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NOTE:
unless noted otherwise, all medical/health advice has been given by non-medically qualified personnel. All advice given on this site is designed to support and not replace any advice given by your personal physician. If you have questions or concerns about individual health matters or the management of your diabetes, please consult your diabetes care team.
unless noted otherwise, all medical/health advice has been given by non-medically qualified personnel. All advice given on this site is designed to support and not replace any advice given by your personal physician. If you have questions or concerns about individual health matters or the management of your diabetes, please consult your diabetes care team.
All types of diabetes have the common hallmark of a high blood glucose
level, which is caused by a complete or partial lack of insulin, but the
root of the cause is slightly different in each case.
For a detailed list of all the various types and causes of diabetes, see Classification of Diabetes.
The main types of diabetes - Type 1, Type 2 and Gestational diabetes - are described in Types of Diabetes.
Here, we look at some of the less common, or lesser known, types and causes of diabetes.
There are a number of specific forms of diabetes, including:
There are several forms of diabetes that are associated with specific genetic defects. Only one gene is affected and the diabetes is usually passed on in a distinctive pattern of inheritance. These types of diabetes are characterised by the onset of high blood glucose levels at an early age - usually before 25 years - and form a subgroup of Type 2 diabetes known as Maturity Onset Diabetes of the Young, or MODY.
MODY is generally diagnosed in a family if at least one member has been diagnosed aged less than 25 years and the characteristic pattern of inheritance of diabetes can be seen within the family.
Pattern of inheritance in MODY families
There are currently 5 different genes that are known to cause 5 different types of MODY. In addition to this, researchers are still working to identify other genes that may result in other forms of MODY. If it is possible that a person may have MODY, then molecular genetic testing can confirm the diagnosis.
MODY tends to affect insulin secretion more than insulin action. Most often, the genetic defect causes problems with the normal glucose-sensing and insulin secretion mechanisms. Insulin resistance is not usually a feature of MODY.
Treatment depends on the type of MODY and the severity of the diabetes. In some cases, diet alone is sufficient to keep blood glucose levels normal. In others, tablets to increase insulin secretion may be needed. In some forms of MODY, beta cell function (the ability to produce insulin) declines over the years. In other forms of MODY, beta cell function remains relatively stable, albeit less than normal.
MODY is thought to account for 1 - 2 % of cases of diabetes in the UK white population (although exact figures are uncertain because it can be mistakenly diagnosed as Type 1 or Type 2 diabetes).
Diabetes induced by certain medications or chemicals
There are many drugs that can reduce insulin secretion. These do not usually cause diabetes themselves, but may bring it on in people who are insulin resistant.
There are also a number of drugs and hormones that can reduce insulin action - i.e. increase insulin resistance. This can result in a raised blood glucose level if insufficient insulin is produced to combat the insulin resistance. The most notable drugs to cause this are steroids, which are drugs that are similar to hormones that we produce naturally. Growth hormone, given to young children, can also result in insulin resistance and has been suggested to cause diabetes.
If insulin secretion or insulin action is reduced then the diabetes tends to resemble Type 2 diabetes.
In many cases these types of diabetes are temporary - when the drug or hormone is no longer taken the diabetes disappears. Sometimes though, the diabetes remains; in such cases it is likely that the diabetes was already there and has been 'unmasked' by the drug treatment.
Some toxic substances, such as the rat poison Vacor, are known to permanently destroy beta cells and cause diabetes. In these instances the diabetes is very similar to Type 1 diabetes because insulin can no longer be produced.
Diabetes caused by other disease of the pancreas
Any disease or trauma that causes injury to the pancreas (the gland that houses the insulin-producing beta cells) can cause diabetes. The diabeets may either be temporary or permanent, depending on the extent of the damage.
Pancreatitis is a disease in which the pancreas becomes inflamed. It often occurs in heavy drinkers or alcoholics. Sometimes, if the resulting damage is serious, the pancreas is unable to produce enough insulin to control the body's blood glucose levels - leading to a form of diabetes which is often permanent.
A condition known as haemochromatosis, in which the body accumulates too much iron, can cause damage to the pancreas resulting in 'bronze' diabetes (the name comes from the change in skin colour which also occurs). Iron is deposited in many organs throughout the body, including the pancreas. This can damage beta cells and impair insulin secretion.
Cystic fibrosis results in damage to the pancreas and this can lead to diabetes. As patients with cystic fibrosis are now living longer, more are tending to develop diabetes.
Both haemochromatosis and cystic fibrosis are inherited disorders.
Surgical removal of all, or a large part of, the pancreas causes diabetes. In such cases, the diabetes resembles Type 1 diabetes and insulin injections are usually needed.
Diabetes associated with other hormone conditions
Several of the body's naturally produced hormones have effects on the way in which the body deals with glucose and some hormones cause a certain degree of insulin resistance. If any of these hormones are produced in excess, as a result of disease, then diabetes may develop if the beta cells in the pancreas cannot produce the extra insulin required to keep blood glucose levels down.
In such cases, diabetes often occurs if there is already a problem with insulin secretion.
Sometimes, the diabetes will disappear if the hormone excess can be controlled.
Three examples of 'endocrinopathies' (hormone conditions) that are associated with diabetes are:
Type 1 diabetes is usually associated with the destruction of the insulin- producing beta cells by an autoimmune response. However, this is not always the case; sometimes there is no evidence that the body has launched an attack on itself.
If there is no obvious reason for the destruction of the beta cells then diabetes is said to be 'idiopathic'. Sometimes it is referred to as Type 1b; autoimmune diabetes is then classified as Type 1a.
Latent Autoimmune Diabetes in Adults (LADA)
In recent years it has become possible to detect signs of autoimmunity by measuring levels of certain autoantibodies in the blood. This has lead to the discovery that some people, thought to have Type 2 diabetes, actually appear to have Type 1 diabetes that has developed very slowly. These people have circulating autoantibodies and eventually become insulin dependent, although this could be up to 10 years after diagnosis.
Since this type of diabetes develops in adulthood and can be controlled by diet and tablets to start with, it is often diagnosed as Type 2 diabetes. Some people have preferred to call it Type 1.5, as in many respects it represents a half-way house between typical Type 1 and Type 2 diabetes.
Early-Onset Type 2 Diabetes (EOD)
There are an increasing number of overweight young people, particularly in minority populations, who are being diagnosed with Type 2 diabetes. The diabetes seems to be typical of that usually seen in adults, and is characterised by obesity and lack of physical activity.
Youth-Onset Atypical Diabetes (YOAD)
Some black children diagnosed with diabetes appear to have an atypical form, which is not characteristic of either Type 1 or classical Type 2 diabetes. It has been proposed that this form be called 'Youth-Onset Atypical Diabetes' or YOAD.
Treatments
All of these lesser known forms of diabetes require different treatments tailored to suit the individual. Some can be managed with diet whilst others may need tablets or insulin injections. The treatment approach will largely depend on whether the diabetes more closely resembles Type 1 or Type 2 diabetes.
With such a diversity of causes - some obvious and some less obvious - it is easy to understand why the diagnosis and treatment of diabetes is not always straightforward.
As researchers continue to find out more about the causes of diabetes, there is no doubt that more and more types and sub-types will be defined.
For a detailed list of all the various types and causes of diabetes, see Classification of Diabetes.
The main types of diabetes - Type 1, Type 2 and Gestational diabetes - are described in Types of Diabetes.
Here, we look at some of the less common, or lesser known, types and causes of diabetes.
There are a number of specific forms of diabetes, including:
- Maturity Onset Diabetes of the Young (MODY)
- Diabetes induced by certain medications or chemicals
- Diabetes caused by other disease of the pancreas
- Diabetes associated with other hormone conditions
- Idiopathic Type 1 Diabetes (Type 1b)
- Latent Autoimmune Diabetes in Adults (LADA)
- Early-Onset Type 2 Diabetes (EOD)
- Youth-Onset Atypical Diabetes (YOAD)
- Maturity Onset Diabetes of the Young (MODY)
There are several forms of diabetes that are associated with specific genetic defects. Only one gene is affected and the diabetes is usually passed on in a distinctive pattern of inheritance. These types of diabetes are characterised by the onset of high blood glucose levels at an early age - usually before 25 years - and form a subgroup of Type 2 diabetes known as Maturity Onset Diabetes of the Young, or MODY.
MODY is generally diagnosed in a family if at least one member has been diagnosed aged less than 25 years and the characteristic pattern of inheritance of diabetes can be seen within the family.
Pattern of inheritance in MODY families
There are currently 5 different genes that are known to cause 5 different types of MODY. In addition to this, researchers are still working to identify other genes that may result in other forms of MODY. If it is possible that a person may have MODY, then molecular genetic testing can confirm the diagnosis.
MODY tends to affect insulin secretion more than insulin action. Most often, the genetic defect causes problems with the normal glucose-sensing and insulin secretion mechanisms. Insulin resistance is not usually a feature of MODY.
Treatment depends on the type of MODY and the severity of the diabetes. In some cases, diet alone is sufficient to keep blood glucose levels normal. In others, tablets to increase insulin secretion may be needed. In some forms of MODY, beta cell function (the ability to produce insulin) declines over the years. In other forms of MODY, beta cell function remains relatively stable, albeit less than normal.
MODY is thought to account for 1 - 2 % of cases of diabetes in the UK white population (although exact figures are uncertain because it can be mistakenly diagnosed as Type 1 or Type 2 diabetes).
Diabetes induced by certain medications or chemicals
There are many drugs that can reduce insulin secretion. These do not usually cause diabetes themselves, but may bring it on in people who are insulin resistant.
There are also a number of drugs and hormones that can reduce insulin action - i.e. increase insulin resistance. This can result in a raised blood glucose level if insufficient insulin is produced to combat the insulin resistance. The most notable drugs to cause this are steroids, which are drugs that are similar to hormones that we produce naturally. Growth hormone, given to young children, can also result in insulin resistance and has been suggested to cause diabetes.
If insulin secretion or insulin action is reduced then the diabetes tends to resemble Type 2 diabetes.
In many cases these types of diabetes are temporary - when the drug or hormone is no longer taken the diabetes disappears. Sometimes though, the diabetes remains; in such cases it is likely that the diabetes was already there and has been 'unmasked' by the drug treatment.
Some toxic substances, such as the rat poison Vacor, are known to permanently destroy beta cells and cause diabetes. In these instances the diabetes is very similar to Type 1 diabetes because insulin can no longer be produced.
Diabetes caused by other disease of the pancreas
Any disease or trauma that causes injury to the pancreas (the gland that houses the insulin-producing beta cells) can cause diabetes. The diabeets may either be temporary or permanent, depending on the extent of the damage.
Pancreatitis is a disease in which the pancreas becomes inflamed. It often occurs in heavy drinkers or alcoholics. Sometimes, if the resulting damage is serious, the pancreas is unable to produce enough insulin to control the body's blood glucose levels - leading to a form of diabetes which is often permanent.
A condition known as haemochromatosis, in which the body accumulates too much iron, can cause damage to the pancreas resulting in 'bronze' diabetes (the name comes from the change in skin colour which also occurs). Iron is deposited in many organs throughout the body, including the pancreas. This can damage beta cells and impair insulin secretion.
Cystic fibrosis results in damage to the pancreas and this can lead to diabetes. As patients with cystic fibrosis are now living longer, more are tending to develop diabetes.
Both haemochromatosis and cystic fibrosis are inherited disorders.
Surgical removal of all, or a large part of, the pancreas causes diabetes. In such cases, the diabetes resembles Type 1 diabetes and insulin injections are usually needed.
Diabetes associated with other hormone conditions
Several of the body's naturally produced hormones have effects on the way in which the body deals with glucose and some hormones cause a certain degree of insulin resistance. If any of these hormones are produced in excess, as a result of disease, then diabetes may develop if the beta cells in the pancreas cannot produce the extra insulin required to keep blood glucose levels down.
In such cases, diabetes often occurs if there is already a problem with insulin secretion.
Sometimes, the diabetes will disappear if the hormone excess can be controlled.
Three examples of 'endocrinopathies' (hormone conditions) that are associated with diabetes are:
- Acromegaly, in which growth hormone is produced in excess
- Cushing's syndrome, in which cortisol is produced in excess
- Hyperthyroidism, in which thyroid hormones are produced in excess
Type 1 diabetes is usually associated with the destruction of the insulin- producing beta cells by an autoimmune response. However, this is not always the case; sometimes there is no evidence that the body has launched an attack on itself.
If there is no obvious reason for the destruction of the beta cells then diabetes is said to be 'idiopathic'. Sometimes it is referred to as Type 1b; autoimmune diabetes is then classified as Type 1a.
Latent Autoimmune Diabetes in Adults (LADA)
In recent years it has become possible to detect signs of autoimmunity by measuring levels of certain autoantibodies in the blood. This has lead to the discovery that some people, thought to have Type 2 diabetes, actually appear to have Type 1 diabetes that has developed very slowly. These people have circulating autoantibodies and eventually become insulin dependent, although this could be up to 10 years after diagnosis.
Since this type of diabetes develops in adulthood and can be controlled by diet and tablets to start with, it is often diagnosed as Type 2 diabetes. Some people have preferred to call it Type 1.5, as in many respects it represents a half-way house between typical Type 1 and Type 2 diabetes.
Early-Onset Type 2 Diabetes (EOD)
There are an increasing number of overweight young people, particularly in minority populations, who are being diagnosed with Type 2 diabetes. The diabetes seems to be typical of that usually seen in adults, and is characterised by obesity and lack of physical activity.
Youth-Onset Atypical Diabetes (YOAD)
Some black children diagnosed with diabetes appear to have an atypical form, which is not characteristic of either Type 1 or classical Type 2 diabetes. It has been proposed that this form be called 'Youth-Onset Atypical Diabetes' or YOAD.
Treatments
All of these lesser known forms of diabetes require different treatments tailored to suit the individual. Some can be managed with diet whilst others may need tablets or insulin injections. The treatment approach will largely depend on whether the diabetes more closely resembles Type 1 or Type 2 diabetes.
With such a diversity of causes - some obvious and some less obvious - it is easy to understand why the diagnosis and treatment of diabetes is not always straightforward.
As researchers continue to find out more about the causes of diabetes, there is no doubt that more and more types and sub-types will be defined.
