Diabetes mellitus classification (type 1 and type 2) and treatment principles

Can people with diabetes enjoy the same lifespan as healthy individuals? This is a common concern for patients and their families. Various medications for diabetes (such as insulin and various hypoglycemic agents) can effectively control the condition, allowing diabetic patients to generally enjoy the same lifespan as healthy individuals. However, some patients are not diligent in their treatment and neglect their diet, leading to an increasing number of complications, which can shorten their lifespan.

(1) Insulin-dependent diabetes mellitus (i.e., type 1 diabetes mellitus)

This disease commonly affects individuals under 30 years of age, but can also occur in adults and even the elderly. It typically has a later onset and is more severe, often leading to ketoacidosis, and in severe cases, coma. Some patients experience varying degrees of improvement in pancreatic β-cell function after insulin treatment. Some patients may even be able to discontinue insulin treatment for a period of time.

(2) Non-insulin-dependent diabetes mellitus (i.e., type 2 diabetes mellitus)

It is more common in adults or the elderly. Patients have a slow onset and mild symptoms. They are often obese. Their plasma insulin levels may be slightly low, normal or high. Type 2 diabetes has a very high incidence rate, accounting for about 90% of all diabetes cases.

Also known as juvenile-onset diabetes, it often develops before the age of 35 and accounts for less than 10% of all diabetes cases. Type 1 diabetes is insulin-dependent; patients need insulin therapy from the onset of the disease and must use it for life. This is because the insulin-producing cells in the pancreas of patients with type 1 diabetes are completely damaged, thus losing their ability to produce insulin. In the case of an absolute lack of insulin in the body, blood sugar levels remain persistently high, leading to diabetes.

Before the discovery of insulin in 1921, there were no effective methods to lower blood sugar in diabetic patients, and most patients died shortly after the onset of the disease from various complications. With the discovery and clinical application of insulin, patients with type 1 diabetes can now enjoy the same health and lifespan as normal people.

Also known as adult-onset diabetes, it usually develops after the age of 35 to 40 and accounts for more than 90% of diabetes patients. Patients with type 2 diabetes do not completely lose their ability to produce insulin; some even produce too much insulin. However, the effectiveness of insulin is greatly reduced, so the insulin in these patients is relatively deficient.

Insulin secretion can be stimulated in the body through certain oral medications. However, in later stages, some patients still require insulin therapy, similar to that for type 1 diabetes.

Insulin-dependent diabetes mellitus and non-insulin-dependent diabetes mellitus were the previous terms for type 1 and type 2 diabetes, respectively. Because these terms often caused misunderstandings among diabetic patients about insulin treatment, they have now been abandoned by the international and domestic diabetes communities.

Diabetes is caused by insufficient insulin or decreased insulin efficacy. Therefore, insulin plays a very important role in the pathogenesis of diabetes. However, because insulin levels in diabetic patients can be low, normal, or even high, diabetes cannot be diagnosed solely based on insulin levels.

In clinical practice, the insulin release test is commonly used to differentiate the type of diabetes and can also serve as a reference for selecting a treatment plan. During the test, the patient ingests 75 grams of glucose, and blood is drawn at fasting time and at 30, 60, 120, and 180 minutes after the meal to measure insulin and C-peptide. If fasting insulin and C-peptide levels are below normal and do not increase after eating, the patient is considered to have type 1 diabetes. If fasting insulin and C-peptide levels are normal, elevated, or slightly low, and increase after eating but the peak value is delayed, the patient is considered to have type 2 diabetes. The measurement of C-peptide is as significant as that of insulin because C-peptide is less broken down in the body, and its measurement value is not affected by insulin antibodies or exogenous insulin, therefore it is considered more valuable.

(1) Dietary therapy. The purpose of dietary control is to maintain a standard weight, correct existing metabolic disorders, and reduce the burden on pancreatic β cells.

(2) Exercise therapy. Exercise therapy plays a very important role in the treatment of type 2 diabetes in children and adolescents. It helps control weight, increases insulin sensitivity, and is beneficial for blood sugar control. At the same time, it can promote growth and development.

(3) Drug therapy. For children and adolescents with type 2 diabetes, treatment should initially focus on diet, exercise, and oral hypoglycemic agents. After 2-3 months of observation, if blood glucose levels remain uncontrolled, oral hypoglycemic agents or insulin can be used to ensure normal development. The selection and application of oral hypoglycemic agents are generally the same as for adults, but individualized treatment is crucial. The application and precautions for insulin are the same as for children with type 1 diabetes.

(4) Psychological education and self-monitoring. Same as type 1 diabetes.

(5) Monitoring. Obese children should be followed up at the outpatient clinic every six months to one year to check their height, weight, blood pressure, blood lipids and blood sugar in order to detect diabetes at an early stage.