Diabetes is not one disease and different types of diabetes have been identified in the scientific community and discussed in the media. I saw the type 1 diabetes quiz on the diabeteens.com web site, which I am sure you scored well on. In a previous blog we discussed the causes of type 1 diabetes: the destruction of pancreatic islet cells (Beta cells) due to an autoimmune process triggered by an outside invader (virus, bacteria, etc.).
But, did you know that the lines between many forms of diabetes sometimes become blurred? Are you aware that youth can have double-diabetes (otherwise known as type 1.5 or type 3 diabetes), neonatal diabetes, monogenic diabetes, medication-induced diabetes, cystic fibrosis related diabetes or type 2 diabetes? The classification of diabetes is no longer simple, or either type 1 or type 2. As researchers collect more information, we are able to classify diabetes into various categories based on biochemical or genetic tests.
In nearly 30 years of experience managing children and teens with diabetes, I must examine each new classification as more and more information emerges. We now know that children and teens can be diagnosed with type 2 diabetes, formerly called adult onset diabetes. In fact, we now know that teens may have evidence of both type 1 and type 2 diabetes, meaning they many look like a person with type 2 diabetes, but have evidence of autoimmunity as in type 1 diabetes. (See Dr. Cogen's previous post, Diabetes and Associated Autoimmune Diseases) Most surprising is that children and teens with type 1.5 diabetes may sometimes require insulin and sometimes may not due to differing amounts of insulin released by the pancreas at various times. There is often a strong family history of type 2 diabetes. Keep in mind that risk factors such as sedentary behavior (playing video games, watching television) and obesity may play a role in the development of both type 2 and type 1.5 diabetes.
As teenagers with Cystic Fibrosis (a genetic disease that primarily causes lung problems) survive into adulthood, they too can develop diabetes due to a loss of islet cells in the pancreas secondary to the actual disease process. As Cystic Fibrosis Related Diabetes progresses, patients often require insulin therapy. We often are called to consult with our pulmonary colleagues in regard to diabetes education and insulin regimes.
Medication induced Diabetes is caused by different medicines used to treat often serious illnesses such as cancer, kidney disease, and even asthma. These medications can cause high blood sugars or damage the pancreatic islet cells and thus stress the pancreas, which requires insulin administration. Fortunately, this form of diabetes may be temporary and resolve itself, but sometimes insulin is necessary for survival.
There has been much publicity about the discovery of neonatal diabetes, a type of diabetes that is usually diagnosed in children less than six-months old. In the past, these infants were given a diagnosis of type 1 diabetes and would begin insulin therapy. However, recent genetic research determined that in some cases, these children have a malfunctioning gene (monogenic diabetes) that does not allow insulin to be released from the cells. Insulin is produced, but it cannot be released due to complex biochemical channel malfunctions. In other words, a door is blocking the release of insulin from the islet cells. Once an oral medication (such as glyburide, which is commonly used for treatment of type 2 diabetes) opens this door, insulin is properly released and blood sugars are controlled. This discovery is very exciting because children, teens, and adults who were receiving insulin injections prior to this discovery have now transitioned to oral medications and are doing very well. I must add that neonatal diabetes is very rare. My team at Children's National now recommends genetic testing for neonatal diabetes in all children under six-months of age with new onset diabetes.
In summary, the diagnosis of diabetes has become very complicated. It is hoped that as we unlock the human genome, additional forms of previously thought autoimmune type 1 diabetes will be discovered along with new forms of therapy. Insulin was only discovered in the early 1920s (see diabetes quiz) and has been around less than 100 years. Just look at what has been discovered in the last five years! Who knows what will be revealed in the next five years?
Questions? Please ask and I will be happy to explain further!
Published On: August 25, 2008