Ask the Endocrinologist

By Wellness360 Magazine

BY MICHAEL J. HALLER, M.D.


FULL NAME
Michael J. Haller

OCCUPATION Professor and Chief, Pediatric Endocrinology at the University of Florida

Dr. Haller is a Gainesville native and proud graduate of the University of Florida College of Medicine. His work is mainly focused on clinical research that seeks to delay the progression of and prevent Type 1 diabetes.

November is National Diabetes Month.

What is the main difference between Type 1 and Type 2 diabetes?

Type 1 diabetes is an autoimmune disease characterized by loss of the insulin producing cells of the pancreas called beta cells. Once enough beta cells are destroyed, the patient develops high blood glucose and requires insulin for the rest of their lives. There are some genetic and environmental links to Type 1 diabetes. Most newly diagnosed patients do not have a strong family history of Type 1 but do often have a family history of other autoimmune diseases.

Type 2 diabetes is a complex disease caused by a combination of genetic and environmental features. That said, it is most commonly associated with overweight/obesity and sedentary lifestyle. Many patients with Type 2 diabetes initially achieve blood glucose control with lifestyle changes and an oral medication called metformin. However, patients who have Type 2 diabetes for more than 10-15 years or those who are unable to achieve effective lifestyle changes typically progress to requiring insulin to manage their diabetes.

Both Type 1 and Type 2 diabetes are associated with increased risk for damage to blood vessels and nerves resulting in increased risk for eye, kidney and cardiac disease.

Is Type 1 diabetes genetic?

Short answer is “no.” Long answer is that the immune system’s control of how it “sees” the world is controlled by a number of genes including the genes that dictate a part of our immune system called the Human Leukocyte Antigens (HLA). People with HLA types called DR3 and DR4 are at the highest risk of developing Type 1 diabetes and represent the overwhelming majority of patients who ultimately get Type 1. However, most people with DR3 and DR4 do NOT develop Type 1 diabetes. This is why most patients who present with Type 1 diabetes do NOT have a family history of the disease even though the genes associated with risk obviously are carried from generation to generation.

Are all carbohydrates bad for those with diabetes?

No. All things in moderation. There are many ways to utilize dietary choices to achieve glycemic control of diabetes, whether it be Type 1 or Type 2 diabetes. For some patients that means restricting carbohydrates while for others that means giving more insulin to “cover” for the carbohydrates they like to eat. Certainly we encourage a healthy diet with a mix of adequate fat, protein, carbohydrate and micronutrients and for most people that means avoiding high calorie, high glycemic index carbohydrates (i.e., candy, soda, Gatorade, etc.)

What age and weight are you more likely to develop Type 2 diabetes?

There is no specific age or weight cut off, but the older one is and the longer they have had obesity, the higher their risk for developing Type 2 diabetes. People of African American, Hispanic, Asian or Native American ethnicity are at increased risk of developing Type 2 diabetes.

Is Type 1 or Type 2 curable? If it is cured, can it come back?

At this point, Type 1 diabetes is not curable. We are continuing to work towards therapies that might one day prevent or reverse the disease but we still have quite a ways to go. On the other hand, Type 2 diabetes can be durably reversed/cured in some patients through weight loss and exercise and in other patients through bariatric surgery. That said, it can/does recur if weight loss is not maintained.

What brings on a sudden drop in sugar levels? If that happens, does it mean I have diabetes? What should I do?

Blood glucose drops in response to insulin being secreted from the pancreas or due to insulin being injected. Most patients without diabetes who “feel hypoglycemic” do not actually have measurably low blood glucose but feel the relative change in their blood glucose caused by its decline once their natural insulin production responds to a high glycemic meal or snack.

Patients with beta cell dysfunction (both pre-Type 1 and pre-Type 2) can have true hypoglycemia related to the poorly timed release of insulin from their beta cells. For most patients, the best management of these symptoms includes exercise, weight loss and eating more frequent, smaller and lower carbohydrate heavy meals/snacks. For patients with Type 1 diabetes who have low blood glucose due to taking too much insulin, they have to immediately consume rapid acting carbohydrates (juice, sugar, glucose tablets) and then eat a snack or meal to avoid a more severe hypoglycemic event. Patients who require insulin also carry glucagon with them to use in an emergency situation in which their blood glucose is too low and they are unable to normalize it with food or drink.

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