Need for Wider Recognition of Non-Classic Forms of Diabetes
Almost all discussion of diabetes revolves around what are called Type 1 diabetes and Type 2 diabetes. Type 1 diabetes is the term used when there is a very low or absent production of insulin, due to destruction of the type of cells in the pancreas that make insulin. Classically, this onsets in childhood and is the result of an immune attack on those cells. The term is also used when those cells are destroyed by other processes. An example would be repeated or severe bouts of pancreatitis (inflammation of the pancreas), which may bring a great deal of pancreatic tissue destruction.
Type 2 diabetes is the term used when the amount of insulin being produced is as much (or more) as would normally be needed to do its job, but the blood glucose is high because the signal of the insulin is not being recognised properly at the level of the cells – most prominently, in terms of blood sugar levels, the muscle cells and the liver. The cells are “resistant to insulin”, and the person has “insulin resistance”. The insulin production is higher than normal, but not high enough to keep blood glucose in the normal range, die to cells not responding properly to the insulin.
These two types can also get mixed up together. A person with Type 1 diabetes (not able to produce enough or any insulin) can also becomes resistant to insulin, which would mean that they need higher amounts of insulin to keep their blood sugar controlled. Someone with Type 2 diabetes can, over time, have a gradual destruction of their ability to make insulin, becoming more like a Type 1 diabetic.
It turns out there is more to the story. There is also MODY and LADA. It turns out that these need to be included more in our awareness. The term “MODY” is an acronym for “Maturity Onset Diabetes of the Young” and “LADA” is an acronym for “Latent Autoimmune Diabetes of Adults”.
For an explanation of these, I refer you to Jenny Ruhl’s site, BloodSugar101.com.
Keep in mind as you read these two articles that our present understanding of both LADA and MODY is not well developed. More research will fill in gaps in our knowledge, so it is to be expected that the known facts and the concepts will develop over time.
From Diabetes in Control comes an article discussing new findings about LADA:
AACE: Latent Autoimmune Diabetes in Adults often Misdiagnosed
|Almost half of nonobese adult with poorly controlled diabetes have latent autoimmune diabetes that has been misdiagnosed as type 2 diabetes….|
Ankit Shrivastav, MD, from the Institute of Postgraduate Medical Education and Research in Kolkata, India, said that, “Young, nonobese, adult-onset diabetic patients with a negative family history, a rapid deterioration of glycemic control, and a rapid onset of complications should be screened for autoantibodies.”
Here is a recent article about MODY:
“Systematic Assessment of Etiology in Adults With a Clinical Diagnosis of Young-Onset Type 2 Diabetes Is a Successful Strategy for Identifying Maturity-Onset Diabetes of the Young”
It is time for these two other forms of diabetes, which had been thought of as uncommon, to be included more generally in our thinking and our approach.
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