 Okay guys, before you dive into this video, please remember to give it a thumbs up or subscribe and so that you can get all the videos you want and you get notified and you help us support us so more people can see these videos that they can educate themselves and understand diabetes better. So type 1 diabetes is autoimmune destruction of beta cells. So basically what happens is as a result of viral or any other environmental stimulus that triggers immune system to attack the beta cells, to attack the beta cells. So once that happens then slowly but surely beta cells die. Sometimes that happens very quickly, sometimes that happens slowly. Some people get type 1 diabetes right after birth. Some people get it in their early teens and so forth. So the type 2 diabetic patients on the other hand, they are developing disease at a much later stage and we are going to talk about why that's the case. Now type 1 diabetic patients as a result, they have autoimmune markers such as antibodies, GAD antibodies, insulin, islet cell antibodies, etc., which we check for. Now type 2 diabetic patients are on the other hand more insulin resistant than insulin deficient. So as a result they actually make a lot of insulin, it's just that that insulin is still not enough to take care of the blood sugar load or the insulin resistance load and we'll talk about that in a minute as well. Now type 1 diabetic patients also are totally insulin dependent, right? So type 2 diabetic patients also take insulin that does not mean that they're insulin dependent. Now some of them are but you know to understand if you're insulin dependent or not that is something that your doctor will tell you just because you're in an insulin does not mean that you are actually insulin dependent. But type 1 diabetic patients versus type 2, definitely. Type 1 diabetic patients are insulin dependent. If they don't take the insulin they will end up with a very severe consequence which is called diabetic ketoacidosis. And diabetic ketoacidosis can actually be very, very dangerous. It can lead to death and as a result we try to avoid diabetic ketoacidosis at all cost. Type 2 diabetic patients can get diabetic ketoacidosis as well but that is much more rare and only happens to a certain subset of type 2 diabetic patients. Now patients are typically overweight with type 2 diabetes. Not always the case but most of the time. Type 1 diabetic patients are on the other hand they are more skinny, they are not overweight and maybe normal weight or underweight. But that's how we initially assess the patient, we look at them, we call that phenotype, we see how they look but we never ever go by the looks and we generally take out our history, we put the pieces together. So that's what we do at Chagrambi. So we make sure that we understand the patient first, we understand their needs are, what their needs are and then we create a craft, a treatment plan. It doesn't have to be medications, right? So we try to get the medications off the list. We are not pro-medicine doctors. So we always try to eliminate diabetes, put the diabetes into remission but also if a medication is needed then we try to get the best medication possible, the most effective, most cost effective. And also when you work with us we typically will get you expensive medications for a very very marginal price. It's just that we have been doing this for a long time, we know how to do it, we dedicate time for it. That's what is missing in a lot of other diabetes practices or endocrinologist offices. The overhead is so much that nobody wants to deal with insurance companies but we do. That's what we do. If we think that you need a DEXCOM G6, if we think that you need Freestyle Libre, we push hard for it. If you think that you need OZMPIC, if you think that you need Rivalous or any of these expensive medications, we try our best to get you and 90% of the time we are successful. Now back to type 1 versus type 2 diabetes. Type 1 diabetic patients tend to also develop other autoimmune disorders. That is not uncommon. So we regularly check them for Hashimoto's Tyroditis. We check them for Celiac disease. We check them for Hypothyroidism as we said. Adrenal insufficiency is not uncommon with type 1 diabetic patients so we always on the lookout to find out if they develop any of these problems especially when they complain. If they don't complain, we still do serial screenings once a year to make sure these patients do not develop these other problems. Now type 2 diabetics do not have that problem just because the underlying pathophysiology of type 2 diabetes is totally different than type 1. It is not that the beta cells are under attack like in type 1 diabetes. Basically type 2 diabetes is more of an insulin resistance problem. It's a supply and demand disease. So if your supply genetically is not strong, if you're not making a lot of insulin then you may develop type 2 diabetes if you become insulin resistant. So it's just like, you know, if you are making $5,000 a month, if you start spending $6,000 a month, you're going to go into debt and you can go bankrupt. So the body works the same way. So if your body can make so much insulin but your body needs more insulin just because of the body size, et cetera, again that's totally relative terms. So you may not be a big guy but if your body is not making enough insulin, you know, that's not necessarily type 1 because you're still making insulin but just not good enough to be able to take care of the blood sugar. So the blood sugar chronically runs high. They don't go into diabetic ketoacidosis but they sometimes need a touch of a medicine in order to help with that. So a lot of videos you guys are watching sometimes. They'll say, oh, diabetes is a sugar disease. You cut the sugar and then suddenly diabetes goes away. Well, that may be true for some patients but not for every patient. A lot of patients will still come and tell me, okay, I've cut the carbs totally, I've been on keto diet, my sugars are still running high. Just because, you know, just because you don't eat carbs doesn't mean that your body doesn't make any insulin. Your body still makes insulin. That is how you get the glucose into cells. Even if you're on a keto diet, for example, your body will turn protein into glucose and for that glucose to get into your cells, you still need insulin. So you have to have insulin in your body. So as a result, guys, so, and then sometimes, you know, as we get older, that's another fact that most people don't understand. Everything goes down, right? So our height goes down, our kidney function goes down, lung goes down. Have you seen a 70-year-old sprinter like a 20-year-old? No, it's just that even if you exercise daily, your exercise capacity will go down. Your lung capacity, your heart capacity will go down. Just like any other organ, pancreas also has a life expectancy, right? So it goes down as we get older. And then ironically, we get fatter as we get older. So think about this. So you are actually spending more and more money, but you are making less and less. So if you're spending more money in your 60s, but you are making much less money compared to your 20s, of course you're gonna go bankrupt. So we expect you to make more money as you get older, as you get more experienced, right? And then be wiser and spend less, maybe, whatever the case, right? But if you do the opposite, if you just go be very wasteful and don't work, then you're gonna go bankrupt and then that's not gonna work. Same thing for the body. So our pancreas goes older as a result. We are making less insulin. That's not something you can work on. Unfortunately, that's genetically determined. And if our body, if not conditioned, if you're not exercising, eating well, and keeping your weight down, then inevitably you're going to have type two diabetes. Again, it's not always your fault. Some people are 400 pounds and they still don't have diabetes in their 50s, 60s, just because genetically they're strong. They make a lot of insulin. Doesn't mean that that's a good thing. You know, they are still insulin resistant. They still get cancer. They still get heart attacks. They still get all those problems. But to develop diabetes, you have to have less insulin than your body needs. That's a relative term again. Now, that is true for type two diabetes. So as a result, we have some type one diabetics, for example, who were diagnosed. Of course they were skinny when they were diagnosed, but they are taking a lot of insulin, eating a lot of carbs. As a result, they look like type two 20 years after just because they gained so much weight and they developed insulin resistance. So you don't have to have type two diabetes to develop insulin resistance. You can be insulin resistant and you can still have type one diabetes. So as a result, you know, these are not hardcore solid facts in terms of their weight and how they look, et cetera. We make a complete analysis to make sure we understand the difference. Now, another difference, type one versus type two diabetes is that we have 80 plus medications in the market. The market is flooded with medications. Not that again, we are not a pro diabetes medicine doctors, but if you need a medication, it is reassuring or at least relieving that we actually can choose from 80 different diabetic drugs. That gives us options, you know, everybody is different and so forth. With type one diabetes, our options are limited. It's just that all these medications are designed to make your beta cells, to make your pancreas work a little harder, a little better. But if your pancreas is dead and you have no beta cells left, most of these medications won't work. Some of the medications work differently. Sometimes they are not approved for type one. Just because of the economics, you know, most companies don't spend money on the studies for type one diabetics because they're the minority. So they try to invest more in the type two diabetes treatment area. As a result, they develop less drugs for type one diabetes versus type two. So we end up using insulin a lot for type one diabetics. Although, although we will use off-label medications sometimes for type one diabetes, just because as a physician, I know how these medications work. And if I think that that medication will help my type one diabetic patient, for example, you know, Vectosa or Ozampic or Ribelsis, these are designed for type two diabetic patients. But the way they work can actually help type one diabetic patients to keep their weight down and so forth. And if they are getting uncontrollable weight gain and no matter what we say with the diet, they are still gaining weight, then I sometimes use medications to cut their appetite or to use these medications to my advantage to help them out. That is also possible. And we do what we have to do for our patients. So again, one more difference between type one versus type two diabetes is that patients with type one diabetes tend to get a lot of low blood sugars. And that happens because they actually end up taking a lot of insulin shots, right? Every time they eat, they have to take an insulin shot and one miscalculation of what they eat and how much insulin they take can cause a severe low blood sugar. They're also missing another important hormone, the type one diabetics, they are missing glucagon, which is a hormone that actually elevates your blood sugar when your sugar is dropping. So that is like a break, this like a protective mechanism. But when pancreas dies, beta cells die, but also alpha cells die that makes the glucagon. So as a result, they don't have the protection from low blood sugars either. That happens more often as they develop diabetes down the road, like 10 years of diabetes type one that is much more common to lose alpha cells eventually. But when you're a new type one diabetic, that's the best time. We sometimes call this honeymoon. Sometimes you don't even need much of an insulin, but as time goes by, managing type one diabetes becomes more and more difficult. So as a result, we use insulin pumps, we use Dexcom G6, we use Freestyle Libre, whatever we can to make sure that we can monitor the blood sugars very effectively and we can intervene when necessary. And I think we do at Sugar MDs guys, so we respond to you immediately. If you have a low blood sugar, you have a high blood sugar, you can get hold of us immediately through texting, emailing. Texting is the best way actually through our app, whatever it may be. If we also sometimes we'll get all lords and we'll say, okay, what's going on with this patient, you know, or she's having a lot of low or high, we contact you and then we kind of fix the regimen. A lot of things can affect the blood sugars guys. It can be stressed, it can be periods for women, it can be depression, it can be the exercise or change in the environment. A lot of things will affect the diabetes management and if you don't really make adjustments or if your doctor doesn't make adjustments on a day to day or at the weekly, monthly, whatever it may be, depending on how stable your life is, your blood sugar may not stay stable. A lot of times people have also misunderstandings about what is low blood sugar, what is high blood sugar and that is, you know, it's an education piece we always try to give to our patients. Now, so we said that hyperglycemia, low blood sugar is very, very common with type one diabetes patients. It can happen with type two diabetes as well, especially if they're on sulfonylurea agents such as galiposide, galiburide, glomerperide, these medications can drop your blood sugars. It's ironic, we tell patients to take the medicine to correct the high blood sugars but then we tell them to eat to prevent the low blood sugar and they end up gaining weight. So these sulfonylureas are not my favorite. We use them sometimes if we have to or some patients are just do well and some others don't. So if you're not doing well on these agents, you definitely need an alternative medication. There are a lot of medications that does not cause dropping blood sugars, that a lot of diabetic medications that can help with the weight loss and control your diabetes at the same time. So if you need a medication, so I think that's your best bet to basically get a medication that can prevent the low blood sugar and also help with the weight loss and we definitely will help you to achieve that goal and to get that medication. They're not cheap, they're expensive but I think with a good team of professionals we can get what we want from insurance provided that it's really medically necessary. That a lot of waste happens in the insurance space and there are a lot of back and forth but we try to provide the cost of active care but our patients are first so we make sure that you guys are taken care of very well. So I hope that explains most of the questions that you may have. If you have more questions, please go ahead and give a thumbs up and subscribe and ask your question. If you are asking a detailed question about your personal history and personal diabetes care, we don't reply to those questions on YouTube. It is not a safe environment. We don't want to expose your information. It's a HIPAA regulation, especially if you're from United States you will know that we have certain laws that prevent us sharing patient information or patient data or exposing patient data to unknown parties. So whatever the consequences may be, we don't know but we abide by the law and we cannot answer specific questions. But if you're asking general questions about type one versus type two, more than welcome, go ahead and do that. Remember to subscribe. We are getting you videos, couple videos every week. They're very informative and diabetes education is a key. Go to our website, sugarmds.com that is also very important for you to understand the diabetes. There's a diabetes education section which we can read a lot of articles.