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Type 1 versus Type 2 Diabetes: What’s the Difference

The two types of diabetes require different treatment. Dr. Hillary Lockemer, pediatric endocrinologist, discusses the differences between type 1 and type 2 diabetes.
Type 1 versus Type 2 Diabetes: What’s the Difference
Hillary Lockemer, MD, FAAP
A pediatric endocrinologist with WakeMed Physician Practices - Pediatric Endocrinology, Dr. Hillary Lockemer earned her medical degree at Eastern Virginia Medical School in Norfolk, Va., and then went on to complete her residency in pediatrics from Children's Hospital of The King's Daughters, also in Norfolk. She further completed a fellowship in pediatric endocrinology from the University of Texas Southwestern Medical Center in Dallas.

Learn more about Hillary Lockemer, MD, FAAP

Prakash Chandran (Host): We commonly think that diabetes is an adult’s disease. But did you know that each year, around 18,000 children are diagnosed with type 1 diabetes? But what causes this to occur? And what can you do if your child is affected? Let’s talk with Hillary Lockemer, the Vice Chair of Pediatrics and Pediatric Endocrinologist At WakeMed Health and Hospitals.

This is WakeMed Voices, the podcast from WakeMed Health and Hospitals. I’m Prakash Chandran. So, Dr. Lockemer, what can you tell us about what causes diabetes in the first place?

Hillary Lockemer, MD, FAAP (Guest): Well, unfortunately, there is still a lot that we don’t completely understand about diabetes. With type 1 diabetes, we know that it’s a autoimmune system error where basically the immune system starts to attack the cells in the pancreas that make insulin. We know that certain people have genes that make them more likely to have this happen, but not everyone who has those genes ultimately develops type 1 diabetes.

Some people think that maybe it’s a virus and so they are looking and trying to see if we can maybe even prevent or delay it with vaccines. But we don’t know for sure what that cause is. With type 2 diabetes, it’s a little bit different. Oftentimes it is more genetic in nature meaning that it tends to run in certain families. For some people, it doesn’t matter what they do, they just can’t avoid getting it. But in type 2 diabetes, we do tend to see it more often in people who weigh more than they should, don’t eat right, and don’t exercise and so, we know that those factors tend to make it more likely that you are going to develop type 2 diabetes.

Host: Yeah, it kind of sounds like in terms of genetic predisposition; we’re disposed to get both but from what I understand; the more kind of sugar and carbs and fats that you eat; the more likely it is that you’ll be susceptible to that type 2 diabetes. Is that correct?

Dr. Lockemer: Correct. And that’s only with type 2 diabetes and that’s a really important distinction to make compared to type 1 diabetes. Because a lot of people think that eating a lot of sugar and candy can increase your risk for both types, but that’s actually not true.

Host: Got it. Okay. So, now that we understand a little bit more about that, let’s talk about how often it occurs in children. Can you talk a little bit around this space for parents that are listening?

Dr. Lockemer: Sure. So, for the type 1 diabetes, it’s about 0.1% of the population ends up having type 1 diabetes. So, obviously, that’s a pretty small number when you think about it, so the risk of someone actually developing diabetes as a kid or child is fairly small. But we are actually seeing more and more people getting diagnosed with it. So, in the last 20 years, we’ve actually seen both type 1 and type 2 diabetes getting more common in kids and teenagers. And interestingly, we are seeing it in parts of the world that typically had very low rates of diabetes and so there’s a shift in kind of the ethnic population that’s getting this as well that we hadn’t really expected.

Someone with type 2 diabetes, in kids and teenagers; we usually think about 15-20% of all kids and teenagers with diabetes ultimately have type 2. So, it’s still a relatively small proportion of our overall pediatric population. And even though the rates of diabetes in general are increasing over that 20 to 30 year period; the proportion of type 1 to type 2 in kids and teenagers has actually stayed pretty stable.

Host: Can you talk a little bit about the signs and symptoms to look for, for both type 1 and type 2 diabetes and I’d also kind of be interested to hear while it may seem like common sense for a lot of people like what is the problem with living with some of these signs and symptoms?

Dr. Lockemer: Sure. So, with type 1 diabetes, we’ll start there. Oftentimes these individuals have no symptoms until all of the sudden for usually about two to three weeks before they get diagnosed with diabetes; they are suddenly very thirsty, they are peeing very frequently, they maybe ravenously hungry, but yet they are losing weight very quickly. That weightloss can sometimes be as much as 15 or 20 pounds in a week and then not surprisingly, a lot of those kids will start to feel very fatigued and they may just kind of look like they are not feeling very well and eventually, they will actually start to vomit, and they can even lose consciousness and not respond very well if they are really, really sick.

For type 2 diabetes, on the other hand, it can sometimes be no symptoms at all, yet their blood sugars could be very abnormal just like someone with type 1 diabetes but yet they are not having the same symptoms. On the other hand, there are some people with type 2 diabetes who have the exact same presentation as someone with type 1 diabetes. So, that’s why it can sometimes be very difficult to distinguish early on whether the child or teenager has type 1 or type 2 diabetes because they can present the same way.

In adults with type 2 diabetes, oftentimes they are just found on a routine screening and they weren’t having any symptoms and that does sometimes happen in our kids with type 2 diabetes as well. But I would say that’s a little bit less common. They oftentimes are having some sort of symptom.

Now, as far as living with these symptoms; the peeing a lot and drinking a lot, that’s just really annoying for most people. Some kids are even suddenly wetting the bed even though they may be 16 or 17, so it can be very embarrassing for them. But it does make it tough for them to sit in school and so sometimes they will actually be getting punished at school because they keep needing to go to the bathroom even though it’s beyond their control.

And then of course, when you have really high blood sugars, the body just feels awful and a lot of people don’t realize that how bad they feel because our bodies are amazing, and they adapt to having those much higher blood sugars. But then, once those blood sugars come back down into the normal range; all of my patients always say the same thing. They always say I didn’t know how bad I felt. And suddenly their school performance, their athletic performance goes back to where it used to be because their body is able to function like it really should.

Host: Yeah, it seems like it’s the boiling frog syndrome when the body just gets used to the pain over time and we forget what it’s like to feel normal. So, I want to move to when a parent suspects that their child has diabetes. What should they do and what kind of treatment options are available. Let’s start with type 1.

Dr. Lockemer: With especially type 1 diabetes, if a parent notices that their child is suddenly drinking a lot more and peeing a lot more, as soon as you pick up on that; I recommend scheduling an appointment with their pediatrician and they can go and get their blood sugar checked in the office, they can do a urine test and that kind of helps us kind of figure out how – like at what stage this is and how quickly we need to get them treated or what kind of the next steps are.

With type 1 diabetes, pretty much universally, they need to be started on insulin immediately and for most places around the country, the way to do that is we have them go into the hospital and usually it’s about a 24 to 48 hour admission just to stabilize those blood sugars, make sure that they are safe and then the teaching process that goes along with giving insulin is pretty rigorous and so, we have just found that being in the hospital where there is nurses and lots of people to assist with practice and questions really helps our families.

If a child is vomiting, if they have lost consciousness, if they just do not look good at all; then I recommend don’t even bother going to the pediatrician, don’t even go to urgent care; go straight to an emergency room. Because those individuals are probably very sick and need immediate care and sometimes, they will even require being admitted to the intensive care unit, so we want to make sure that they get treated as quickly as possible.

For type 2 diabetes, because as I said, sometimes there aren’t really any symptoms, and so oftentimes these individuals are just getting picked up on a routine screening. But if you do have a very strong family history of type 2 diabetes; you can talk with your pediatrician about some of the risks that your child might have and when they may need to start being screened for that.

But again, if you notice any of the symptoms; they are losing weight very quickly, despite not making any changes to their diet or activity level, if they are peeing a lot or drinking a lot again, I would recommend going to the pediatrician and getting their blood sugar checked and maybe a urine test and sometimes for those individuals, they can actually be seen in the outpatient pediatric endocrinology clinic and we can start them on some oral medications first. Over time however, their pancreas may not be able to make insulin so they may require insulin as well just like someone with type 1 diabetes.

For longer term treatments for both type 1 and type 2 diabetes; more commonly in both these types of diabetes we are using something called continuous glucose monitors or CGMs which help monitor the blood sugar every five minutes without having to do a finger prick to check the blood sugar. There’s also more people, mostly with type 1 diabetes, but I do have some patients with type 2 diabetes that use insulin pumps. And it’s basically just a different way of giving the insulin underneath the skin rather than using shots; they are able to use a device that actually delivers it under the skin and then that way, they only have to kind of get a bigger poke every two to three days rather than about four to six shots every single day.

Host: That’s good to know that there are those options on there and yeah, I have a couple of friends that have those, I guess the glucose monitoring devices just right under their shirts. You don’t even notice them, and it’s been a lot better there.

Dr. Lockemer: Yup, they’ve gotten so much smaller. I even have a hard time picking out where my patient’s CGMs are and I’m actually looking for it. So, I think it’s fantastic for patients with diabetes.

Host: So, in wrapping up here, is there anything else that you want parents to know about diabetes that we didn’t cover today?

Dr. Lockemer: I think the biggest thing is especially with type 1 diabetes; there is still so much we don’t know about it and at this point, we cannot prevent it from happening. So, if your child does develop type 1 diabetes, there is nothing that you as a parent could have done or that you missed that might have caused this to happen. And I think it’s really important for them to understand that.

And then anytime that you think that your child might be having these symptoms, it is so easy to get a blood sugar check and so just talking with the pediatrician and keeping an eye out for these symptoms and getting it checked sooner rather than later because that can really avoid sometimes hospitalization in these patients, or it can avoid an intensive care unit stay which is always fantastic.

Host: That’s a perfect way to end it Dr. Lockemer. I really appreciate your time. That’s Dr. Hillary Lockemer at WakeMed Health and Hospitals. Thanks for checking out this episode of WakeMed Voices. Head to to get connected with Dr. Lockemer or another provider. If you found this podcast helpful, please share it on your social channels. That would help us out. And be sure to check the entire podcast library for topics of interest to you. We’ll see you next time.