What’s Worse: Type 1 or Type 2 Diabetes?

Written By Abel Tamirat, MD

Published OnDecember 16, 2025

Many people wonder what’s worse: type 1 or type 2 diabetes. Both are serious chronic conditions that affect blood sugar, blood glucose levels, and long-term health. Each type comes with its own risk factors, complications, and challenges. Instead of one being universally worse, the impact depends on several factors including genetics, lifestyle factors, how early you diagnose diabetes, and how well a person can manage diabetes.

Type 1 diabetes is an autoimmune condition where the immune system attacks and destroys the insulin-producing cells (beta cells) in the pancreas. This means the pancreas cannot make enough insulin to help the body use glucose, the body's main source of energy. Type 2 diabetes, however, is primarily driven by insulin resistance, where the body's cells do not use insulin properly, causing glucose to build in the bloodstream.

This guide explains the differences, serious complications, life expectancy, and what ultimately determines which condition creates greater health risks.

Type 1 Diabetes

Type 1 diabetes—often called juvenile diabetes because it commonly appears in children or young adults—occurs when the body attacks its own beta cells through an autoimmune reaction. This destruction leads to little or no insulin production, making people insulin dependent for life.

People with type 1 diabetes require:

Insulin therapy through insulin injections or an insulin pump
Careful monitoring of blood glucose and blood sugar levels
A consistent balanced diet, healthy lifestyle, and daily planning

Without insulin, type 1 diabetes can progress rapidly and cause life-threatening complications such as diabetic ketoacidosis.

Type 2 Diabetes

Type 2 diabetes (also called diabetes type 2) is far more common, affecting a large portion of the US population. It develops gradually and is influenced by:

Family history
Lifestyle factors such as physical inactivity, poor diet, and lack of regular exercise
High blood pressure and high cholesterol
Excess weight or difficulty maintaining a healthy weight
Prior gestational diabetes

Here, the pancreas still makes insulin, but the body needs more insulin to regulate blood sugar because the cells become resistant. Over time, the pancreas may struggle to keep up, reducing insulin production further.

Type 2 diabetes is often linked to chronic health conditions like cardiovascular disease, kidney failure, and nerve damage if left untreated.

What’s Worse: Type 1 or Type 2 Diabetes

Both types carry significant risks, but in different ways.

Type 1 diabetes may be considered worse short-term because:

The body cannot regulate blood sugar without insulin.
Missing insulin leads to rapid spikes in blood glucose levels.
It can quickly result in life-threatening complications like DKA.

Type 2 diabetes may be worse long-term because:

It often goes undetected for years.
Chronic high blood sugar damages blood vessels, blood flow, and organs.
People often have other chronic conditions, such as high cholesterol or hypertension.
Long-term complications like kidney disease, nerve damage, and heart disease may appear before diagnosis.

Neither type is universally worse. Severity is influenced by how well someone manages their condition, their access to treatment, and how early they begin lifestyle modifications.

Type 1 vs Type 2 Diabetes

Type 1 diabetes carries immediate dangers because lack of insulin causes the body to break down fat too quickly, producing ketones. This leads to diabetic ketoacidosis, which causes:

Nausea and vomiting
Rapid breathing
Confusion
Loss of consciousness

This is a medical emergency.

Type 2 diabetes rarely results in sudden emergencies, but extremely high blood glucose levels may trigger hyperosmolar hyperglycemic state (HHS), which can be life-threatening if untreated.

When comparing the long-term impact of both types, remember that diabetes is a metabolic disease impacting the whole body. Support your overall health by understanding how at-home liver tests work for metabolic monitoring.

Blood Sugar and Long-Term Complications

Prolonged high blood sugar leads to:

Heart disease and stroke
Kidney failure
Nerve damage
Vision problems such as blurred vision
Poor blood flow and foot ulcers
Slow wound healing

Whether you have type 1 diabetes or type 2 diabetes, uncontrolled levels dramatically increase your risk.

Monitoring blood sugar control is fundamental to managing both types. As an early sign of issues, it is essential to understand what glucose in urine means and how it directly affects your kidney health.

Risk Factors

Some risk factors worsen both conditions:

Poor diet with few lifestyle changes
Physical inactivity
High blood pressure
High cholesterol
Family history of diabetes
Chronic stress
Being overweight or obese

Preventing or controlling these factors significantly improves long-term outcomes.

Health Conditions and Lifestyle Factors

Most of the long-term impact of diabetes comes from how well blood sugar is controlled.

Effective ways to manage diabetes include:

Maintaining a healthy weight or seeking weight loss where appropriate
Following a balanced diet rich in whole foods
Increasing regular exercise
Managing blood pressure and cholesterol
Avoiding smoking
Taking medications exactly as prescribed

For some people with type 2 diabetes, lifestyle modifications alone can dramatically improve their condition. In some cases, options like bariatric surgery may significantly improve insulin sensitivity.

Diabetics of either type face an increased risk of infections; learn about a common health risk by reading our guide on urinary tract infections (UTIs), including early signs and management.

Islet Cells, Insulin Therapy, and Treatment Differences

Type 1 Diabetes:

Always requires insulin therapy
Often uses insulin pumps or continuous glucose monitors
Daily management requires counting carbs and adjusting insulin doses

Type 2 Diabetes:

Often begins with lifestyle changes
May require oral medications such as alpha glucosidase inhibitors
May eventually require insulin
Early stages may still allow the pancreas to regulate blood sugar with support

Regardless of type, tracking the health of your kidneys (a primary target for long-term diabetic complications) is essential. Consider using at-home kidney function tests for regular monitoring.

Life Expectancy

Many people with diabetes live long, full lives. Life expectancy depends on how effectively blood sugar is controlled and how early complications are prevented. Untreated diabetes dramatically increases the risk of cardiovascular disease, kidney failure, and other serious complications.

Proper management can significantly extend life expectancy for both type 1 and type 2 diabetes.

The appearance of protein (albuminuria) is a key long-term risk signal of diabetic kidney disease in both Type 1 and Type 2. Use a comprehensive urine test to monitor protein levels and filtration performance.

The Bottom Line

When comparing Type 1 vs Type 2 diabetes, it is not about which one is “worse,” but how early each is diagnosed, how well blood glucose levels are managed, and whether someone adopts key lifestyle changes such as maintaining a healthy weight, eating a balanced diet, and staying physically active.

Both conditions require lifelong care. With proper treatment, monitoring, and healthy habits, people with either type can experience excellent quality of life.

Want to check your blood sugar or diabetes risk from home?
You can take an at-home metabolic and diabetes test through Ribbon Checkup and get results instantly.

Explore diabetes and metabolic tests

Related resources

References

Cleveland Clinic. (n.d.). Type 2 diabetes. Retrieved December 3, 2025, from https://my.clevelandclinic.org/health/diseases/21501-type-2-diabetes

DiMeglio, L. A., Evans-Molina, C., & Oram, R. A. (2018). Type 1 diabetes. The Lancet, 391(10138), 2449–2462. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31320-5/fulltext

Gregg, E. W., et al. (2014). Changes in diabetes-related complications over time. New England Journal of Medicine, 370(16), 1514–1523. https://www.nejm.org/doi/full/10.1056/NEJMoa1310799

Mayo Clinic. (2024, February 16). Type 1 diabetes: Symptoms & causes (Complications section). https://www.mayoclinic.org/diseases-conditions/type-1-diabetes/symptoms-causes/syc-20353011

Mayo Clinic. (2024, February 16). Type 2 diabetes: Symptoms & causes (Complications section). https://www.mayoclinic.org/diseases-conditions/type-2-diabetes/symptoms-causes/syc-20351193

MedlinePlus (NIH). (2024, July 21). Diabetes complications. https://medlineplus.gov/diabetescomplications.html

Rawshani, A., et al. (2017). Risk factor control and mortality in Type 2 diabetes. New England Journal of Medicine, 376(15), 1407–1418. https://www.nejm.org/doi/full/10.1056/NEJMoa1608664

Rawshani, A., et al. (2018). Excess mortality and cardiovascular disease in type 1 diabetes by age and glycaemic control: A registry-based study. The Lancet Diabetes & Endocrinology, 6(1), S18–S19. https://www.thelancet.com/journals/landia/article/PIIS2213-8587(18)30005-6/fulltext

Tuomi, T., Santoro, N., Caprio, S., Cai, M., & McClain, D. (2014). The many faces of diabetes: Type 1, Type 2, and other forms. Nature Reviews Endocrinology, 10(10), 567–576. https://www.nature.com/articles/nrendo.2014.153

Written by Abel Tamirat, MD

Dr. Abel Tamirat is a licensed General Practitioner and ECFMG-certified international medical graduate with over three years of experience supporting U.S.-based telehealth and primary care practices. As a freelance medical writer and Virtual Clinical Support Specialist, he blends frontline clinical expertise with a passion for health technology and evidence-based content. He is also a contributor to Continuing Medical Education (CME) programs.

Back to blog

All Categories