The Difference Between T1 & T2 Diabetes

In this podcast, Dr Sandra Cabot and naturopath Margaret Jasinska discuss the main differences between type 1 and type 2 diabetes, as there is often confusion between the two. Type 1 diabetes is an autoimmune disease, where antibodies attack the pancreas and it stops producing insulin. Whereas in type 2 diabetes, the pancreas produces insulin but it doesn’t work properly. The treatment is completely different and there is risk of misdiagnosis. Listen to the podcast to find out more!

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DR CABOT: Hello. My name’s Dr Sandra Cabot. And today I’m joined by naturopath and author Margaret Jasinska.

MARGARET: Hi, Dr Cabot! Thanks for having me on.

DR CABOT: And we’re talking to you today about the difference between type 1 diabetes and type 2 diabetes, which can be a very confusing subject for patients and even some doctors. Because there’s different varieties and there’s different stages of diabetes.

But let’s start with diabetes type 1, which used to be called juvenile onset diabetes. And the way that I like to describe diabetes type 1 is, the patient doesn’t produce any insulin or very insignificant amounts. Whereas in type 2 diabetes, they do produce insulin, but it doesn’t work. So, this could be analogous to a type 1 diabetic not having a key. Insulin is a key. They don’t have a key. Whereas a type 2 diabetic has a key. But the key doesn’t work.

MARGARET: Yes. So, the key is to enable glucose to enter the cells of your body to be used up for energy.

DR CABOT: Yes.

MARGARET: And so, with diabetes, the glucose accumulates in the bloodstream because it can’t get in.

DR CABOT: That’s right. It stays in the blood and it damages all the proteins in your body. And that’s why you get organ damage and neuropathy. So, it’s a good way to think about it. The type 1 diabetics, they don’t have insulin, which is the key to put the blood sugar in the cells where it’s needed. The type 2 diabetics have a key that doesn’t work. So, the end result is the same. And that is high blood sugar levels, which damage all your organs.

The other thing that makes the difference between type 1 diabetes and type 2 diabetes so clear, is that type 1 diabetes is an autoimmune disease. Whereas type 2 diabetes really is more to do with diet and lifestyle and information.

MARGARET: Yeah, your metabolism basically. Type 2 diabetes is end stage insulin resistance. The insulin resistance got so bad that the insulin is no longer able to control blood sugar.

DR CABOT: That’s right. And it gradually gets worse and the blood sugar levels become higher and higher. And sometimes the type 2 diabetic will eventually need insulin injections. But they’ll never become a type 1 because the cause is different.

And so, in young children who present with diabetes type 1, it’s usually very dramatic. They may present unconscious in ketoacidosis, and we have to give them intravenous insulin and bicarbonate and lots of other things to save their life.

And we do tests to differentiate between type 1 and type 2 diabetes. And in type 1 diabetes, we will find antibodies that are destroying the insulin-producing cells in the pancreas.

MARGARET: Yes. So, there’s proof. We can prove that it is an autoimmune disease. So, the immune system of the individual is attacking their pancreas so it can’t make enough insulin anymore. And like you said, Dr Cabot, it’s usually a rapid onset and it’s a medical emergency and terrifying for the parents because the child usually needs to spend several days in hospital to get the condition under control.

DR CABOT: Yes. And so, when we test for the antibodies, we’re looking at antibodies that could attack the insulin or antibodies that could attack the insulin-producing cells in the pancreas or anti-gather antibodies, which actually attack an enzyme that is needed for insulin to work. And if you’ve got these abnormal antibodies in high amounts, you’ve got autoimmune diabetes, otherwise known as type 1 diabetes.

MARGARET: Yeah. So, it’s quite a few different types of antibodies. So, it’s amazing that more people aren’t type 1 diabetics.

DR CABOT: Yes. Well, thank goodness that that’s the case, Margaret, because 90% to 95% of diabetics are type 2 diabetics. So only about 5% of diabetics are type 1. And it is a harder disease to control. The only treatment that works is insulin. And thank goodness we have these wonderful insulin pumps, which are able to simulate the natural function of the pancreas. That’s a big medical breakthrough.

But the far more common diabetes type 2, is obviously more problematic, as far as the amount of people who get complications from diabetes. And this can be prevented by treating diabetes type 2 correctly. And also, by diagnosing diabetes type 2 correctly, because a significant percentage of type 2 diabetics actually have an adult onset autoimmune disease, which is very significant in causing their diabetes. And that really needs to be differentiated from your more common diabetes type 2 in adults. So, for example, if you have a so-called diabetic type 2 patient who’s not responding well to standard treatment of drugs, you really need to look deeper and see if they have got an underlying autoimmune disease attacking their pancreas.

MARGARET: Yes. Exactly. If you’re trying to do all the right things with your diet, with your medication, with your supplements. But the diabetes is… your blood sugar is unstable or the diabetes is getting worse. You really need to go back to your doctor or find a different doctor and have additional tests. Because you may have been diagnosed with the wrong type of diabetes. It happens quite often. Doctors can make assumptions based on your age, based on your risk factors, based on your weight. But the assumption isn’t always correct.

DR CABOT: That’s right. And this autoimmune type of diabetes is called LADA (L-A-D-A), which stands for latent autoimmune diabetes in adults. And it’s not rare. Indeed, researchers have estimated around 10% of people diagnosed incorrectly with type 2 diabetes actually have LADA. So, in other words, they have got an autoimmune cause of their diabetes. So, they need to be checked with the right blood tests to see if they’ve got the antibodies that are destroying their pancreas and their insulin.

MARGARET: Yes. And to see how much insulin they are producing, also. That’s a useful test.

DR CABOT: Yes. That’s right! And if you have somebody who’s a type 2 diabetic, often a doctor will order a two-hour glucose tolerance test, where we give a big load of glucose and then we measure the blood sugar every half hour, or every two hours to see the rise. And unfortunately, it’s not common practice for the doctor to order insulin levels at the same time. But if you give a patient a big load of glucose, their insulin level should go up quite high. It should go up to about 60, 70 to control the blood sugar level. Now, if that rise doesn’t happen, you know there’s something wrong. So, in somebody with LADA, their insulin may only go up to 10 or 20, but their blood sugar level goes very high. So, you know that their pancreas is failed because of the antibodies that have destroyed the islet cells in the pancreas.

MARGARET: Yes. Not as aggressively as in type 1 diabetes, though. The autoimmune disease, in that case, is very aggressive and the patient will have no insulin production or something like 0.5 or 1 when you do a blood test. So, someone with the LADA still makes some insulin, but nowhere near enough to control their blood sugar.

DR CABOT: That’s right. And it’s called latent because of that. It takes longer to become obvious. But you’ve got a suspected in so-called type 2 diabetics who are treated with medication and it doesn’t really help their blood sugar control. They don’t feel better. They are adults over the age of 30 and they’re not overweight. That’s a clue.

MARGARET: Yeah. You might be slim, fit, healthy and think, “Why on earth did I get type 2 diabetes?” Well, it could be this.

DR CABOT: And they may not even have fatty liver either. They look healthy, they’re slim. And yet, because of their age, they’re diagnosed incorrectly as a type 2 diabetic. So, they should be tested for the antibodies and the treatment is completely different.  If their insulin level does not rise adequately during a two-hour glucose tolerance test, then it’s highly suspicious for LADA. And they will only be successful if they’re treated with insulin.

Now, type 2 diabetes. Well, that’s gonna respond beautifully to dietary modification. So, we just might mention that, Margaret.

MARGARET: Yeah. So, people with type 2 diabetes, well, you can get your blood sugar down and improve liver health and usually reverse a fatty liver with a low carbohydrate diet. Because if you’ve got high blood sugar, there’s too much sugar in your bloodstream. Don’t put any more in through your mouth.

DR CABOT: That’s right. Because your liver can make glucose. You don’t need to eat it.

MARGARET: Exactly. Yes. There are certain essential proteins, essential amino acids, there are essential fats, essential fatty acids. There are no essential carbohydrates. And we’re not saying you have to avoid carbohydrate 100%. But eating a lot less carbohydrate than you currently do, will usually give you really good outcomes with type 2 diabetes.

DR CABOT: Yes. What about a ketogenic diet for diabetes type 2?

MARGARET: Well, there’s a lot of research that shows that that works really well. And with our patient experience that works really well. And gosh! You can read so many success stories on the Internet, if you want to. And on Facebook, on social media of people reversing their type 2 diabetes with a ketogenic diet. And everyone has a different version or a different interpretation of what ketogenic means. It really just means keeping your carbohydrate intake low enough so that you are burning fat for fuel. Whether that’s the fat on your fork or the fat on your body stores. It’s up to you whether you want to count how many grams of carbohydrate you eat. I say to my patience, “If you’re eating meat, seafood, poultry, eggs and natural fats, like olive oil or coconut oil or animal fat. Well, there’s zero carbohydrate in those foods, so no counting necessary. And if you eat those foods with watery vegetables, things like celery, cucumber, radishes, cauliflower, mushrooms. There’s virtually no carbohydrate in those foods either. So, there’s really no need to count those. I think counting only becomes necessary if people want to include carbohydrate-rich foods in their diet, like fruit, or they want to eat a small amount of chocolate or high-carb foods. Then you might need to count to make sure your body’s in ketosis. But you can also just measure your blood sugar yourself at home. That’s a great way for monitoring your progress, and it can be very motivating. Because then the numbers won’t lie. If you ate not particularly healthy food yesterday and today your blood sugar is high. And another day, you eat really well and you do some exercise. It’s like the figures won’t lie. They’ll tell you whether you’re getting success or not.

DR CABOT: And it may be a big change for you because many types of diabetics have been addicted to carbohydrates because they are very addictive. And we get into a habit of eating too many carbohydrates and they’re everywhere. They’re in the supermarket. They’re in your face and we’ve normalized it. So, it can be hard for people that get very strong cravings when they first give up the carbohydrates. So, one thing that I’ve found very helpful for patients is the herb berbrine.

MARGARET: Yeah, berberine is excellent because it gets to the heart of insulin resistance. So, it helps insulin to work more efficiently in your body. So therefore, you don’t have to produce as much insulin. So therefore, the cells of your body become more sensitized to the insulin. So, blood sugar can come down. You can lose weight more easily, particularly weight from around your torso. You can reverse a fatty liver. There’s research that shows berberine reduces the risk of liver scarring because there are different types of fatty liver. There’s the garden-variety of fatty liver, which isn’t ideal but won’t kill you. But there is a more aggressive form of fatty liver that can cause liver cirrhosis or liver cancer. So berberine helps reduce the risk of that. Berberine helps to keep your blood fats looking good. So, when you have a blood test for cholesterol and triglyceride, and of course, with your blood tests for your blood sugar and the average three-monthly blood sugar test. If you’re taking berberine, all those things look better.

DR CABOT: Yeah. And I generally tell people to take a 500 milligram capsule of Berberine in a dose of two capsules, twice a day.

MARGARET: Yeah. Absolutely. For a day, particularly when you’re starting out, in order to get results quickly. Results are motivating. People get excited when they can see things are working and they’re making progress.

DR CABOT: That’s right! And the other thing, if you do get cravings and you think, “Oh, I’m hungry! I gotta eat something!” You can try the Synd X Protein powder. It’s very, very low in carbohydrate. Very high in protein. It’s sweetened with stevia and it has extra amino acids, as well as the whey protein. And that will help your liver to make glucose and help to stabilize your blood sugar. And it will give you energy. So, these little natural tricks really make it easier for you.

Okay! So, hope you’ve enjoyed learning about the difference between type 1 and type 2 diabetes. And remember, if you’re a type 2 diabetic and you’re really doing your best and you’re take medication and you’re not overweight and you’re really not doing well, get your doctor to check for the autoimmune variety of adult onset diabetes. Thanks for listening. Bye!