November 9, 2010

The Types of Diabetes

This subject is unusual for me and yet it has an appeal as I have a friend with a child which fits this very well. He has already been talked to about this and sent several emails. He notified me that he is having his infant son tested this week. After reading the background for this blog, he started checking where to have his son tested.

First I would like to set some terms which are new to me. We are all familiar with Type 1 and Type 2. The term used for these, polygenic, comes from the fact that they develop from multiple genes. The other term, used for the more rare types of diabetes is monogenic. These develop from mutations of a single gene.

This defines the types into two distinct classes. Monogenic diabetes forms comprise two to three percent of all diabetes in young people. This is either inherited for some and others have the gene mutation develop basically overnight. Both sides reduce the ability of the body to produce insulin. This is the area of greatest confusion for the medical professionals as they diagnose Type 1, when it is not.

The different types of monogenic diabetes include permanent neonatal diabetes (PND), transient neonatal diabetes (TND), and maturity onset diabetes of the young (MODY). These are the main forms and some may not respond to treatment and some are mild and should not be treated – a complete surprise. The newborn children and children generally under the age of seven months are likely to have PND or TND. MODY then normally is found in children and adolescents, but may be mild. Therefore it may not be detected until they are adults.

This is the reason I urge that all children be properly tested to determine what type of diabetes they have. I suspect that many that are diagnosed with Type 1 may not in fact have Type 1, but one of the monogenic types. If they truly have Type 1, then you will know for sure by full testing, and genetic testing is the only way to know positively.

Some monogenic forms may be treated with oral medications while others will require insulin, and still others are mild and require very little treatment. This is why I urge testing rather than relying on a doctors diagnosis if Type 1. Definitely consider testing for monogenic diabetes if you or members of your family meet the following criteria:
diagnoses with diabetes under seven months, familial diabetes in the immediate family, mild hyperglycemia, and other pancreatic features.

Testing for monogenic diabetes are often simple and inexpensive and at the time of diagnosis are not typically done. Many doctors are not even aware of the tests. Am I? No; however, two of the tests are listed here. The list of all tests is apparently are not available to non-medical people. The tests should also make management of blood glucose easier and treatment more reliable plus better long-term health.

To repeat, NDM generally occurs in the first six months of life and only one in 100,000 to 500,000 infants. NDM is often mistaken for Type 1, but Type 1 diabetes normally occurs later after the first six months. In about half of those with NDM, the condition becomes permanent. In the other half, NDM is short lived or transient and disappears during early childhood; however, it can reoccur later in life. NDM can be identified to specific genes.

There is a point that is often overlooked with NDM. NDM can also affect the unborn. They do not grow well in the womb and are born much smaller in weight. If caught early by knowledgeable doctors, and given appropriate therapy, they can often be normalized in growth and development.

The other monogenic, MODY, usually develops during during early adolescence or adulthood. It can often be missed until later in life. MODY accounts for one to five percent of all cases of diabetes in the United States. If a parent has MODY, the children are at a greater risk for developing MODY. Each child of a parent with MODY will have a 50 percent risk.

There are several types of MODY because there are a number of gene mutations that cause MODY. It is often confused for Type 1 or Type 2 as the people a seldom overweight and do not have other risks. People with MODY can be treated with oral diabetes medications, but treatment varies with the genetic mutation causing MODY.

Commercial genetic testing for NDM and MODY is now available. See this reference for one company. The Kovler Diabetes Center at the University of Chicago offers help to parents and offers many other services related to NMD and MODY. Check out their web site here. Also check out monogenic diabetes dot org. There is a lot of good information available.

The article that got me started is this one. Continue reading the next article listed at the bottom of each section. Some of this is repeated from the monogenic diabetes dot org.

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