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Patients with diabetes classically have been described to be of 2 types – Type 1 Diabetes Mellitus(T1DM) and Type 2 Diabetes Mellitus (T2DM).
World Diabetes Day 2024
Diabetes is one of the most common chronic diseases which is encountered in our day to day life. Patients with diabetes classically have been described to be of 2 types – Type 1 Diabetes Mellitus(T1DM) and Type 2 Diabetes Mellitus (T2DM). In T1DM there is an absolute deficiency of insulin, whereas in T2DM insulin is not efficient enough due to insulin resistance. Dr Shrinath P Shetty, Endocrinologist, KMC Hospital Dr B R Ambedkar Circle, Mangalore discusses about the various other forms of diabetes.
Type 1 Diabetes Mellitus
Blood Sugar is maintained in a narrow range of 80-140 mg/dl through insulin and other hormones. Whenever a patient eats or sugar becomes higher, the pancreas increases the release of insulin. Insulin helps in moving the glucose in the blood inside the cells – thus reducing blood sugars. In patients with type 1 diabetes, insulin production and release doesn’t happen because of which their blood sugar remains high. Patients with T1DM have the following features:
1. Absolute insulin deficiency
1. Younger age of diagnosis
2. Don’t respond to oral tablets for sugar control- need insulin
3. Frequently develop complications called diabetic ketoacidosis (DKA) due to high sugar
4. It is an auto-immune disease – where our bodies produce antibodies which attack our own body. Hence auto-antibodies like anti- GAD antibody, anti-insulin antibody may be positive
Type 2 Diabetes Mellitus
T2DM is characterized by insulin resistance, where the insulin produced is not efficient. Hence more insulin is required by the body for daily needs, these patients respond to oral medications initially but may later need insulin. Patients generally are obese, with a positive family history and poor lifestyle. Features common to Type 2 DM are
1. Insulin resistance
2. Older age
3. Obesity and poor lifestyle
Pancreatic Diabetes
Insulin comes from pancreas; hence patients can have diabetes when their pancreas is affected due to other diseases like chronic pancreatitis. One such conditions is called chronic fibro calcific pancreatic diabetes.
MODY – Maturity onset diabetes of Young
In this type of diabetes patients get diagnosed with diabetes at a very young age, often leading to mis-diagnosis as T1DM. But unlike T1DM they respond to oral anti-diabetic drugs. They have very strong family history at least for 3 generations with more than 50 % of them having diabetes. This diabetes is confirmed with genetic studies
LADA (Latent Auto-immune diabetes of Adults)
In this kind of diabetes patients behave like T2DM initially, but within the 1st 5 years they start behaving like T1DM requiring insulin.
Secondary Diabetes
Patients can have diabetes due to other hormonal issues like Cushing syndrome (excess steroids) or Acromegaly (growth hormone excess) or due to thyroid disorders. Sometimes steroids used for other diseases can increase blood sugars leading to diabetes. Usually the diabetes is reversible once the main disease is treated or steroid is withdrawn
Gestational Diabetes
Blood sugars can go up during normal pregnancy which could be harmful for the mother and child. Hence the criteria for diagnosis and treatment are stricter in these patients. Patients are asked to maintain blood sugars of < 95 mg/dl fasting and < 140 mg/dl 1-hour post prandial.
Mild disease can be managed with diet and exercise. However, if the goals are not achieved they may need metformin or insulin. The good thing about this diabetes is – the diabetes gets back to normal once the child is delivered. But patients may have a risk of developing diabetes in the future, hence yearly screening is recommended.
