Editor’s note: Wellness Word is an informational column which is not meant to replace a healthcare professional’s diagnosis, treatment or medication.

Diabetes mellitus is a term loosely meaning “sweet urine”.  It is characterized by a high level of glucose in the bloodstream (hyperglycemia) which spills over into the urine.  There are several different types of diabetes, but they are not actually the same disease. Type 2 diabetes is by far the most prevalent type of diabetes with 90-93% of all diabetics in the USA being Type 2.  A more apt name might be “Insulin Resistance” or “Insulin Inefficiency” because the cause of high blood sugar in Type 2 diabetes is not so much a deficiency of insulin, but a resistance to insulin’s efforts to move glucose from the blood into the cells.

The hyperglycemia of Type 1 diabetes (T1D) occurs through a different mechanism.  In Type 1, the person’s immune system attacks the beta cells of the pancreas, eventually leaving the person unable to produce insulin, the hormone that moves glucose into the cells for energy production.  The person literally begins to starve to death – even with abundant food.  A Type 1 diabetic is completely dependent on an external source of insulin to sustain their life.  Insulin is not available in pill form and must be injected under the skin with either needles or an insulin pump, which the person wears on their body.  A more apt name for Type 1 diabetes might be “Insulin Deficiency” or “Autoimmune Diabetes”.

So while all types of diabetes are defined by high blood sugars, the mechanism of how each type develops (i.e. the pathogenesis) differs.

T1D often develops during childhood but can start in adulthood as well.  It used to be called “Juvenile Diabetes” for this reason.

Only about 5% of all diabetics in the USA are Type 1, but unfortunately those numbers are increasing.  The reason isn’t entirely known, but there are several factors that influence immune function that are linked to the development of T1D (and other autoimmune diseases): viral illness, exposure to environmental toxins, leaky gut syndrome, microbiome changes, early exposure to foods & decreased breast feeding, gluten or dairy intolerance, inflammation, and stress & psychological factors – all potential triggers of an underlying genetic tendency.

Hypoglycemia, or low blood sugar, is the most dangerous aspect of daily life with T1D.  This can happen if too much insulin is injected, not enough food is eaten, exercise is more intense than expected or a host of other influential factors. The brain needs glucose to function and when blood glucose is too low for even a short amount of time, coma, brain damage or death can occur. Imagine living with that risk every day of your life!

Conversely, high blood sugar, or hyperglycemia can also be a risky situation. High blood sugar is toxic to certain tissues of the body and may lead to diabetic complications over time like blindness, nerve pain in legs and feet, heart and stomach irregularities, poor circulation, vascular disease, and kidney failure. An extreme manifestation of high blood sugar is DKA (diabetic ketoacidosis) in which blood glucose elevates very quickly causing dehydration and an acidic state in the blood. DKA is dangerous and can lead to seizures, coma, and death. Mostly these serious complications can be avoided with excellent blood sugar control.  And luckily excellent blood sugar control is an attainable goal.

Misunderstandings and assumptions about diabetics are rampant including what they can and can’t eat, how their diabetes developed, what are the best treatment options, and even if the disease in some way is the person’s “fault” (the latter is not a helpful distinction and creates unnecessary blame and shame).

Type 1 Diabetes is NOT caused by eating too much sugar or not exercising.  While sugar and refined carbohydrates are not ideal foods for T1D’s, it is possible for them to eat sugary foods, dose insulin, and be just fine.  All foods can be ingested and covered with insulin, but just like someone without diabetes, healthier food choices lead to better outcomes.  In Type 1 diabetes there is inherently a defect in carbohydrate metabolism (all carbohydrates break down into glucose in the body), therefore it makes sense to minimize carbohydrate intake in general, keeping in mind individual needs vary.

Reducing insulin resistance should be the focus of treatment in a Type 2 whereas keeping blood sugar in range by modulating insulin and lifestyle factors is the goal in Type 1–simple, but not always easy. Having a good supportive care team can make a big difference.

Dr. Julie Verfurth focuses her naturopathic practice on holistic diabetes care & mind-body medicine. www.julieverfurth.com or 503.886.8622.