Diabetes mellitus is a disorder of insulin deficiency that results in higher blood sugar levels and disrupts normal growth and metabolism. Diabetes mellitus, often called simply diabetes, comes in two basic forms: type 1 and type 2.  Type 1 diabetes, or juvenile diabetes, is caused by a loss of the insulin producing cells of the pancreas.  This is most often an autoimmune process in which the body improperly destroys its own cells. This results in inadequate insulin, poor growth and high blood sugars. Until recently type 2 diabetes was typically felt to be an adult-onset disorder.  Unfortunately, the incidence of type 2 diabetes in children has increased dramatically in recent years.  This is mostly due to an increased prevalence of obesity in children.  Type 2 diabetes is caused by resistance of the body's cells to normal amounts of insulin. The treatment for type 1 diabetes involves injections of insulin.  Treatment for type 2 diabetes most often begins with weight loss however medications may be necessary.

But what are the two types of diabetes mellitis and how are they different? 

Type 1 diabetes 

Sometimes called juvenile diabetes, type 1 diabetes involves loss of normal insulin producing cells of the pancreas.  This is most often caused by an autoimmune process.  Type 1 diabetes is treated with insulin shots. 

Type 2 diabetes 

Type 2 diabetes, sometimes called adult onset diabetes, involves an inappropriate response of body cells to insulin.   Type 2 diabetes is most often associated with obesity. The first treatment for type 2 diabetes is weight loss in obese children with the disorder.  Some children require medications that help improve the effects of insulin.

What is insulin?

Insulin is a protein produced by the beta cells of the pancreas.  It acts as a hormone, a chemical that travels through the blood to all the tissues of the body.  It helps push sugar from the blood into the cells.  Without insulin cells are unable to pull in enough sugar from the blood to meet energy needs.

What causes diabetes? 

Type 1 diabetes 

Type 1 diabetes is caused by destruction of the insulin-producing cells of the pancreas by the body's immune system.  The trigger for this is unknown. The decreased amount of insulin leads to high blood sugar levels and inability of the body's cells to obtain adequate energy and nutrients for normal growth and metabolism. High blood sugar levels leads to increased urine output and damage to small blood vessels.

Type 2 diabetes 

Type 2 diabetes is caused by decreased sensitivity of the cells of the body to the effects of insulin.  This leads to increased blood insulin levels and also high blood sugar levels. Like type 1 diabetes, high blood sugar levels lead to increased urine output and damage to small blood vessels.

What are the symptoms of diabetes? 

Type 1 diabetes 

• Increased frequency of urination
• Enuresis (bed wetting)
• Waking at night to urinate 
• Increased thirst 
• Increased hunger 
• Weight loss 
• Dehydration 
• Nausea 
• Vomiting 
• Malaise (a general sick feeling) 

• Rapid breathing 
• Lethargy
• Confusion 
• Weakness 
• And rarely death 

Type 2 diabetes 

• Most cases of type 2 diabetes in children have few or no symptoms.
• Obesity
• Acanthosis nigrans, a dark (sometimes), velvety rash on the back of the neck and other skin creases
• These children may have the same symptoms listed above for type 1 diabetes.

How is diabetes diagnosed?

• History & physical exam
• An elevated blood sugar
• Glucose (sugar) in the urine
• Ketones in the urine
• Hemoglobin A1c (a measure of blood glucose levels over several months)
• GAD, islet cell, insulin autoantibodies are often present in type 1 diabetes 
• Glucose tolerance testing for type 2 diabetes

How is diabetes treated?

Type 1 diabetes 

• Insulin (long-acting and short-acting)
• Special diet

Type 2 diabetes 

• Weight loss
• Exercise
• Special diet
• Medications

What are the potential complications of diabetes?

Short-term complications 

• Diabetic ketoacidosis - most common cause of hospitalization and death in children with diabetes.
• Hypoglycemia (low blood sugar) - from too much insulin, inadequate intake of food, or illness
• Hyperglycemia (high blood sugar) - from not enough insulin, excess sugar or food intake, or illness
• Seizures (from hypo- or hyper-glycemia)

Long-term complications

• Kidney disease
• Eye disease
• Nerve damage
• Blood vessel damage
• Fetal damage in pregnant females
• Poor growth
• Depression and family stress

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