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Diabetes International Foundation - Different Types of Diabetes   Type 1Type 1 is an autoimmune disease, and people require insulin at diagnosis. Each different mutated gene causes a slightly different type of diabetes.MODY is typically diagnosed in late childhood, adolescence, or early adulthood. The urinary system and reproductive organs may also be abnormally formed. Will treatment change if I have MODY?That depends on the type of MODY. MODY caused by mutations in the HNF1A or HNF4A genes often, though not always, responds well to low doses of sulfonylureas.
The best treatment for other MODY types is unclear and varies from one person to the next. If I have MODY, can I pass it on to my children?MODY is an autosomal dominant disease. That means that each child will have a 50% chance of inheriting the gene mutation that can cause MODY.
In TNDM, the diabetes may go away and no longer require treatment after the first few months of life. It is very important to have genetic testing done to help guide treatment, prognosis and monitoring for diabetes recurrence. How many people have neonatal diabetes?Neonatal diabetes is very rare.
A diagnosis of diabetes before 6 months of age makes monogenic neonatal diabetes much more likely than type 1 diabetes.
However, it can be hard to tell them apart: in both types, elevated levels of glucose (sugar) in the blood can cause symptoms of frequent urination, severe thirst and dehydration.


In extreme cases, the baby may experience ketoacidosis, a condition in which acid levels in the body rise to very dangerous or even life-threatening levels. However, this change is only possible with certain types of neonatal diabetes (such as those caused by mutations in the KCNJ11 or ABCC8 genes). While the peak ages for type 1 diabetes occur in the childhood to adolescent age group, I have had adult patients as old as 80 years of age receive a new diagnosis Type 1. The first thing (but not the only thing!) to consider is the BMI (body mass index). Lean patients are much more likely to have type 1 diabetes or some other form of insulin-deficient diabetes (like monogenic, see below). A positive test for acetone or other ketones is not definitive for type 1 but it should raise suspicions when the blood sugar is high. Children can appear to develop diabetes practically overnight requiring insulin right away, whereas adults with type 1 might take several years of progressive failure of one oral agent after another until insulin is finally started. Most but not all patients with type 1 will be positive for auto-antibodies against proteins of the beta cell.
A positive test in any one of these is consistent with autoimmune type 1 diabetes, and insulin is the only appropriate therapy, although combinations that include insulin can often be helpful. This is usually done by measuring the c-peptide level, a by-product of insulin secretion that was discovered at the University of Chicago.
There are many caveats to this test so by itself it might be misleading in a non-research setting. I should point out that there are other important forms of diabetes.


Most primary care providers would be familiar with steroid-induced diabetes and gestational diabetes.
While steroid-induced is a form of Type 2, gestational could be either type 1 or type 2 or monogenic and should be investigated further. Diabetes can also be associated with acromegaly, thyroid disease, and cystic fibrosis, for example. Our team studies rare forms of diabetes that are strongly inherited – the monogenic forms. These also have the hallmarks of young onset, are antibody negative, and usually positive for tests of insulin production such as the c-peptide test. They are important because they can have specific outcomes, specific treatments, and specific associated factors.
They occur in about 2% of everyone with diabetes, meaning about 3-500,000 people in the United States alone have one of these forms – a significant number that is largely missed. The bottom line here is that Type 1 diabetes is increasing  in many populations, although perhaps not as dramatically as Type 2 diabetes associated with obesity. What I teach is that it is always important to ask oneself why a given patient has diabetes and what kind they have.



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