaps even moving onto insulin injections in combination with his current medication. Your doctor will be able to talk you through the most viable options. What you must remember (which I'm sure you're aware of anyway) is that changes will have to be made one way or another, so you should insist the doctor suggest some for you. I would imagine that the 3-month average test (HbA1c) will already tell you doctor this.

[pjams]

Hi Tamarante: Participating in this forum alone should give you a lot of information. There are so many people here who can give you good advice based on their own experiences. Believe me, these guys are well informed and good.

Depending where in NJ you are, you may want to look into the Diabetic Care & Control program offered by St. Peters Hospital in New Brunswick. They have good endocrinologists, counselors, educators and dietitians. They have many one-on-one programs to educate people. They helped me a lot to become aware and to control. Of course, your husband should be willing to participate willingly.

Good luck to both of you!