Type 1 Diabetes vs Type 2 Diabetes
A newly diagnosed diabetic in DKA needs insulin immediately — but a Type 2 patient admitted with HHS at glucose 900 may go home on metformin alone. Picking the wrong treatment pathway, or missing which emergency belongs to which type, costs points and endangers the client.
Side-by-side comparison
Side-by-side2 compared
Dimension
Type 1 Diabetes
Type 2 Diabetes
Pathophysiology & risk
- Autoimmune beta-cell destruction; absolute deficit
- Onset childhood–young adult; lean build
- Insulin resistance + relative deficiency
- Onset > 40 yr (rising in obese youth)
- Overweight/obese, central adiposity
Signs & symptoms
- Abrupt polyuria, polydipsia, polyphagia
- Unexplained weight loss; may present in DKA
- Insidious; often asymptomatic at dx
- Fatigue, recurrent infections
- Acanthosis nigricans
Diagnostics & labs
- A1C ≥ 6.5% / FPG ≥ 126 mg/dL
- ★Autoantibodies + (GAD65, IA-2)
- C-peptide low/undetectable
- A1C ≥ 6.5% / FPG ≥ 126 mg/dL
- Autoantibodies absent
- C-peptide normal/high early
Nursing priorities
- ★Insulin from day one — never omit
- Match insulin to carbs/activity; watch for DKA
- Lifestyle + metformin first-line
- Step up agents per A1C; watch for HHS
Treatment & meds
- Basal-bolus regimen or insulin pump
- No oral agents alone
- Metformin first; add GLP-1 / SGLT2
- Insulin as beta-cell function declines
Patient teaching
- Sick-day rules; stopping insulin → DKA in hours
- Rotate sites; treat hypoglycemia (15-15 rule)
- Weight loss, diet, exercise; foot care
- May need insulin later — not a failure
Red flags — escalate
- ★DKA: glucose ≥ 250, ketones, Kussmaul
- Severe hypoglycemia
- ★HHS: glucose > 600, osm > 320
- Sulfonylurea-induced hypoglycemia
Complications
- DKA; retinopathy, nephropathy, neuropathy
- HHS; macrovascular (CAD, stroke, PAD)
Pathophysiology & risk
Type 1 Diabetes
- Autoimmune beta-cell destruction; absolute deficit
- Onset childhood–young adult; lean build
Type 2 Diabetes
- Insulin resistance + relative deficiency
- Onset > 40 yr (rising in obese youth)
- Overweight/obese, central adiposity
Signs & symptoms
Type 1 Diabetes
- Abrupt polyuria, polydipsia, polyphagia
- Unexplained weight loss; may present in DKA
Type 2 Diabetes
- Insidious; often asymptomatic at dx
- Fatigue, recurrent infections
- Acanthosis nigricans
Diagnostics & labs
Type 1 Diabetes
- A1C ≥ 6.5% / FPG ≥ 126 mg/dL
- ★Autoantibodies + (GAD65, IA-2)
- C-peptide low/undetectable
Type 2 Diabetes
- A1C ≥ 6.5% / FPG ≥ 126 mg/dL
- Autoantibodies absent
- C-peptide normal/high early
Nursing priorities
Type 1 Diabetes
- ★Insulin from day one — never omit
- Match insulin to carbs/activity; watch for DKA
Type 2 Diabetes
- Lifestyle + metformin first-line
- Step up agents per A1C; watch for HHS
Treatment & meds
Type 1 Diabetes
- Basal-bolus regimen or insulin pump
- No oral agents alone
Type 2 Diabetes
- Metformin first; add GLP-1 / SGLT2
- Insulin as beta-cell function declines
Patient teaching
Type 1 Diabetes
- Sick-day rules; stopping insulin → DKA in hours
- Rotate sites; treat hypoglycemia (15-15 rule)
Type 2 Diabetes
- Weight loss, diet, exercise; foot care
- May need insulin later — not a failure
Red flags — escalate
Type 1 Diabetes
- ★DKA: glucose ≥ 250, ketones, Kussmaul
- Severe hypoglycemia
Type 2 Diabetes
- ★HHS: glucose > 600, osm > 320
- Sulfonylurea-induced hypoglycemia
Complications
Type 1 Diabetes
- DKA; retinopathy, nephropathy, neuropathy
Type 2 Diabetes
- HHS; macrovascular (CAD, stroke, PAD)
★ marks the fact that sets a column apart.
Clinical Pearl
Type 1 = no insulin, makes ketones; Type 2 = has insulin, makes hyperosmolarity.
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