Beyond Types 1 and 2: Other Forms of Diabetes

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In addition to the most well-known diabetes types 1 and 2, there are several other different varieties. Although all forms of diabetes are characterized by hyperglycemia levels, these lesser known subclasses suffer from clear underlying disease pathology and are less frequently observed in the general population.

Some of the other medically recognized forms of diabetes are:

• Gestational diabetes
• Latent Autoimmune Diabetes in Adults (LADA)
• Mature-onset diabetes in young (mody)
• Secondary diabetes

This article focuses on a summary of the underlying causes of these forms of diabetes and available treatments.

Diabetes Overview

When the media talks about diabetes, they usually talk about type 2. Type 2 diabetes accounts for more than 90% of all diabetes cases, and affects mostly adults. The diagnosis and progression of type 2 diabetes is closely linked to family history and lifestyle factors such as diet, sedentary habits, and excessive weight. Patients with type 2 diabetes often have varying degrees of insulin production and are insulin resistant. They are universally recommended lifestyle modifications such as healthier diets and exercise, and are usually taking drugs such as oral medications such as metformin, or injectable medications such as semaglutide (ozenpic), insulin, or a combination of these.

In contrast, according to the World Health Organization, type 1 diabetes is an autoimmune condition in which insulin-secreting cells are destroyed in the pancreas, accounting for only about 2-3% of diabetes cases around the world. Causes of type 1 diabetes include both genetic and environmental factors, but ultimately, they are mystical. Patients with type 1 diabetes should receive regular medicated insulin to survive.

The forms of diabetes described below can share characteristics with both type 1 and type 2 diabetes. In both cases, some kind of metabolic dysfunction causes hyperglycemia, but details vary.

Gestational diabetes

Gestational diabetes is defined by increased insulin resistance during pregnancy, leading to hyperglycemia levels. This condition is often non-specialized and is usually captured by routine testing. Untreated gestational diabetes can lead to adverse complications for both mothers and children.

In most cases, gestational diabetes after pregnancy is broken down after pregnancy, but women who experience gestational diabetes are more likely to experience it again in future pregnancy, and researchers estimate that 50% of women with gestational diabetes can develop type 2 diabetes.

Experts believe that hormonal changes, especially during the second half of pregnancy, are the cause of gestational diabetes. All women increase insulin resistance during pregnancy, but the pancreas can usually be adjusted by producing enough extra insulin to maintain blood glucose levels within the normal range. If the pancreas is unable to produce sufficient insulin, elevated blood glucose levels can lead to the diagnosis of gestational diabetes.

According to the American Diabetes Association, about one in every 10 pregnancies are affected. Typically, women are screened for gestational diabetes early in the third stage of pregnancy using the Oral Glucose Tolerance Test (OGTT) or early in pregnancy if they are thought to be at high risk for the condition.

Treatment may include diet and exercise, insulin, and sometimes oral medications. There is an entire article on gestational diabetes that explores the conditions to be treated properly before and after pregnancy and the importance of treating it properly: gestational diabetes and the importance of postnatal care.

Women who have already experienced gestational diabetes may have a genetic tendency to develop insulin resistance, one of the signatures of type 2 diabetes. The latest recommendations from the Women’s Preventive Services Initiative suggest that a woman with a history of gestational diabetes is screened for type 2 diabetes within a year of giving birth to a woman with a history of gestational diabetes, saying “at least every three years for more than 10 years after pregnancy.”

Lada

Potential autoimmune diabetes in adults (LADA) is a type of type 1 diabetes that is particularly slow-developing. It is usually diagnosed in adults.

At diagnosis, LADA patients generally exhibit less severe hyperglycemia than those seen in new onset type 1 diabetes patients.

The onset of this disease is slower than that normally observed in type 1 diabetes and is usually present over the age of 35, so this condition is often misdiagnosed as type 2 diabetes. LADA patients may not need insulin immediately and may respond well to oral medications such as metformin at first. Like type 1 diabetes, it may take years for pancreatic beta cells to progress to patients, where patients need to strongly control blood glucose.

LADA can be diagnosed via specific antibody tests. It is estimated that within about five years, all LADA patients will need insulin in some capacity. For more information about LADA, please see here.

Mod

Mody-onset diabetes is a specific hereditary diabetes in which the pancreas cannot produce adequate insulin.

This form of diabetes is rare, and practitioners often misdiagnose people either type 1 or type 2 initially. Genetic testing can make the correct diagnosis.

Mody superficially resembles type 2 diabetes. It causes chronic hyperglycemia, but patients do not necessarily need insulin. It can also lead to the same long-term complications as type 1 and 2 diabetes.

Mody is usually caused by mutations to a single gene, and the severity of conditions varies slightly depending on the particular genetic gene. Genetic testing helps to accurately improve the mody subtypes that patients have. Treatment may include oral medications (sulfonylurea), insulin, and/or lifestyle modifications, depending on the situation.

Read this comprehensive article to learn more about Mody.

Type 3C diabetes / Secondary diabetes

Type 3C or secondary diabetes refers to blood glucose dysregulation caused by direct trauma to the pancreas, such as surgery, chemotherapy, or unrelated endocrine disease. For example, patients with pancreatic cancer can cause damage to the pancreas as a result of disease or treatment, leading to insulin resistance or deficiency.

Type 3C diabetes is actually more common than type 1 diabetes, and misdiagnosis can be very common.

The use of certain drugs, such as steroids and some antipsychotics, is also linked to the development of secondary diabetes.

Because glucose intolerance scales vary from patient to patient, it is difficult to generalize treatment options. Treatment may be more or less similar to treatment for type 1 or type 2 diabetes, but clinicians are more likely to identify the best treatment regimen if they know they are dealing with type 3C.

In extreme cases, type 3C diabetes requires more than insulin, such as a whole pancreatectomy. The pancreas has many functions within the body, some of which are very healthy in most people with diabetes, such as secretion of digestive enzymes. Complete loss of pancreatic function can be a difficult condition to manage.