Type I vs Type II Diabetes
Type I is also known as juvenile onset diabetes and Type II is formerly known as adult onset diabetes. Type II is referred to as “formerly known as adult onset” because of significant increase in the number of adolescents who have been diagnosed with this form of the disease. Young people, like my son, who are diagnosed in their teens and must begin thinking about the consequences of their actions and taking medicines daily well before most of their peers.
In Type II diabetes there is less production of insulin from the pancreas but there is also resistance to insulin in the cells of the body. To use the analogy - less “keys” (insulin) as well as “broken locks” (dysfunctional insulin receptors that normally use insulin to allow glucose/blood sugar into cells to be used as fuel). In Type I diabetes the pancreas stops producing insulin altogether. No insulin means difficulty with getting glucose into cells for energy. No source of energy and the person dies.
Although there is likely a spectrum of diabetes between the entire loss of insulin with Type I and the insulin resistance in Type II, Type I diabetes is an ever-present life-threatening emergency. Although going one day without insulin is unlikely to lead to death, people with Type I diabetes still must think about their illness every day. There is no vacation, no “I don’t want to think about it today”, no “cheat days”. For them, every single day brings the calculation of how much insulin is needed for the amount of food taken in and the amount of exercise performed. Few of us can conceive of such an overwhelming, time consuming process, and it is truly for a lifetime as Type I diabetes is detected many times in early childhood.
The most important thing to be aware of regarding Type I diabetes is that it means monitoring of blood sugar and multiple doses of insulin daily.
The medication, insulin, is life sustaining. Although there are many types of insulin available now, there is no other treatment for this disease such as an oral substitute or surgical intervention.
Insulin is an injectable medication (must be given by a needle or tube inserted under the skin) and it must be refrigerated when stored. Insulin was first harvested from animals for use in humans in the early 1920s (the discoverers of the process went on to win the Nobel Prize in 1923). In the 1970s human insulin was manufactured from recombinant DNA and since that time there has been development of a variety of insulins, both long and short acting (as well as combinations of the two) that more closely mimic the way in which insulin is produced and released in the human body. Combined with advances such as insulin pumps (which automatically release specified amounts of insulin through a tube into the body) and continuous blood glucose monitors (which check blood sugar levels without need for repetitive finger sticks to obtain blood) the ease of treatment has improved.
So why then is a medication whose original patents sold for $1 each in 1923 so expensive??
Fact-based answers to this question can be hard to accurately source, but an article in the American Journal of Managed Care (AJMC) in 2019 indicated that a one-month supply of insulin in 1996 cost approximately $21. By 2001 that cost was $35 and by 2019 that same vial of insulin cost $275, a 1200% increase from the original price!
These huge increases in insulin costs over the course of the early 2000’s has tempered somewhat in the last year or so as prices have dropped somewhat or stabilized. Drug manufacturers will point out that they each have programs to assist with medication costs for people who are uninsured or have high out of pocket costs. However, this still does not explain why the same vial of insulin that costs almost $300 in the US and only costs $32 in Canada (AJMC, June 10, 2019). Further attention to this issue, and likely federal legislation to address collective bargaining and cost disparities, will be needed ongoing to avoid further deterioration in the situation and continued loss of life due to “insulin rationing”
I have found that the biggest takeaway in Diabetes Awareness is understanding that both types – Type I and Type II - are a biological process that affects up to a third of the US population. This also means understanding the risk factors that lead to development of this disease and that portions of people with diabetes require their medicine (insulin) to live. Finally, this means that, regardless of type, all persons with diabetes must think about balancing diet, exercise, and medicine to avoid the complications of poorly controlled blood sugar levels for the remainder of their lives.
For more information, please visit the American Diabetes Association website.