"Doctor, how is my child's diabetes different from my Father-in-law's diabetes?" Type 1 vs Type 2 Diabetes

Not all "Sugar problems" are the same. Unfortunately for Children with Diabetes, their families and surrounding people often confuse their problem with the problems grown-ups with diabetes have. Whereas this is factually not correct, it also leads to several problems for these children and also unnecessary trauma to these families.

How is Childhood Diabetes different from Adulthood Diabetes. ?

Let's talk about the "Adult" Diabetes first. The reason I am talking about this first is that most people who talk about diabetes in society have a family member with Type 2 Diabetes or know about other people with this type of diabetes, or have this disease as adults and hence consider the children to be having the same issues. (Type 2 diabetes is the most common form of diabetes worldwide and accounts for 90 to 95% of the cases according to studies) 

Hence most people know diabetes as type 2 diabetes and confuse childhood diabetes as the same. So often I receive families of children with Type 1 diabetes coming to the clinic for the first time, worried and panicky because the family with very poor knowledge of diabetes is scared on hearing all the disasters people with Type 2 Diabetes are facing in their terminal stages. 

The "names" are different

Childhood Diabetes is known in medical terms as Type 1 diabetes whereas adult diabetes is known as Type 2 diabetes. The other names of childhood diabetes are insulin-dependent diabetes mellitus or juvenile diabetes. 

(There are several other rare types of diabetes like MODY, LADA etc) But this post is about differentiating the common diabetes in children and the common diabetes in adults so we shall limit our discussion to the two common types of diabetes. Type 2 Diabetes is much more common and 90-95% of cases of diabetes are Type 2 diabetes.

      In both the disorders, the cause of concern is the raised blood glucose and the treatment is also directed at maintaining a normal blood glucose. However, the cause for the raised blood sugar is different in both the situations. 

The basic cause of the raised blood sugar is different

Type 2 diabetes (adult diabetes) happens when the body becomes resistant to insulin and does not have enough insulin to overcome the resistance. In simple terms, the insulin BECOMES WEAK or LESS EFFECTIVE in managing the body's blood sugar and hence the blood sugar stays persistently raised. Persistently raised blood sugar causes the different complications of type 2 diabetes.


On the other hand, the cause of Childhood diabetes is that the body has stopped making any insulin. to understand the basic nature of childhood diabetes click to read my article here .

The Inheritance pattern or family risk is different 

The risk of parents passing the diabetes genes to their children is much less in childhood diabetes. Hence Childhood diabetes is not as much a FAMILY DISEASE as is Adult diabetes.

As per the University of California UCSF,  80-90% of people with Type 2 diabetes have other family members with diabetes. If one identical twin has type 2 diabetes, there is up to a 75% chance that the other will also be diabetic.
For type 1 Diabetes the risk of getting it from a family member is MUCH MUCH LESS. To understand the genetic basis of childhood diabetes click to read my article here.

(According to the Joslin Diabetes Center, if an immediate relative (parent, brother, sister, son or daughter) has type 1 diabetes, the risk of developing type 1 diabetes is about 10 to 20 times the risk of the general population (normally a 1% risk). If one child in a family has type 1 diabetes, their siblings have about a 1 in 10 risk of developing it by age 50. Interestingly, a child from a father with type 1 diabetes has about a 10% chance of developing it, while a child with a mother with type 1 diabetes has about a 4% risk of developing it if the mother was 25 or younger at birth, and a 1% risk of developing it if the mother was older than 25 at birth (consistent with the general population risk).

Childhood Diabetes is NOT a BAD LIFESTYLE disease

No one should blame the children or their families for diabetes because unlike adult diabetes, there is no role of bad lifestyle in causing childhood diabetes.

Overeating, eating too much sugar, obesity, no exercise and other bad lifestyle habits are in some way responsible for adults getting type two diabetes but childhood diabetes has different causes and unfortunately none of them is in control of the family of the child. To understand why children get diabetes click to read my article here .

It is important to write here that because of bad lifestyle habits children are getting Adult like Type 2 Diabetes t younger and younger ages ( as early as 8 years in my clinic!!!! 🙁🙁🙁🙁🙁)

The treatment is different 

The treatment in 'Adult' diabetes (Type 2 Diabetes) is directed at methods to maintain a normal blood glucose level. And as we cannot target the cause of Type 2 Diabetes directly (which means there is no medicine which can reverse insulin resistance), what doctors try with different medicines is to INDIRECTLY keep blood sugar within the normal range and hope those complications do not occur. For example, some medicines act by 

a) Reducing the bodies' blood sugar production 

b) Increasing the bodies' blood sugar excretion

c) Reducing the amount of blood sugar absorbed from the food 

Hence we are trying to maintain blood glucose in the normal range by INDIRECTLY modifying different mechanisms in the body.

On the other hand, because the cause of type 1 diabetes is that the body has stopped making insulin, the treatment of childhood diabetes, very logically, is the replacement of insulin from outside by way of under-the-skin injections

By DIRECTLY replacing the amount of insulin needed by the child at different times of the day we can maintain the blood sugar within the normal range and prevent complications from occurring to a large extent. Hence we cannot give TABLETS to children to treat diabetes. To understand why insulin cannot be given as a tablet click to read my article here.

The immediate pattern of the problem is different 

The immediate course of Adult Diabetes (type 2 diabetes) at the start of the problem is very different from the immediate course of type 1 diabetes. The disease process in type 2 diabetes is slow to develop and it takes a significant amount of time (sometimes years) for patients to feel any drastic changes in their health. In many cases, damage to the body parts (eyes, heart, nerves) has already started by the time an adult is diagnosed with Type 2 Diabetes. 

However, childhood diabetes is rapid to develop and the problems start appearing within weeks of onset of the disorder. At timely diagnosis, their body is largely free from damage. To understand what happens to the child when childhood diabetes starts read my article here. 

Children need to check blood Glucose levels much much more frequently than Adults with Type 2 Diabetes

It is very important to understand that because of the slow nature of the progression of adult diabetes blood sugars are not very unstable which means they do not change drastically minute by minute so a patient does not need to check blood sugar three or four times a day. But blood sugars are changing every minute in childhood diabetes because there is absolutely no insulin in the body, so more frequent blood sugar testing is indicated to keep the glucose in safe range. In addition, modern methods of treatment require blood glucose-based insulin dosing hence these children have to check blood sugars 2 to 3 times a day at a minimum.

Hence as a Society, we need to understand the two types of diabetes better. and we need to stop judging families with children fighting diabetes based on the limited knowledge we may have. These Children are fighting a daily battle. They don't need any sympathy as they are strong kids themselves but an understanding attitude from the society will definitely help.

Spread the knowledge, so that no one mis-judges a child again........

Dr Uppal is a Pediatric Endocrinologist and Director at ENDOKIDZ Centre for Growth, Diabetes, and Hormones for children, Jalandhar Punjab.