New and Improved Types of Diabetes

For the ancient Greeks, diabetes meant polyuria and polydipsia (too frequent urination causing severe dehydration causing severe thirst causing the diabetic to drink a lot of water). There were two types of diabetes: mellitus, where the urine was sweet, and insipidus, where it was not.

Today, insipidus is not taught to primary care physicians in the US (but it is in the UK), so there was a New York Times story about a woman with insipidus who was told her excessive drinking of water was a psychological problem for 30 years before she found a specialist who knew about insipidus and how to treat it. Diabetes in the US now means diabetes mellitus, always (since very few US physicians know there is any other kind). Wikipedia says diabetes insipidus is not diabetes at all, and must never be confused with diabetes, since diabetes must always mean mellitus. The new and improved definition of diabetes is a fasting blood sugar of more than 126 mg/dl or 7 mmol/L.

So then diabetes had two types, Juvenile and Adult. Juvenile diabetes occurred in childhood, and required insulin, while Adult diabetes occurred later in life and was not responsive to insulin, but must be treated with other medications. This did not always work out very well when an adult’s islets of Langerhans took early retirement and the physicians insisted it must be treated without insulin.

After that, diabetes had three types, Type I, where the patient had no insulin (which always results in high blood sugar), and Type 2, where the patient had insulin and high blood sugar, and gestational diabetes that only occurred during pregnancy (and did not have a numbered Type).

This has changed again, so now there are 5 types of diabetes: Type 1 has antibodies, and antibodies are the only test for Type 1. Type 2 has no insulin and no antibodies, and is no longer considered Type 1. If your C-Peptide is 0, but you have no antibodies, you are the new and improved Type 2. Type 3 is severe insulin resistant diabetes. Type 4 is mild obesity caused insulin resistant diabetes. And Type 5 is mild age-related insulin resistant diabetes. The new Types 1 and 2 both used to be called Type 1, while Types 3, 4, and 5 all used to be called Type 2, but modern medicine has moved beyond that.

(I don’t see the old gestational diabetes anywhere among the new 5 Types, but then it never did have a numbered Type associated with it. Adding it in, there are 6 Types, of which 5 are numbered and one is not.)

There are actually more types.
Type 1 can be antibody driven or not.
Juvenile or LADA.
Diabetes during pregnancy is really a sub type of type 2, that shows up from the extra stress and physical pressure from the baby. It usually goes away, but comes back later in life.
You also left out geriatric diabetes, when your pancreas just can’t keep up.
And diabetes from injury which is sort of like type 1.

I can’t imagine doctors in the USA don’t know what diabetes insipidus is.
It’s totally unrelated though and is not a metabolic syndrome.
I learned about it at university and I’m not even a doctor.

If you asked a doctor about excessive thirst and urination, with no sugar, I’m pretty sure most would consider insipidus as well as a few other things.

I have a few physician friends, I’m going to ask them out of nowhere just to see for the fun of it.

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There is also MODY ( Maturity-onset diabetes of the young) which is a genetic form of diabetes that can be identified through genetic testing.

And then there are a few people like me where the best clinics in the world have tried to type and we don’t fit into any of them. The closest they can come to for me is that I have all the symptoms of MODY, but no one up or down in my family chain is diabetic and therefore the clinics could not pay for the genetic testing but insisted I was MODY. To put this to rest, I paid for the genetic testing and none of my genes are a match for MODY so back to square 1. Nobody knows my type. I have heard that there are in excess of 30 different types of diabetes. Who knows, and who really cares as long as it can be kept under control. I keep my A1C in the low 5’s using only fast acting insulin for my OMAD one meal a day and that keeps me mostly flatlined.

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My husband had brain surgery 33 years ago and developed diabetes insipidus which was immediately identified by his U.S. doctors and treated but not with insulin. It disappeared within a few months.

I don’t believe that Diabetes is a disease. It is a symptom that shows up as high blood sugars and the causes vary. I wish there were a different name based upon the cause of high blood sugars and not a collective name based on the symptom.

I’m like “whu???” I had to do a little research on this because while I know there are many types of diabetes (1, 1.5/LADA, 2, gestational, the multitudes of MODY, etc…), I’ve never actually heard of “Type 5”.

The best I’ve found was a 2018 study published in The Lancet Diabetes and Endocrinology, in which they are NOT redefining the Typing and diagnosis of diabetes, but rather trying to break the “one size fits all” treatment mold for Type 2s. They introduced the idea of SUBTYPES, or “clusters” as they’re calling them.

https://www.thelancet.com/journals/landia/article/PIIS2213-8587(18)30051-2/fulltext?elsca1=tlpr

And an article written about it:

Dr. Kathleen Wyne, an endocrinologist at The Ohio State University Wexner Medical Center, who was not involved with the study, said that the new classification could be very useful, but stressed that the researchers aren’t suggesting getting rid of type 1 and type 2 diagnoses. Rather, they are suggesting that there are subtypes.

“This is not changing the diagnosis or the terminology for the diagnosis,” Wyne said. “It’s just providing a way to classify within the diagnosis” of type 1 and type 2, she said.

Type 1s basically get an honorary Cluster 1 classification. We don’t change to Type 2 after we stop producing the antibodies anymore, as I gathered from the OPs post The definition of this cluster sounds more like they’re trying to make it easier for the mis-diagnosed people to get the insulin treatment they need, rather than the stigma that currently goes with Type 2s and insulin… Like they’ve somehow failed at doing diabetes. It might even make battling insurance easier when the usual Metformin routine isn’t working.

I think the MODYs are falling into cluster 2, and LADA is fuzzy. There seems to be an emphasis of young in both cluster 1 and cluster 2, even though we know these things present as adults, too. This doesn’t seem to actually have caught on, though. There’s not really a lot of discussion about this. Maybe this is why.

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Damage to the pancreas from disease, pancreatitis or injury is type 3c. People with type 3c many need as much insulin as a type 1, less or none depending on the damage to the Beta cells.

There are 7 types of diabetes. Diabetes Insipidus has four “types”: Central, Nephrogenic, Dipsogenic, and Gestational.

There are 3 types of diabetes mellitus. We are familiar with type 1, type 2 and some of us with type 3c. These all have subtypes to complicate matters.

Read Wayne Bottlick’s answer to this question on Quora- “How many types of diabetes are there? What are the differences.”
https://www.quora.com/How-many-types-of-diabetes-are-there-What-are-the-differences?q=how%20many%20types%20of%20diabetes

There’s an incredible amount of disinformation on the internet, and Quora is no exception. However, Mr Bottlick, a life long type 1 DM is very knowledgeable.

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There is a type that is related to radiation poisoning.

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this links to a 2004 ADA article on Types of diabetes. More have been added since.

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Every so often you come across an article that tries to label different variations…one of the last articles I read tried to say type 1a and type 1b. Yea, like that will help straighten up confusion. I don’t believe any of the type 1-8 etc definitions have stuck or ever become official. I believe it stands if your pancreas won’t make insulin, then you are a type 1. You could still be insulin resistant as a type 1, but a type 2 always starts with insulin resistance, they are making insulin, they just don’t use it well.

But I would prefer a separation of type 1 and type 2, a different name, as there are so many type 2’s now that people don’t have a clue what type 1 is and how it is different.

@Timothy I came across a while ago where gestational diabetes can also be a precursor sign to type 1 later in life, not just type 2. Gestational diabetes can be a lack of insulin or insulin resistance, it makes sense it could be a precursor to either one.

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Why not simply label them as insulin dependent or non-insulin dependent for public knowledge? At the end of the day isn’t that the simplest label? For medical uses, insurance (maybe) etc sub-types could be of value but truly whether you need insulin to survive or not is the major delineator in my book

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@El_Ver The problem is treatment. I have type 2 DM which has progressed to requiring multi daily injections. Broadly speaking I am insulin dependent. However, I do still make some insulin on my on. Treatment of type 2 DMs varies from control with diet and exercise, or with oral or non insulin injectables, some need basal insulin or premeal bolus insulin or like me on Metformin (oral) and both basal and bolus insulin.

Type 3c DMs have may make enough insulin depending on the damage to the pancreatic beta cells, but, the pancreas does a whole lot more than make insulin. BG control is probably compromised and the digestive enzymes. This is a much more complex disorder than either type 1 or 2 DM.

LADA which is type 1 but different, often response well in the early days to type 2 DM drugs.

We all would like things simplified, but that’s not the way of the world.

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@El_Ver It wouldn’t work to just label insulin dependent or non insulin dependent. It is two different diseases completely.

But treatment is also highly different. A type 2 needing insulin usually requires more insulin as they are insulin resistant. But they also make some so they are not as likely to go into DKA without it. That’s the biggest trick, a type 1 will die without insulin, even a type 2 insulin dependent could feasibly cut out all carbs and probably survive for quite a while because of any small production of insulin that remains.

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