Understanding the types and treatment of diabetes

What do you think of when you hear the word “diabetes”? Do you think of your grandma pricking her finger to check her blood sugar?

Maybe you think about your friend from middle school who always had to have a sweet snack with him in case he felt “low.” Whatever it is you may think about diabetes, there is so much more.

Diabetes mellitus is a complex condition characterized by the body’s inability to regulate blood glucose levels. According to the American Diabetes Association, about 38.4 million Americans are affected by diabetes. 1

Throughout this article, we will cover the main types of diabetes, complications of diabetes and new screening methods and treatment for Type 1 diabetes mellitus.

Type 2 diabetes mellitus is the most common type of diabetes. It more commonly affects older adults, with certain risk factors putting patients at an increased risk. Some of these risk factors include age over 44, obesity, family history, lack of physical activity, nonalcoholic fatty liver disease, history of gestational diabetes, or being an African American, Hispanic or Latino, American Indian, or Alaska Native person. 2

Type 2 diabetes is characterized by the body’s inability to respond to insulin properly. When insulin is released from the pancreas, glucose in the blood is shifted into the cells for energy. In people with type 2 diabetes, glucose is not very responsive to insulin; therefore, glucose levels rise in the blood.

In the early stages of type 2 diabetes, the pancreas overproduces insulin in response to the lack of glucose entering the cells. Over time, the pancreas begins to burn out, producing less insulin altogether. Elevated blood glucose levels may lead to many complications, spanning multiple organ systems. The majority of these complications result from a single cascade: elevated glucose levels damaging blood vessels. These damaging effects can lead to retinopathy, nephropathy, cardiovascular events, neuropathy and immune suppression.

The risk of developing these complications is why getting screened and treated for diabetes is so important. There are many different oral and subcutaneous treatments for type 2 diabetes, but insulin can end up being necessary for treatment.

Type 1 diabetes mellitus, formerly referred to as “Juvenile-onset diabetes,” is characterized by the inability of the pancreas to produce insulin due to islet cell destruction. 3

This type of diabetes usually has a quick onset, with a mean diagnosis age of 22 years old. Islet cell destruction is often secondary to an autoimmune disease.

Islet cells produce insulin. Insulin is the hormone that lowers our blood glucose levels throughout the day and night. If glucose cannot enter the cell, the human body cannot survive. The body’s metabolic state is impaired, disrupting many processes. For instance, without insulin, the cells are deprived of glucose. At the cellular level, our bodies enter a state of starvation; therefore, they use the next best energy source: fat.

When lipids are broken down in the liver, they are eventually converted into free fatty acids, which are then converted into ketone bodies.

These ketones decrease blood pH, leading to acidosis. This life-threatening complication is called diabetic ketoacidosis. Unfortunately, this is how many patients with type 1 diabetes get diagnosed. They end up in the ICU fighting for their life.

Treatment for Type 1 diabetes is lifelong insulin. Unfortunately, insulin therapy can be very difficult and distressing for patients. In addition, insulin, insulin pumps and continuous glucose monitoring devices can become a financial burden for patients. According to APC Diabetes Monthly, 20.4% of 495 participants younger than 65 years old admitted to rationing insulin due to costs. 4

In recent years, new ways to screen and treat early stages of Type 1 diabetes (T1D) have developed. These latest developments have paved the way for clinicians to monitor and detect the early stages of the disease.

We now know that autoantibodies can be detected long before the onset of T1D. Therefore, the American Diabetes Association recommends screening for four islet autoantibodies: insulin (IAA), glutamic acid decarboxylase 65 (GAD65), insulinoma-associated antigen-2 (IA-2), and zinc transporter 8 (ZnT8). Patients with a history of autoimmune diseases like Graves’ disease, Hashimoto’s thyroiditis and Celiac disease, as well as a family history of Type 1 Diabetes, are strong candidates for screening. 5

If two or more autoantibodies are detected, the chance of developing T1D in their lifetime is about 100%. 6

Early detection allows patients and their family members the ability to learn and understand the diagnosis before the stressful learning curve of insulin therapy begins. In addition, patients diagnosed with early-stage T1D may now be candidates for the only FDA-approved medication that delays the need for insulin use. This medication is known as teplizumab. Teplizumab is a CD3-directed monoclonal antibody that prevents the destruction of insulin-producing beta cells. On average, this drug can delay the need for insulin therapy for up to four years.

One of LSU Health Shreveport’s very own Physician Assistant Program alumni, Heather Roan, Endocrinology PA-C, is one of the first providers in northwest Louisiana to treat a patient with early-stage T1D with Teplizumab. These new tools for screening and treating early-stage T1D give patients time — time to learn and process what it means to live with T1D. This time can raise patients’ awareness, helping prevent severe complications such as DKA.

Truly understanding diabetes is essential for patients to make informed decisions about their health. Being aware of symptoms, complications, screening methods and treatment options can make all the difference in millions of people’s daily lives. Always consult your medical provider if you have any questions or concerns about your diabetes risk or treatment.

1. American Diabetes Association. American Diabetes Association Website. Accessed October 4, 2025. https://diabetes.org

2. Centers for Disease Control and Prevention. Diabetes Risk Factors. May 14 2024. Accessed October 4 2025. https://www.cdc.gov/diabetes/risk-factors/index.html

3. Sapra A, Bhandari P. Diabetes. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan–. Updated June 21, 2023. Accessed October 13, 2025. https://www.ncbi.nlm.nih.gov/books/NBK551501/

4. ACP Diabetes Monthly. American College of Physicians. Accessed October 13, 2025. https://diabetes.acponline.org

5. Med Learning Group. Early Screening and Detection. DETECT T1D Clinician Portal. Accessed October 14, 2025. https://detect-t1d.com/clinician-portal/early-screening-and-detection/

6. About TZIELD® (teplizumab-mzwv). Accessed October 22, 2025. https://www.tzieldhcp.com/about-tzield