It is different from type 1 and type 2 diabetes and is often under-recognised or misdiagnosed. Accurate diagnosis is important to ensure the right treatment and support.

What is Type 3c diabetes?

Type 3c diabetes occurs when the pancreas becomes damaged and can no longer produce enough insulin or digestive enzymes. Unlike type 1 diabetes, which is autoimmune, or type 2 diabetes, which is linked to insulin resistance, type 3c is secondary to a condition affecting the pancreas itself.

The pancreas has two main roles:

• Producing insulin and other hormones that regulate blood glucose
• Producing enzymes that help digest food

When it becomes inflamed, injured or partially removed, both of these functions can be disrupted.

Causes of Type 3c diabetes

The most common causes of Type 3c diabetes include:

• Chronic pancreatitis – long-term inflammation of the pancreas
• Pancreatic cancer
• Surgical removal of part or all of the pancreas (pancreatectomy)
• Cystic fibrosis
• Trauma to the pancreas
• Hereditary conditions such as haemochromatosis
• Autoimmune pancreatitis

In many cases, damage to the pancreas results in both diabetes and problems with digestion, such as malabsorption or weight loss.

Symptoms

The symptoms of type 3c diabetes are often similar to other forms of diabetes, but may also include signs of pancreatic insufficiency. Common symptoms include:

• Frequent urination
• Excessive thirst
• Fatigue
• Unexplained weight loss
• Blurred vision
• Abdominal pain
• Bloating or discomfort after meals
• Pale, greasy or foul-smelling stools (steatorrhoea)

These digestive issues occur because the pancreas is no longer producing enough enzymes to break down food properly.

Diagnosis

Type 3c diabetes is frequently misdiagnosed as type 2 diabetes, especially in people without obvious signs of pancreatic disease. A correct diagnosis is essential for effective management.

Diagnosis may involve:

• A thorough medical history, particularly noting any pancreatic conditions or surgery
• Blood tests to check glucose levels and HbA1c
• Pancreatic imaging (CT scan, MRI or ultrasound)
• Tests for pancreatic enzyme function, such as faecal elastase
• Screening for vitamin and nutrient deficiencies

One key difference is that people with type 3c diabetes often have low insulin levels and reduced pancreatic enzyme levels, whereas those with type 2 diabetes do not typically experience digestive problems.

Treatment

Treating type 3c diabetes requires a dual approach, as both blood sugar control and digestive health need to be managed.

Key aspects of treatment include:

• Insulin or other diabetes medications – to manage blood glucose levels
• Pancreatic enzyme replacement therapy (PERT) – to support digestion and nutrient absorption
• Nutritional support – often with the help of a dietitian to ensure a balanced diet and address deficiencies
• Vitamin supplementation – particularly fat-soluble vitamins (A, D, E and K)
• Regular monitoring – of blood glucose, weight and nutritional status
• A multidisciplinary team approach is often needed, involving endocrinologists, dietitians and gastroenterologists.

Living with Type 3c diabetes

Living with type 3c diabetes can be more complex than living with type 1 or type 2, due to the combination of digestive and glucose control challenges. However, with the right support, many people can manage their symptoms effectively and maintain a good quality of life.

Our platform offers:

• Access to expert advice on nutrition, medication and lifestyle changes
• Digital tools for logging meals, tracking blood sugars and monitoring symptoms
• Personalised coaching and support from qualified professionals
• Peer support from others living with diabetes

Type 3c diabetes is a lesser-known form of diabetes caused by damage to the pancreas which affects both insulin production and digestion, making diagnosis and management more complex.

If you or someone you care for has a history of pancreatic problems and has been diagnosed with diabetes, it is important to discuss the possibility of type 3c with your healthcare provider.

With the right care, support and education, people with type 3c diabetes can lead healthy and fulfilling lives.

• Support: Speak to other people with Type 3c diabetes

Cystic fibrosis related diabetes (CFRD) refers to a form of diabetes as a direct consequence of having cystic fibrosis.

Diabetes is a common complication of cystic fibrosis with around 40-50% of adults with cystic fibrosis developing diabetes.

Note that the diet advice for people with CFRD is often notably different to the diet advice for other types of diabetes.

What is cystic fibrosis?

Cystic fibrosis is caused by a genetic mutation of the CFTR gene which causes the normal flow of

salt
and water through the body to be blocked.

This results in the body producing unusually thick mucus which can cause problems in the body such as raising the risk of dangerous lung infections and preventing the pancreas from working properly to digest food.

The symptoms of cystic fibrosis are usually spotted within the first year of a baby’s life and include:

• Particularly salty-tasting skin
• Persistent coughing
• Shortness of breath
• Frequent chest and lung infections
• Poor growth or weight gain

Cystic fibrosis affects digestion and so a high calorie diet is needed to maintain a healthy weight.

Symptoms of diabetes in cystic fibrosis

The following symptoms of diabetes may be noticed in people with cystic fibrosis:

• 
  Increased thirst
• 
  Increased need to urinate
• 
  Excessive tiredness
• 
  Unexplained weight loss
• Unexplained decline in lung function

Diagnosis of diabetes in cystic fibrosis

It is important that a diagnosis of diabetes is not delayed to prevent deterioration of lung function. If you have the symptoms of diabetes, contact your health team who will be able to arrange a diagnosis.

An

oral glucose tolerance test
or

continuous glucose monitoring
may be used to diagnose CFRD.

Causes

Cystic fibrosis can cause scarring of the pancreas which can affect the organ’s ability to produce insulin.

Another contributing factor is

insulin resistance
which can also occur in people with cystic fibrosis. The impact of insulin resistance can be significantly increased whilst, or as a result of, taking corticosteroids to treat symptoms of cystic fibrosis.

Treatment

Treatment for cystic fibrosis related diabetes should aim to address the issue of keeping blood glucose levels under control, whilst enabling someone with CFRD to get sufficient nutrition to maintain a healthy weight.

CFRD is usually treated with

insulin
Insulin helps to keep blood glucose levels under control which can to prevent health complications related to diabetes developing and helps the body to get the energy needed to keep a healthy weight.

Oral hypoglycemics (tablets) may be taken if there are sufficient difficulties in taking insulin. Regular

blood glucose testing
is an important part of the management of CFRD.

Insulin requirements may be higher during times when corticosteroids are taken to manage the symptoms of cystic fibrosis.

Management of diabetes in people with cystic fibrosis presents a different set of challenges to people with type 1 or type 2 diabetes and people with CFRD should be referred to a consultant with a specialism in managing patients with CFRD.

The combination of diabetes with cystic fibrosis can be a challenge and

psychological support
can be an important part of managing the two conditions as well as accepting your diagnosis.

Diet for cystic-fibrosis related diabetes

Cystic fibrosis means that adequate digestion of food is more difficult. As a result, people with CF need to have a high calorie diet which may require frequent snacks. Unlike other types of diabetes, people with CF related diabetes may be encouraged to have refined

carbohydrates
with an appropriate amount of insulin taken to compensate for the expected rise in blood sugar levels.

A higher fat content of the diet may be advised in place of some refined carbohydrates if blood glucose levels are hard to manage.

Complications

In addition to complications that can result directly from cystic fibrosis, such as osteoporosis, sinusitis and infections of the lung, people with CF related diabetes may also experience complications as a result of diabetes including:

• 
  Retinopathy (retinal damage)
• 
  Nephropathy (kidney disease)
• 
  Neuropathy (nerve damage)

The likelihood of developing these complications can be reduced through

keeping blood glucose levels under good control

Macrovascular complications, such as heart disease and stroke, tend to be relatively rare in people with CFRD.

Outlook

The median average for life expectancy for people with cystic fibrosis, according to the Cystic Fibrosis Trust, is currently 41 years. Around 10 years ago, life expectancy was estimated at 34 years so modern treatment has made significant improvements in recent years.

People with CFRD have had shorter life expectancies. In 2001, life expectancy for people with CFRD was 24 years, but this is likely to have significantly improved as well in recent years.

Double diabetes is when someone with type 1 diabetes develops insulin resistance, the key feature of type 2 diabetes.

Someone with double diabetes will always have type 1 diabetes present but the effects of

insulin resistance
can be reduced somewhat.

The most common reason for developing insulin resistance is obesity and whilst type 1 diabetes is not itself brought on by obesity.

People with type 1 diabetes are able to

become obese
and suffer from insulin resistance as much as anyone else.

What is the difference between type 1 and type 2 diabetes?

Type 1 diabetes
is an autoimmune disease whereby the body’s immune system attacks and kills off its own insulin producing cells.

The autoimmune effect is not prompted by being overweight. Over a period of time, the vast majority, if not all, of insulin producing cells are destroyed.

Without being able to produce insulin,

blood sugar levels rise
and the

symptoms of diabetes
appear.

Type 2 diabetes is closely related to obesity, 85% of cases of type 2 diabetes occur in people who are obese. Although the process is not yet fully understood, it is largely believed that obesity causes the body’s cells to become resistant to insulin.

As a result, people with either

type 2 diabetes
or pre-diabetes start to produce more insulin than those without the condition and one of the consequences of this is further weight gain which helps to reinforce the condition.

Type 2 diabetes develops gradually, usually over a period of years before symptoms, such as frequent urination, become noticeable.

Progression of double diabetes

Similar to type 2 diabetes, double diabetes, if not treated appropriately can become more severe over time.

If double diabetes is allowed to progress more insulin will need to be injected which promotes further weight gain and increases the body’s resistance to the insulin further requiring even greater

insulin

Treating double diabetes

Someone with double diabetes will need to keep taking their insulin every day as their type 1 diabetes will always be present.

In addition, they will need to try to combat the insulin resistance by

adapting their lifestyle
to help regain their sensitivity to insulin and slowly and safely reducing the amount of insulin they take.

Eating foods with

fewer carbohydrates
and a higher fibre content can be effective. Including more exercise into one’s daily routine can also help to increase insulin sensitivity.

Medication usually prescribed for type 2 diabetes may also be prescribed to help improve insulin sensitivity as well as to aid

weight loss

Prognosis of double diabetes

Double diabetes can be problematic in that it is taking a condition, type 1 diabetes, with a relatively high risk of complications, such as

heart disease,

stroke
and

kidney disease, and then increasing the risks by adding the associated problems of weight gain and obesity. If overall blood glucose control is also not good, the risks are further increased.

If

blood sugar levels
are well controlled and body weight is reduced, the risks of diabetic complications can be reduced.

A number of medications have side effects which include the raising of blood glucose levels. Drug induced diabetes is when use of a specific medication has lead to the development of diabetes.

In some cases the development of

diabetes may be reversible
if use of the medication is discontinued, but in other cases drug-induced diabetes may be permanent.

Drug induced diabetes is a form of

secondary diabetes, in other words diabetes that is a consequence of having another health condition.

Which drugs can induce diabetes?

A number of drugs have been linked with an increased risk development of

type 2 diabetes

• 
  Corticosteroids
• Thiazide diuretics
• Beta-blockers
• Antipsychotics
• 
  Statins

Is diabetes permanent?

Diabetes may not be permanent but this can depend on other health factors.

With some medications, blood glucose levels may return back to normal once the medication is stopped but, in some cases, the development of diabetes may be permanent.

Managing drug induced diabetes

If you need to continue taking the medication that has brought on diabetes, it may make your diabetes more difficult to control than would otherwise be the case.

If you are able to stop the course of medication, you may find your blood glucose levels become slightly easier to manage.

Following a

healthy diet
and meeting the

recommended exercise
guidelines will help to improve your chances of managing your blood glucose levels.

Can drug induced diabetes be prevented?

It may be possible to reduce the risk of developing diabetes by ensuring you to keep to a

healthy lifestyle
whilst you are on the medication.

Being on smaller doses of the medication or shorter periods of time may help to reduce the likelihood of developing

high blood sugar levels
and diabetes. Doctors will usually try to put you on the smallest effective dose where possible to help reduce complications such as diabetes from developing.

If you are at a higher risk of type 2 diabetes, you may wish to discuss how the medication and dosage may affect your risk of developing diabetes.

• Read more on
  
  preventing diabetes

Corticosteroids

Corticosteroids
are a powerful group of medications used to treat a range of conditions characterised by inflammation such as rheumatoid arthritis and lupus.

Corticosteroids can raise blood glucose levels which may return to normal after the steroid treatment is concluded.

However, particularly if corticosteroids are taken over longer periods of time, steroid treatment can sometimes lead to the development of type 2 diabetes permanently.

Whilst on steroid medication, you may need to take diabetes medication which may include

insulin

When you come off the steroids course of treatment, you may be able to go onto less strong diabetes medication or come off blood glucose lowering medication altogether.

• Read more on
  
  steroid induced diabetes

Beta blockers

Beta-blockers work by blocking the release of adrenaline and noradrenaline which helps to reduce blood pressure and reduce heart rate.

Beta-blockers may be prescribed to treat conditions such as:

• Angina
• 
  Heart disease
• 
  Hypertension (high blood pressure)

Beta-blockers can however reduce

sensitivity to insulin
and can therefore raise the risk of type 2 diabetes developing.

Thiazide diuretics

Thiazide diuretics, also referred to as ‘water tablets’ and may be taken to reduce high blood pressure or to remove excess water from the body.

Side effects of taking thiazide diuretics include increased blood sugar levels and having low levels of salts, such as potassium, magnesium and sodium, in the body. Blood glucose levels may, but not always, return to normal if treatment with thiazide diuretics is stopped.

Antipsychotics

Antipsychotics may be used to treat schizophrenia and symptoms of psychosis which may occur in people with dementia.

Side effects of antipsychotics include weight gain and

hyperglycemia (high blood glucose levels)
Blood sugar levels may return to normal if medication is stopped.

However, if significant weight has been gained over the course of the treatment. Insulin resistance and type 2 diabetes may be permanent.

Statins

Statins are

cholesterol
lowering medications that have been widely prescribed since they were introduced in 2003.

In 2011, a study published in the JAMA medical journal showed a link between taking higher doses of statin medications and a higher risk of type 2 diabetes.

In 2012, the US Food and Drug Administration introduced warnings on statins to advise on the higher risk of higher blood glucose levels and memory problems associated with the medication.

Hemochromatosis is a condition in which the body absorbs excess iron from food.

The condition is caused by a faulty gene and can lead to gradual damage to a number of organs.

Hemochromatosis is sometimes referred to as bronze diabetes because it can lead to darkening of the skin and

hyperglycemia

Symptoms

The symptoms of hemochromatosis occur gradually with signs often first becoming apparent after the age of 40.

Symptoms may include:

• 
  Fatigue
• 
  Joint pain
  – particularly affecting the fingers
• Unexplained bronzing or tanning of the skin
• 
  Erectile dysfunction
• Missed periods
• 
  Increased urination
• 
  Thirst
• Loss of body hair
• Cardiomyopathy – weakening of the heart

Causes of hemochromatosis

Hemochromatosis is a relatively common inherited genetic condition. People with hemochromatosis have two sets of a mutated HFE gene.

People with one set of the faulty gene will not have hemochromatosis but could pass it on children if their partner is also a carrier of the faulty gene.

The faulty gene causes the body to absorb too much iron from food. Usually the body absorbs only as much as it needs.

The body has no natural response to help excrete the excess iron and so, over the years, the body stores the iron in organs such as the

liver, pancreas and the skin, in that order.

Excess iron in the liver can cause liver damage and excess iron in the

pancreas
can lead to diabetes. Forms of diabetes that are caused by another medical condition are referred to as

secondary diabetes

Diagnosis

Hemochromatosis can be diagnosed with a transferrin saturation or serum ferritin blood test, or if needed a DNA blood test to check for the presence of a faulty HFE gene.

A liver biopsy may be carried out to assess whether liver damage has occurred.

If you have close family members diagnosed with hemochromatosis, you may wish to be tested for it.

Treatment

Hemochromatosis is usually treated with regular phlebotomy, a procedure which involves removing iron-rich blood from the body.

An alternative treatment is chelation therapy which involves taking a medication called Deferasirox.

Treatment for hemochromatosis is ‘off-label’ as it is has not been clinically trialled for hemochromatosis, but it may be prescribed if you have a condition, such as anaemia or

heart disease, which could prevent you having phlebotomy.

Hemochromatosis and diabetes

In some cases, treating hemochromatosis may reverse the development of diabetes. In other cases, there may be permanent damage to the pancreas which will require diabetes medication to keep blood glucose levels under control.

Your health team will be able to advise whether medication is needed, and if so, whether you need to take tablets or

insulin

Neonatal diabetes is a rare form of diabetes that is usually diagnosed in children under 6 months of age.

This early occurring type of diabetes is caused by one of a number of genetic mutations and is therefore described as a

monogenic

form of diabetes.

Neonatal diabetes is treatable and may or may not

require insulin
so a diagnosis by genetic testing is recommended.

Types of neonatal diabetes

There are two main types of neonatal diabetes:

• Transient Neonatal Diabetes Mellitus
• Permanent Neonatal Diabetes Mellitus

Transient neonatal diabetes is so called because it usually disappears within a year of birth but can come back again
typically during adolescence

Permanent neonatal diabetes, once diagnosed, stays for the rest of life.

How common is neonatal diabetes?

Neonatal diabetes is very rare, occurring in around

1 in 300,000

to

1 in 400,000 births

Out of the two types of neonatal diabetes, the transient type is slightly more common affecting 50-60% of cases of neonatal diabetes.


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Symptoms and diagnosis

The

symptoms
of neonatal diabetes include persistent thirst, frequent urination and dehydration.


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Presence of diabetes mellitus can be diagnosed with a blood glucose test. A diagnosis of diabetes before 6 months should suggest neonatal diabetes, as opposed to

type 1 diabetes

In some cases, neonatal diabetes may be diagnosed after 6 months however.

Genetic testing is advised for children diagnosed with diabetes under the age of 9 months to asses which form of diabetes is present and to guide the best form of treatment.


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Treatment

Neonatal diabetes will usually either be treated with a drug called glibenclamide or with insulin.

Around 50% of people with neonatal diabetes can be treated with glibenclamide, a drug which causes the pancreas to release more insulin. Glibenclamide is in a class of diabetes drugs called

sulfonylureas
If glibenclamide is not effective enough, insulin will need to be taken.

If neonatal diabetes is transient, it won’t require treatment during the years in which it is resolved. However, the condition should be monitored for reappearance of diabetes in adolescence and later years.

Complications

A number of health complications can occur in people with neonatal diabetes, depending on which gene is affected. The following complications are relatively common in children with neonatal diabetes:

• Developmental delay such as muscle weakness and learning disabilities
• 
  Diabetic ketoacidosis
• Low birth weight
• Muscle weakness
• Epilepsy
• Macroglossia – a larger than normal tongue

Treatment with glibenclamide has been shown to help reduce the effects of developmental delay.

Prevention

Neonatal diabetes is genetic disorder for which, unfortunately, there is no known prevention.

Secondary diabetes is diabetes that results as a consequence of another medical condition.

Because the cause of diabetes ranges between different conditions, the way in which blood glucose levels are controlled can also vary.

Secondary diabetes will often be permanent but for some forms, it may be possible to reverse or eradicate the effects of

hyperglycemia

Which conditions can lead to secondary diabetes?

Health conditions which can cause diabetes include:

• 
  Cystic fibrosis
• 
  Hemochromatosis
• 
  Chronic pancreatitis
• 
  Polycystic ovary syndrome (PCOS)
• 
  Cushing’s syndrome
• 
  Pancreatic cancer
• 
  Glucagonoma
• Pancreatectomy

Drug induced diabetes includes diabetes that results from taking certain medications. Medications which may bring on diabetes include corticosteroids, beta-blockers and thiazide diuretics.

• Read more on
  
  drug induced diabetes

Managing secondary diabetes

How secondary diabetes is managed can vary quite significantly depending on which condition has caused it.

Insulin resistance

Some medical conditions listed will result in

insulin resistance, which is where the body is not able to adequately respond to insulin.

This forces the body to release more insulin in an attempt to keep blood glucose levels under control. Insulin resistance is a characteristic of

type 2 diabetes

Insulin resistance is a feature of diabetes caused by Cushing’s syndrome and PCOS.

Lifestyle changes
are an important part of treatment.

If medication is required to control blood glucose levels,

metformin
is commonly prescribed with stronger medication, including insulin, available if blood glucose levels remain elevated.

Loss of pancreatic function

Some forms of secondary diabetes, such as diabetes as a result of pancreatitis, cystic fibrosis or hemochromatosis, may result in a loss of pancreatitic function; that is the pancreas may not be able to produce enough insulin to keep blood glucose levels stable.

In these forms of secondary diabetes,

injections of insulin
may need to be taken to keep blood sugar levels under control.

However, in some cases, taking diabetes medication in tablet form may be sufficient.

People that have had a pancreatectomy will not be able to produce any of their own insulin and will therefore need to take regular insulin injections in a similar way to people with type 1 diabetes.

Excess glucagon production

In

glucagonoma, tumours in the pancreas lead to too much glucagon being released.

Glucagon
works in the opposite way to insulin, and instructs the release of glucose into the blood, which can result in blood sugar levels going too high.

Treatment for glucagonoma is to directly target the tumour with anti-tumour therapy such as chemotherapy or through surgery to remove the tumour.

Is secondary diabetes permanent?

In some cases diabetes will be permanent. The cases when diabetes needn’t be permanent are if the cause of diabetes can be corrected. For instance, it can sometimes be possible to reverse the effects of diabetes in hemochromatosis if the condition is adequately treated in time.

Diabetes as a result of glucagonoma may also be temporary if treated successfully soon enough.

Corticosteroids are used to reduce harmful inflammation but can lead to diabetes – often referred to as steroid diabetes.

People on steroids who are already at a higher risk of

type 2 diabetes
or those who need to take steroids for longer periods of time are the most susceptible to developing steroid induced diabetes.

What is the role of steroids?

Steroids are taken to reduce inflammation, brought on by the body’s immune system, and can be taken as treatment for a number of illnesses including:

• Asthma
• Lupus
• Rheumatoid arthritis
• Crohn’s disease
• Ulcerative colitis

To achieve their purpose, corticosteroids mimic the action of cortisol, a

hormone produced by the kidneys
and responsible for brining on our body’s classic stress response of higher blood pressure and increased blood glucose levels.

Corticosteroids

increase insulin resistance
thus allowing blood glucose levels to rise and remain higher.

Read more on

steroids and their side effects

What are the symptoms of steroid induced diabetes?

People taking steroids may notice the following

symptoms of diabetes
:

• Dry mouth
• Blurred vision
• Increased thirst
• Increased need to urinate
• Tiredness and lethargy

However, symptoms may not be present unless blood sugar levels are significantly higher than normal.

Is steroid induced diabetes permanent?

High blood glucose levels whilst taking steroids may subside after you stop taking steroids, however, some people may develop type 2 diabetes which will need to be managed for life.

Type 2 diabetes is more likely to develop following longer term usage of steroids, such as usage of oral corticosteroids for longer than 3 months.

Am I at risk of developing steroid induced type 2 diabetes?

People at a

higher risk of developing type 2 diabetes
include:

• Those that are overweight
• If you have one or more close family members with type 2 diabetes
• If you have had
  
  gestational diabetes
• If you have
  
  polycystic ovary syndrome
• If you are over 40 and of caucasian origin
• If you are over 25 and are of
  
  South Asian, African-Caribbean or Middle Eastern origin

Did steroids bring on my type 2 diabetes?

There has been debate as to whether corticosteroids are a cause for diabetes or whether steroids advance the development of existing

type 2 diabetes

A study published in 2012, carried out by the University of Sydney, looked to investigate answers to the question.

The study, titled

Steroid-Induced Diabetes: Is It Just Unmasking of Type 2 Diabetes?
, found that those which developed new onset steroid induced diabetes had lower risk profiles than is typical of people with type 2 diabetes.

How is steroid induced diabetes treated?

The treatment for diabetes you are put on may depend on the extent of insulin resistance and how high your blood glucose levels are. It may be possible to treat your diabetes with diet and physical activity but you may need oral

anti-diabetic medication
or insulin.

If you have been diagnosed with diabetes, you will need to attend health screenings at least once

annually so your health can be monitored and treated
appropriately.

Wolfram syndrome, also known as DIDMOAD, is a very rare

genetic disorder
that children can be born with – roughly

1 in 500,000

children are affected by the condition.

The term DIDMOAD describes common features of the condition which may include

diabetes insipidus, diabetes mellitus, optic atrophy and deafness.

Some of the features of Wolfram Syndromen, such as diabetes insipidus and

diabetes mellitus, can be treated although complications, including kidney problems, are common.

History of Wolfram syndrome

Wolfram syndrome was first described in 1938 by Dr Don J Wolfram who observed the features in 4 siblings with the same condition.

Symptoms and features of Wolfram syndrome

Symptoms and features of Wolfram syndrome include:

• Diabetes insipidus: Caused by insufficient production of the hormone vasopressin leading to symptoms of
  
  regular thirst
  and a
  
  frequent need to urinate

• Diabetes mellitus: Caused by insufficient production of the hormone insulin, also leading to thirst and frequent need to urinate, in addition to
  
  significant weight loss, fatigue and
  
  high blood glucose levels

• Optic atrophy: Caused by death of the optic nerve leading to
  
  visual impairment and sometimes grey vision

• 
  Deafness
  : Difficulty hearing high pitched sounds or within crowded rooms.

The symptoms diabetes mellitus and optic atrophy will usually both appear before the age of 15 years old.

Around

3 in 4

patients develop diabetes insipidus and

2 in 3

will develop deafness before reaching adulthood.

The following complications are common in Wolfram syndrome:

• 
  Blindness
• Renal (kidney) problems:
  
  causing incontinence
• Neurological problems: causing ataxia (loss of balance), breathing difficulties, sudden muscle jerks and loss of taste and smell.
• Digestive disorders: including
  
  constipation
  and
  
  diarrhoea

• Chronic fatigue
• 
  Depression

Causes of Wolfram syndrome

Wolfram syndrome is caused by a mutation in the WFS1 gene.

The WSF1 gene controls the production of a protein called wolframin which is thought to be involved in the regulation of calcium in many parts of the body.

If you have a child with Wolfram syndromen, there is a

1 in 4

chance that each of your

other children
will develop Wolfram syndrome. It is possible to carry out genetic testing, whilst pregnant, to determine whether the developing baby will develop Wolfram’s syndrome.

Diagnosis of Wolfram syndrome

Wolfram syndrome will

usually by diagnosed if the symptoms of diabetes mellitus
and optic atrophy are present. Genetic testing can be used to confirm Wolfram syndrome.

How do you treat Wolfram syndrome?

Treatment for Wolfram syndrome involves treating each of the individual symptoms.

• Diabetes insipidus: Controlled by taking the hormone vasopressin either by nasal spray, tablets or by injection.
• Diabetes mellitus:
  
  Controlled by taking insulin
  and regularly
  
  monitoring blood glucose levels
• Optic atrophy: No treatment is available for optic atrophy
• Deafness: Can be treated with a hearing aid
• Muscle jerks: Can be controlled with anticonvulsant medication

Type 1.5 diabetes is a non-official term that is sometimes used to refer to a form of type 1 diabetes known as

Latent Autoimmune Diabetes in Adults (LADA).

The term type 1.5 refers to the fact that the condition is a form of type 1 diabetes that can share some features that are more commonly associated with type 2 diabetes.

Type 1.5 diabetes is

diagnosed
during adulthood as are most cases of type 2 diabetes. Type 1.5 diabetes also has a slow onset, similar to type 2 diabetes.

However, type 1.5 diabetes is an autoimmune disease like type 1 diabetes and will almost certainly require insulin therapy at some point in the future.

Misdiagnosis

Misdiagnosis as having

type 2 diabetes
is common.

Around 15-20% of people diagnosed with type 2 diabetes may actually have Type 1.5 diabetes.

Medications designed to reduce

insulin
resistance do not work, as people with type 1.5 have little or no resistance to insulin.

Type 1.5 Medication

Oral medications may be effective at first, meaning misdiagnosis takes longer to establish.

Amongst those with type 1.5 diabetes, insulin is required on average within four years.

Type 1.5 Symptoms

People with type 1.5 diabetes often do not have standard type 2 diabetes symptoms, including

metabolic syndrome
indicators.

People with type 1.5 diabetes often have a lower risk of heart problems once

blood sugar
is controlled.

Diabetes insipidus, often shortened to DI, is a rare

form of diabetes
that is not related to blood sugar-related diabetes mellitus, but does share some of its signs and symptoms.

Diabetes insipidus is simply

excessive urination (polyuria)
and complications thereof, caused by an antidiuretice hormone called a vasopressin.

Read on to find out more about what diabetes insipidus is, how it affects the body, the different forms of the disease, and how it is diagnosed and treated.

What are the symptoms of diabetes insipidus?

Diabetes Insipidus leads to frequent urination, and this is the most common and clear symptom. In extreme cases, urination can be in excess of 20 litres per day.

A secondary symptom is

increased thirst, as a result of passing so much water.

If this is not met, then dehydration can occur which, in turn, can lead to:

• Cracked skin
• 
  Fatigue
• Confusion
• 
  Dizziness
  and even
• 
  Unconsciousness

Children suffering from the condition may become irritable or listless, with fever and vomiting also possible.

How does diabetes insipidus compare with diabetes mellitus?

Diabetes insipidus and diabetes mellitus should not be confused. The two conditions are unrelated, with diabetes insipidus a completely different type of illness. Diabetes mellitus is also far more common.

Diabetes mellitus occurs due to

insulin resistance
or insulin deficiency and subsequent high blood glucose levels.

Diabetes Insipidus on the other hand develops as a result of the stilted production of a hormone in the brain, which is released to stop the kidneys producing so much urine in order to retain water. Without this hormone, water is not retained and the

kidneys constantly work
to their maximum capacity.

The word “Mellitus” tagged onto the main form of diabetes comes from an old word roughly meaning “to sweeten with honey” and is a reference to the

high levels of sugar in the blood

By contrast, “Insipidus” means “un-tasty” and so is used to describe a form of diabetes that does not result in high sugar levels.

The different types of diabetes insipidus

There are 4 types of diabetes insipidus, including:

Neurogenic diabetes insipidus

Neurogenic diabetes Insipidus, or central and cranial diabetes insipidus as it is sometimes referred to, is a form of DI that is caused by a problem in the hypothalamus section of the

brain
It can stop producing the antidiuretic hormone (ADH), also known as vasopressin.

This hormone tells the kidneys to stop producing urine, and is released when there is a relatively low amount of water in the body. If ADH isn’t produced, the kidneys will go on producing urine, resulting in frequent trips to the toilet and a higher risk of

dehydration

Head injury, brain tumours or brain surgery can all result in damage to the hypothalamus or pituitary gland, which can prevent it from producing and storing the ADH.

A lack of oxygen reaching the brain,

caused by a stroke
or a breathing trauma, such as choking or drowning, can cause sufficient damage to prevent production, as can some infections such as meningitis.

Nephrogenic diabetes insipidus

There are 2 forms of nephrogenic diabetes:

Congenital nephrogenic diabetes insipidus

Congenital diabetes Insipidus is present from birth and is caused by several genes that cause the kidneys of the foetus to form improperly. Kidneys contain cells called nephrons which regulate what water is passed by urine and what water is reabsorbed back into the body. These nephrons react to the ADH released by the hypothalamus, and if they are damaged, they can end up ‘ignoring’ the ADH, leading to constant production of urine.

Deformations can occur in the body by the presence of several rogue genes. This mutation can only be passed from unaffected mothers to their sons. However, this very rarely happens, apparently affecting just 1 in 250,000 births.

There is an even rarer gene mutation that can cause nephrogenic diabetes insipidus in both males and females.

Acquired nephrogenic diabetes insipidus

Acquired diabetes insipidus occurs after birth as a result of an outside factor

damaging the kidneys
and leading to the excessive urination.

Lithium is used in some medications, particularly for bi-polar disorder, and long term intake of lithium can cause damage to the nephrons in the kidneys. Being taken off lithium however, can restore normal kidney function if it is diagnosed early, so having kidney function tests every three months is advised by the NHS if you are on lithium containing medication. Your doctor will talk to you about this.

Infections, blockages (such as kidney stones) or other forms of damage to the kidney could lead to diabetes insipidus, so if you have undergone any of these and are experiencing excessive urination, you should contact your doctor.

Gestational diabetes insipidus

During pregnancy, the uterus produces vasopressinase which can break down ADH. The nephrones in the kidneys do not receive the ‘stop making urine’ message and continue to produce it.

Usually Gestational diabetes insipidus will disappear after the pregnancy. Just like gestational diabetes mellitus, one case of

gestational diabetes
insipidus means that another case during subsequent pregnancies is likely.

Dipsogenic diabetes insipidus

Some cases of diabetes insipidus occur because of an issue with the thirst function. Similar damage to the hypothalamus that causes neurogenic diabetes insipidus can also result in a malfunction to the thirst mechanism, resulting in thirst that won’t go away. This will lead to a constant need to drink, which in turn can lead to excessive urination.

How is diabetes insipidus diagnosed?

Diagnosing DI can be complicated as it shares many

symptoms of diabetes
mellitus. There are however, a series of tests that can determine exactly what the patient is suffering from. These include urinalysis, fluid deprivation, and even MRI scans.

If a GP thinks a patient may have DM, they will carry out a urine glucose test, which should result negatively if the patient has DI.

Treating diabetes insipidus

If you have a mild form of DI, usually only passing around 3-4 litres of urine a day, you may not be given any treatment and told that the disorder is manageable by drinking plenty of water.

If your condition is more severe, you may be given one of the following:

Desmopressin for treating neurogenic diabetes insipidus

Desmopressin is a manufactured version of ADH given as a medication for diabetes insipidus. It acts in place of the natural hormone your body can’t produce.

In more extreme cases of DI, desmopressin may be prescribed in either a tablet or a nasal spray form. The nasal spray is more effective, and gets into the bloodstream more efficiently and quicker, but can be blocked by colds or flu.

There are fairly low rates of side effects in patients on desmopressin, but they can include

• Headache
• 
  Nausea and vomiting
• 
  Dizziness

The main concern with desmopressin is overdosing, as this can cause your body to retain too much water.

Stick to the dosage your doctor has prescribed and don’t increase the dose if it is ‘not working’. Consult your doctor if the symptoms persist, even whilst on treatment.

Thiazide diuretic treatment for neurogenic diabetes insipidus

Thiazide diuretics are a type of medication that increases urination rate but can strangely help prevent urination in sufferers of diabetes insipidus. This is because thiazides increase the concentration of the waste product in the urine, which can have a consequential effect of reducing the amount of urine produced in DI sufferers.

Nephrogenic diabetes insipidus treatment

Nephrogenic DI is much harder to treat. This is because there is a problem with the kidneys themselves, not just the message that tells them what to do.

If you are on a medication containing lithium, coming off that prescription may help. However, you should not alter your medication without consulting your doctor, and they will tell you what to take or try to find and alternative treatment.

Dietary changes may also help to alleviate your symptoms, but again, consult your GP before making any

drastic change to your diet

LADA stands for Latent Autoimmune Diabetes of Adulthood. LADA is a form of

type 1 diabetes
that develops later into adulthood.

LADA tends to develop more slowly than type 1 diabetes in childhood and, because LADA can sometimes appear similar to

type 2 diabetes, doctors may mistakenly diagnose LADA as type 2 diabetes.

The definition provided by Prof. David Leslie, Principle Investigator of Action LADA, is that in Europe:

LADA is defined as initially non-insulin requiring diabetes diagnosed in people aged 30-50 years with antibodies to GAD – glutamic acid decarboxylase.

How does LADA compare with other diabetes types?

LADA is sometimes referred to as type 1.5 diabetes. This is not an official term but it does illustrate the fact that LADA is a form of type 1 diabetes that shares some characteristics with type 2 diabetes.

As a form of type 1 diabetes, LADA is an autoimmune disease in which the body’s immune system attacks and kills off insulin producing cells.

The reasons why LADA can often be mistaken for type 2 diabetes is it develops over a longer period of time than type 1 diabetes in children or younger adults.

Whereas type 1 diabetes in children tends to develop quickly, sometimes within the space of days, LADA develops more slowly, sometimes over a period of years.

The slower onset of

diabetes symptoms
being presented in people over 35 years may lead a GP to initially diagnose a case of LADA as type 2 diabetes.

Symptoms of LADA

The first symptoms of LADA include:

• 
  Feeling tired all the time
  or regularly tired after meals
• Foggy headedness
• Experiencing hunger soon after meals

As LADA develops, a person’s ability to produce insulin will gradually decrease and this may lead to symptoms such as:

• 
  A hard to quench thirst
• 
  Needing to frequently urinate
• 
  Blurred vision
• Tingling nerves

It is important to catch the symptoms at the earliest stage because diagnosis of LADA at a later stage increases the risk of developing diabetes complications.

Having tingling nerves can be a sign of neuropathy (nerve disease) so if this symptom is appearing regularly, especially if in addition to other symptoms listed above, it is advisable to see a doctor.

How common is LADA?

According to the UK Prospective Diabetes Study found that antibodies specific to LADA cases are found in between 6% and 10% of diabetes cases. Amongst people diagnosed with diabetes at an age younger than 35 years old, LADA may account for up to 25% of cases.

How is LADA diagnosed?

Often LADA will be initially diagnosed as diabetes by way of the usual diagnosis procedures.

Following a diagnosis of diabetes, your doctor or you may have reason to suspect that the type of diabetes present is LADA.

Determining the presence of LADA is achieved by examining the presence of elevated levels of pancreatic autoantibodies amongst patients who have recently been diagnosed with diabetes but do not require insulin.

A

GAD Antibody test
can measure the presence of these autoantibodies.

These antibodies can identify LADA, and also can predict the rate of progression towards insulin dependency.

Another test that can be performed is a C-peptide test. However, C-peptide tests may not always draw conclusive results in people with LADA at an earlier stage of the condition’s development.

LADA can be misdiagnosed

As noted, because of the age at which it can develop and the slower onset of the condition, LADA can often be mistakenly misdiagnosed as type 2 diabetes.

It is beneficial if LADA is diagnosed correctly as if LADA is incorrectly diagnosed as type 2 diabetes, it could lead inappropriate treatment methods that could lead to poorer diabetes control and could accelerate the loss of insulin producing ability.

There are some clues that can give rise to a clinical suspicion of LADA rather than type 2 diabetes. These include:

• An absence of
  
  metabolic syndrome
  features such as obesity, high blood pressure and cholesterol levels
• Uncontrolled hyperglycemia despite using oral agents
• Evidence of other autoimmune diseases (including Graves’ disease and Anaemia)

Note that some people with LADA can exhibit features of

metabolic syndrome
such as being overweight or obese which may complicate or delay a diagnosis of LADA.

How is LADA


treated


?

Because LADA develops slowly, someone with LADA may be able to produce enough of their own insulin to keep sugar levels under control without needing insulin for a number of months or sometimes even years after the initial diagnosis of diabetes.

Insulin will almost certainly be required at some point in the future.

In some cases, insulin therapy may be postponed. However, there is evidence to suggest that starting insulin treatment soon after a diagnosis of LADA will help to better preserve the pancreas’ ability to produce insulin.

Regular blood glucose testing is advised for people with LADA at a similar number of tests per day that are advised for people with type 1 diabetes.

This means that it is advisable to

test your blood sugar levels
before each meal and before bed.


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What complications are related to LADA?

Ketoacidosis
is a short-term complication of LADA, particularly once the pancreas has lost much of its ability to produce

insulin

People with LADA should be aware of the signs of ketoacidosis and

how to test for ketones
if needed.

The risks of long term complications of diabetes will be similar to the risks in people with type 1 and type 2 diabetes.

The possible long term complications of diabetes include:

• Heart disease and stroke
• 
  Retinopathy
  (retinal disease)
• Nephropathy (kidney disease)
• 
  Neuropathy
  (nerve disease)
• Foot problems

What complications are related to LADA?

Ketoacidosis
is a long-term complication of LADA, particularly once

insulin
dependence develops.

Cardiovascular disease risks are similar to those of type 2 diabetics, but if this complication develops hyperglycaemia is a stronger risk factor.

Microvascular complications such as

retinopathy
and

neuropathy
are similar to those people with type 2 diabetes.

How is LADA managed?

The treatment of LADA needs to focus on controlling hyperglycaemia and preventing the onset of any complications.

It is important to preserve beta cell function amongst LADA patients for as long as possible. Insulin can be used to treat LADA, as can

metformin
and

thiazolidinediones

Anything that can help to restore beta cell function should be considered.

Type 5 diabetes is more likely to be inherited than other forms of diabetes, as it is strongly linked to genetics.

MODY is sometimes compared to type 2 diabetes, and shares some type 2 diabetes symptoms.

People with MODY are often young and not necessarily overweight.

What is MODY diabetes?

MODY affects around one or two per cent of people with diabetes and may go unrecognised in its early stages.

It usually develops before the age of 25 and runs in families. MODY is not always treated with insulin.

It also runs in families, and can pass from one generation to the next. MODY does not always require insulin treatment.

Why is MODY inherited so easily?

MODY is caused by a change in a single gene. Each child of an affected parent has a 50 per cent chance of inheriting the gene and developing MODY.

Why MODY is different from other types of diabetes

Understanding MODY, including its different forms, helps people get the right treatment.

It also provides useful information about how the condition may progress and whether other family members are at risk.

What are the different types of MODY?

The most common type is HNF1 alpha, which accounts for about 70 per cent of MODY cases. Insulin production reduces over time, and symptoms usually appear during the teenage years or early twenties.

Glucokinase MODY is the second most common type. It happens when a gene that helps the body sense blood glucose levels does not work properly. This form is often identified during routine blood tests, such as during pregnancy.

HNF4 alpha is a less common form of MODY, often diagnosed later in life. HNF1 beta is associated with kidney cysts and other kidney problems.

PDX1 (also known as IPF1) is extremely rare, with only one known family in the UK affected.

NeuroD1 is another rare type, reported in only two families in the UK. There is limited information on the rarest forms of MODY.

HNF4 – alpha is a less common form of MODY that is often diagnosed at a later stage. HNF1 – beta is a type of MODY associated with renal cysts.

PDX1 and IPF1 are the same type of MODY, and are incredibly rare, affecting only one UK family to date.

NeuroD1 is another rare type of MODY, affecting only two families in the UK. Little information is available about the rarer forms of MODY.

What complications are caused by MODY?

MODY can lead to complications, just like other types of diabetes if not controlled.

Careful management and regular monitoring are essential to reduce the risk of health problems.

I am worried I might have MODY, what should I do?

If you are concerned you may have MODY, speak to your GP as soon as possible.

A genetic test may be recommended, especially if there is a strong family history of diabetes diagnosed at a young age.

Alström syndrome is a rare genetic disorder that is characterised by a number of features, notably including extreme sensitivity to light, hearing problems, heart problems, obesity and

type 2 diabetes

Most of the features of Alström syndrome are treatable although

health complications of the condition
are common.

It is estimated that around 200 families in the UK may be affected by Alström syndrome.

Symptoms, features and complications

There are a number of common features of Alström syndrome which include:

• 
  Eye problems
  : Including retinal degeneration (progressive worsening of vision), nystagmus (involuntary eye movements) and photophobia (extreme sensitivity to light)
• 
  Hearing impairment
• Cardiomyopathy: Disorder of the heart muscle
• 
  Obesity
• 
  Insulin resistance
  and
  
  hyperinsulinemia
  : Leading to type 2 diabetes
• Hypertriglyceridaemia: Abnormally high triglyceride levels in the blood
• Renal dysfunction: Kidney disorders

Heart and eye problems will often be diagnosed shortly after birth whilst hearing problems usually occur before the age of 10. Children with Alström syndrome will usually gain weight quickly, despite eating healthily and

diagnosis of type 2 diabetes within childhood
is common.

The features which a child develops, as well as the severity of the symptoms, can vary from child to child.

Additional complications which can follow include:

• Bladder and bowel problems
• 
  Bone and joint problems
  : Including arthritis
• 
  Hypogonadism (low testosterone levels)
• 
  Polycystic ovary syndrome (PCOS)
• Hypothyroidism: Underactive thyroid function

Causes of Alström syndrome

Alström syndrome is caused by a mutation in the ALMS1 gene.

A mutation in this gene is known to affect a protein related to cilia, minute whiskers which are present on the surface of cells.

If each parent has a mutation in the ALMS1 gene, there is a

1 in 4

chance that each child they have will develop Alström syndrome.

How is Alström syndrome diagnosed?

A diagnosis of Alström syndrome may be made based on presence of the symptoms. If confirmation is needed, genetic testing can be used to identify mutation of the ALMS1 gene.

Treatment

There is no cure for Alström syndrome and each feature of the condition requires treatment to control.

• Eye problems: Whilst retinal degeneration cannot be treated, extreme sensitivity to light can be treated by wearing dark glasses.
• Hearing impairment: Hearing aids can be used to improve hearing.
• Heart problems: May be treated with medications including digoxin, furosemide, ACE inhibitors and beta-blockers.
• Obesity: Treated through adjustments to physical activity and diet.
  
  Low carbohydrate diets have been found to be effective

• Type 2 diabetes: Lifestyle adjustments as with obesity treatment. If lifestyle changes do not reduce blood glucose levels sufficiently,
  
  medications such as metformin
  or
  
  GLP-1 receptor agonists
  may be prescribed.
• Hypertriglyceridaemia: May be
  
  treated with cholesterol modifying drugs such as statins

• Renal dysfunction: Lifestyle changes and, if necessary, blood pressure and diabetes medications, can help to reduce the risk of kidney failure. If kidney failure develops,
  
  kidney transplantation may be advised

Brittle diabetes mellitus (or labile diabetes) is a term used to describe particularly hard to control type 1 diabetes.

Those people who have brittle diabetes are more likely to experience frequent, extreme swings in

blood glucose levels, causing

hyperglycemia
or

hypoglycemia

Signs of brittle diabetes

Brittle diabetes presents as type 1 diabetes that is very difficult to control. People with brittle type 1 diabetes may experience the following symptoms:


^[365]

• Unpredictable, sharp changes in blood glucose levels without an obvious cause
• Frequent episodes of very high and very low blood sugar
• Greater likelihood and frequency of experiencing ketoacidosis and/or severe hypoglycemia

Likelihood of brittle diabetes

Brittle diabetes is relatively rare.

Research
suggests it is more common in females than males and tends to occur in young adulthood.

Brittle diabetes is less common in people over 40 years of age which suggests that brittle diabetes may, in some cases, resolve itself in time.


^[366]

How can brittle diabetes develop?

Brittle diabetes has a number of potential causes. Psychological issues


^[365]

and inconsistent digestion as a result of nerve damage


^[366]

account for most cases.

Brittle diabetes is often associated with

stress,

depression
and other psychological issues. Stress can lead to acute and temporary insulin resistance. This means that the body does not respond to insulin and this can come on and disappear very quickly without warning. This can lead to distinct challenges when needing to judge insulin doses.

Additionally, other psychological issues may add further complications to the management of type 1 diabetes.

Autonomic neuropathy, nerve damage that affects the functioning of organs, can lead to problems with delayed stomach emptying (

gastroparesis
) and affect the functioning of the intestines.

Not knowing when food will be digested can make it hard to judge when or how much insulin should be given.

Other problems that may result in brittle diabetes include:

• 
  Insulin
  absorption problems
• Drug interactions

Managing brittle diabetes

As one of the main problems with brittle diabetes is unpredictable rises and drops in sugar levels, a

reduced carbohydrate diet
can help to reduce the wide swings in blood glucose, making sharp rises and drops less likely and less severe.

Diabetes technology such as insulin pumps, continuous glucose monitors or flash glucose monitors tend to give people more opportunity to control their blood sugar levels more effectively.

In the UK, you may be eligible to be put one or more of these technologies. This is more likely to be the case if brittle diabetes is putting you in danger or severely hampering your chance to lead a relatively normal life.

Read more:

• 
  Insulin pumps
• 
  Continuous glucose monitors
• 
  Flash glucose monitors

Addressing the causes of brittle diabetes

Identifying the factor or factors that may be causing brittle diabetes may help your health team to choose treatment strategies to address the causes. Your health team can help to identify which factors may be the cause of very difficult to control blood sugar levels.

If the cause is to do with autonomic neuropathy, your diabetes team may be able to offer you advice to help you safely manage

insulin doses

If psychological issues are suspected, your health may be able to help you address these. Talking therapies and

mindfulness-based therapies
are examples of treatments that have had success in dealing with problems such as stress, anxiety and depression.

Juvenile diabetes refers to diabetes in the young. Type 1 diabetes effects 90% of people younger than 25 who have diabetes.

Diabetes is the most common metabolic disease in the young.

There is no agreed definition of what is meant by a young person in this context, however most people would refer to a young person as being under 16 or 18 years of age.

Various age ranges have been used in the literature.

Diagnosis and epidemiology

The Scottish Study Group for the Care of the Diabetes in the Young showed that currently there are nearly 2000 people with diabetes aged under 16 years in Scotland, with an annual incidence of 25 per 100,000 population and a near tripling of new cases in the last 30 years.

Type 1 diabetes, resulting from beta-cell destruction and absolute insulin deficiency, accounts for over 90% of diabetes in young people younger than 25, and is autoimmune in origin.

Non-type 1 diabetes is recognised with increasing frequency, particularly emerging molecular forms of diabetes, diabetes secondary to pancreatic disease and a rise in

type 2 diabetes
and other insulin resistance syndromes in the young.

Type 1 diabetes

12-15% of young people under the age of 15 with diabetes mellitus have an affected first degree relative (a positive family history).

Children are thrice as likely to develop diabetes if their father has diabetes rather than their mother.

While there are known antibody markers of prediction in high-risk subjects, there is no evidence for effective methods of

prevention of diabetes

Screening is currently considered unethical except in the context of a trial.

There are several randomised trials in progress (e.g. ENDIT, DPT-1, DIPP) investigating different therapies for the prevention of type 1 diabetes. It is anticipated that results will be available in the next five years.

Diabetes and cystic fibrosis

20% of patients with cystic fibrosis develop

secondary diabetes
by the age of 20, with an incidence which increases thereafter to 80% by the of age 35.

Limited data suggest that clinical symptoms deteriorate when diabetes develops in cystic fibrosis, although no evidence exists that the presence of diabetes or its

treatment
affects long-term survival.

Initiating therapy at diagnosis

Home-based instruction of the newly diagnosed child or young person appears to be at least as effective as inpatient instruction in terms of

glycaemic control
and family acceptability over a two-year period. Management in the community using a home-based education programme for patients with newly diagnosed diabetes has been shown also to be cost-effective.

The evidence on the role of the intensification of therapy in the attempt to achieve as rapid as possible normoglycaemia is inconsistent. In particular, there is no evidence of a sustained effect of any specific insulin therapy on glycaemic control during the first few months after diagnosis.

Therefore, no recommendation can be given for the most appropriate

insulin therapy
at diagnosis.

Continuing management

There is at present no evidence for the effectiveness of any medication other than insulin in the management of type 1 diabetes in the young.

Insulin regimen

Conventional therapy for type 1 diabetes (twice daily insulin with support from a multidisciplinary healthcare team and regular diabetes and health monitoring) is associated with variable results.

Limited data support an improvement in glycaemic control using three rather than two injections per day.

Evidence regarding the impact of an intensive insulin regimen upon long term control is derived principally from the Diabetes Control and Complication Trial (DCCT) which also involved a comprehensive patient support element (diet and exercise plans, monthly visits to the health care team etc).

Intensive insulin therapy (four injections or more per day or pump insulin) significantly improves glycaemic control over a sustained period compared with conventional insulin therapy (two injections per day). DCCT did not include children aged less than 13, due to the study desig, it is impossible to separate the benefits of intensive insulin therapy from

intensive support

While there is no evidence on the most effective form of support package, in general this refers to increased contact between patients and their families with a local multidisciplinary team of health professionals delivering specific health care strategies

The risk of

hypoglycemia
increases with intensive therapy but rapid acting insulin analogues, as part of a three or four injection regimen can reduce hypoglycaemia.

Diet control

A discipline that includes diet control improves glycaemic control. Limited evidence was identified concerning the optimal type of dietary therapy.

There is a lack of evidence to recommend either a qualitative or quantitative approach as the most effective mode of dietary therapy.

Psychological factors

Specifics that contribute to an increased risk of young people with diabetes developing psychological problems include:

• a reluctance to cope with the situation
• too great an onus placed on the child
• family difficulties
• lack of communicatio, both within families and with the diabetes team
• low socio-economic status
• non-traditional family structure
• poor maternal health, especially depression.

Eating disorders
are more prevalent in adolescents with diabetes compared with non-diabetic peers, and adversely affect glycaemic control.

Specific psychological problems (e.g. maladaptive coping strategies) linked to future glycaemic control, can be identified at diagnosis and 1-2 years later, using validated tools performed by a trained practitioner.

Psychological or educational interventions
have positive effects on psychological outcomes, knowledge about diabetes and glycaemic control. Maintaining parental involvement improves glycaemic control. Interventions which promote diabetes-specific coping skills are effective and add to the effectiveness of intensive management.

While type 1 and type 2 diabetes are well-defined, the way in which less-common forms of diabetes are classified has changed over the years.

There is no single definition of type 3 diabetes.

Currently, the American Diabetes Association sets out four different groups of diabetes:

• Type 1 diabetes
• Type 2 diabetes
• Gestational diabetes mellitus (GDM)
• Specific types of diabetes due to other causes – including monogenic diabetes, diseases of the exocrine pancreas (such as cystic fibrosis), and drug- or chemical-induced diabetes.

Note that type 1 and type 2 are the only forms of diabetes officially assigned a numbered type.

Historical classifications of diabetes types

In 1999, the World Health Organisation (WHO) published a report of a WHO consultation. The report, titled ‘Definitio, Diagnosis and Classification of Diabetes Mellitus and its Complications’, laid out the following areas of diabetes.

• 7.3.1 Genetic defects of beta-cell function
• 7.3.2 Genetic defects in insulin action
• 7.3.3 Diseases of the exocrine pancreas
• 7.3.4 Endocrinopathies
• 7.3.5 Drug- or chemical-induced diabetes
• 7.3.6 Infections
• 7.3.7 Uncommon but specific forms of immune-mediated diabetes mellitus
• 7.3.8 Other genetic syndromes sometimes associated with diabetes

These categories have led to some researchers and healthcare professionals to name these forms (7.3.1 to 7.3.8) as type 3a through to type 3h diabetes. However, these numbered forms have not been officially recognised by major diabetes organisations such as the World Health Organisation or the American Diabetes Association.

In research literature, the term type 3c has been used for pancreatogenic diabetes (which includes diabetes that may result from pancreatitis), which falls under 7.3.3 (diseases of the exocrine pancreas) in the above list.

It is useful to be aware that the use of ‘type 3’ terminology sometimes appears in common usage but is not a term that is officially recognised.

Other unofficial uses of type 3 diabetes

In 2008, researchers from Brown University, Dr Suzanne de la Monte and Dr Jack Wands, put forward a proposal that Alzheimer’s disease could be termed type 3 diabetes.

The reasoning is based on the fact that insulin resistance within the brain was shown to be a feature of Alzheimer’s disease.

While this has been proposed, major health organisations do not recognise Alzheimer’s disease as a type of diabetes within their classifications.

There are a number of different types of diabetes, some of which are more prevalent than others. The most common form of diabetes in the general population is type 2 diabetes, which often develops from

pre-diabetes

Type 1 diabetes is more common in children and gestational diabetes is a form of diabetes that can occur during pregnancy.

Learn more about the different types of diabetes:

Diabetes Types

Type 1 Diabetes

Type 2 Diabetes

Gestational Diabetes

Diabetes LADA

Diabetes MODY

Double Diabetes

Type 3 Diabetes

Steroid Induced Diabetes

Brittle Diabetes

Secondary Diabetes

Diabetes Insipidus

Juvenile Diabetes

Which type of diabetes do I have?

In some cases, it may not be clear which type of diabetes you have. If your doctor cannot be sure which type of diabetes you have, they may run one or more tests to help

determine your diabetes type

Learn about the

differences between type 1 and type 2 diabetes

Conditions which can lead to diabetes

Some conditions, including genetic syndromes and surgery, can lead to high blood glucose levels and therefore diabetes.

Such types of diabetes account for around 1 to 2% of all diagnosed cases of diabetes.

Examples of such conditions include:

• 
  Glucagonoma
  – a condition in which the body produces too much of the hormone glucagon
• Chronic pancreatitis – a condition which causes inflammation of the pancreas
• Cystic fibrosis – a genetic condition that causes mucus to build up in the lungs and digestive system
• Pancreatectomy – surgical removal of the pancreas

Conditions linked with type 2 diabetes

There are a number of conditions that are not necessarily a direct cause but are closely linked with type 2 diabetes.

Conditions closely linked with type 2 diabetes include:

• 
  Alzheimer’s disease
  – as noted above, this has been referred to as type 3 diabetes by some researchers
• 
  Polycystic ovary syndrome (PCOS)
  – a condition which can impact on fertility in women
• 
  Cushing’s Syndrome
  – a condition characterised by excess production of the hormone cortisol
• 
  Pancreatic cancer
  – has been linked with type 2 diabetes with some debate as to which condition may influence the other

Conditions linked with type 1 diabetes

Type 1 diabetes is an autoimmune disease, meaning that the body’s immune system mistakes its own cells for invading pathogens that need to be destroyed.

People with type 1 diabetes tend to have a higher risk of having other autoimmune diseases than the rest of the population.

Other autoimmune diseases include:

• 
  Coeliac disease
• Rheumatoid arthritis
• Addisons disease
• Autoimmune thyroid disease