Type 1 v/s Type 2 DiabetesDiabetes is a chronic condition of high blood sugar levels. When food is consumed, our body converts the carbohydrates present in the food into sugar. .This sugar is processed by a hormone called insulin secreted by the pancreas. The processing of sugar is necessary to create energy to perform bodily functions. But too much sugar level in the body due to an absence or low production of insulin can cause Diabetes. Diabetes is broadly classified into two types - Type 1 and Type 2 Diabetes.Type 1 Diabetes is an autoimmune condition that affects people at any age but usually develops in children or young adults. In Type 1 Diabetes, a person is completely dependent on insulin (via injection, pen or pump) as there is no insulin being produced in the body. People with Type 1 Diabetes require daily injectible insulin to manage their blood sugar levels. In Type 1 Diabetes, at the time of diagnosis, this reserve of insulin is less than 1 per cent which is almost negligible. People need two continuous sources of energy - glucose (blood sugar) and oxygen. To use glucose there must be insulin in the body. People with Type 1 Diabetes are unable to produce insulin and that's why they need insulin administration. For people with Type 1 Diabetes, oral anti-diabetes medication should not be prescribed as they can cause adverse outcomes.In people with Type 2 Diabetes, insulin is either secreted in smaller amounts or the secreted insulin is incapable of processing sugar present in the blood. At the time of Type 2 Diabetes diagnosis, it is managed with diet and exercise and sometimes oral medication. When Type 2 Diabetes is diagnosed, approximately 50 per cent of insulin reserve stays in the body. But eventually the number of medicines may increase depending on the blood sugar level. For longstanding Diabetes, insulin is prescribed if lifestyle modification and oral medication are unable to lower blood sugar levels.Alternative to iniectionsWith the advancement in technology, almost painless insulin pens with fine needles are widely available. An alternative to injections is pump therapy in which insulin is delivered into the body using a small patch or cannula attached to the body and a tube connecting the insulin delivery system.An insulin pump is a device that mimics the functioning of a natural pancreas. The pancreas secretes insulin in twomodes - bolus and basal. When we consume any meal, bolus insulin is secreted depending upon the carbohydrate load of that meal and basal insulin is the continuous secretion of insulin which pushes glucose into our body so that we get energy between two meals. The rate of basal insulin secretion in a healthy human being varies from time to time. When we are at stress, the rate is more, in the morning the rate is a little lesser and at night it is much less. This natural change could be easily mimicked by a pump.The latest pumps are equipped to measure blood sugar levels round the clock anddeliver insulin doses accordingly. This helps reduce the number of pricks to the body and the cannula is required to be changed once in five days. So this is almost a painless treatment.One of the reasons for low use of insulin pumps is that most people are uninformed by their paediatric endocrinologists or the treating doctors about the availability of such devices. Secondly, those who are using an insulin pump should be technologically comfortable while using it.Insulin pumps are costly - this is one reason why people are unable to use them. Every doctor must inform his or her patient about the availability of such a device allowing the person the right to choose this relativelypain-free insulin delivery option.Technology in Diabetes managementTechnology plays a big role in Diabetes management. The treating physician should inform children, adolescents and adults with Type 1 Diabetes and their caregivers about the latest tools and technologies. It is also people's responsibility to look into different options available for Diabetes management and ask if technology is helpful for them.For example, most children with Diabetes require four pricks of insulin - one long-acting and three short-acting. Sometimes, more than three pricks are used. In such cases, a continuous glucose monitoring system (CGMS) or ambulatory glucose profile (AGP) could be recommended. CGMS consists of a small wearable sensor that records blood sugar levels every 5 minutes and could be replaced in 14 days. AGP records blood sugar levels every 15 minutes for 2 weeks. Once the wearable is inserted, it provides a graphical representation of blood sugar levels in a day. Insulin therapy combined with continuous glucose monitoring could help people with Type 1 Diabetes better manage their condition..Common hurdlesThere are problems with Diabetes management in different domains. People with Diabetes often face negative feedback and reactions when friends and family find out about their diagnosis. There are hurtful questions asked regarding whether their life would be normal. At the same time, society is not completely at fault here. Thishappens because people, by and large, lack information about Diabetes. It is important to inform caregivers and family members that people with Type 1 Diabetes need insulin from the first day of their diagnosis. Correct information and medical support is essential for people with Type 1 Diabetes to live a healthy life. Family members should understand that Diabetes could, at times, lead to distress in people. They should tryto provide them with a healthy space to feel safe and accepted.Secondly, schools and educational institutions need to be made aware of Diabetes and how to support the students with Diabetes. No school can deny admission to children based on their diagnosis of Type 1 Diabetes. Parents of children with Type 1 Diabetes must be aware of their rights. Educational institutes must ensure that their staff receives language sensitisation and Diabetes awareness training to create a supportive environment for children with Type 1 Diabetes.In my knowledge, one helpful thing is patient education. Every child, adolescent and person with Type 1 Diabetes and their family members should have knowledge about Type 1 Diabetes. They should know what the condition is, why insulin is required, what its complications are and how to handle them. .Initiatives in Type 1 Diabetes awareness For the past 28 years, I have been dealing with cases of Type 1 Diabetes and we also run a non-profit organisation called SPAD - Society for Prevention and Awareness of Diabetes. We host at least 4 programs every year for people with Type 1 Diabetes and we try to focus on almost all aspects - from insulin administration to dose titration, injection sites to acute complications like hypoglycaemia, hyperglycaemia or diabetic ketoacidosis and infections. We also try to discuss a lot of social issues like what could happen in school, how to handle matters in school, college, job and marriage and so on.In 2007, for the first time in India, we organised a meet exclusively for people with Type 1 Diabetes in Kanpur. We invitedpeople from across the country. We discussed different issues related to Diabetes and it was the first meet of such kind. It brought Type 1 Diabetes to the forefront in many corners of the country. Many groups started doing good work in Type 1 Diabetes. I also requested various research organisations, societies and state chapters of Diabetes study to have some topics of Type 1 Diabetes in India so that a clinician is made aware of this problem and how to better guide a person.To concludeDiagnosis of Diabetes is a stressful event. It is distressing for the family and as a treating physician, at times, I get affectedtoo. But the half glass full is that with timely diagnosis and help, every person withType 1 Diabetes can lead a healthy and fulfilling life.