Types of Diabetes

What are the types of Diabetes?

There are two main types: type 1 or Insulin deficient and type 2 or Insulin resistant or adult-onset Diabetes.

In type 1 Diabetes pancreas does not produce Insulin and you cannot survive without Insulin. This happens because body produces antibody to Insulin producing cells and they get destroyed.

In type 2 diabetes, the pancreas does produce insulin but it is insufficient and/or less effective.

Diabetes can manifest for the first time in pregnancy, called gestational Diabetes.

Certain medications like steroids in high doses can cause diabetes, another cause of Diabetes is Pancreatitis (acute or chronic) – they are called secondary diabetes. Tests are done to differentiate Type 1 from 2 Diabetes (AUTOIMMUNE DIABETES PROFILE)        

Test	Normal Value	How does it help?
Insulin Auto-Antibody (IAA)		Elevated levels of IAA confirm a diagnosis and Predict the risk for developing type-I Diabetes
GAD – 65 Antibody		The presence of GAD-65 autoantibody (most common autoantibody) also confirms the autoimmune nature of Diabetes, i.e , type-I Diabetes.
Estimated Average Glucose (eAG)	70 - 115(mg/dl)	Estimated Average Glucose is calculated by converting the A1c number (a percent) to equivalent glucose level(mg/dl)
C-Peptide	0.81 - 3.85 (ng/ml)	C-Peptide test is used to monitor insulin production, It helps to determine how much insulin a person’s pancreas is still producing.
Heamoglobin A1C		Heamoglobin A1c is the part of total haemoglobin that has glucose attached to it. High A1c levels are caused by high levels of blood glucose over the preceding 3 months

What way this autoimmune profile help us in treatment?

Adult can have type 1 Diabetes just as it presents in the children, autoimmune profile can help in typing the Diabetes and correct treatment can be started.

There is another type of Diabetes interestingly where autoimmune profile helps, it is called LADA– Latent autoimmune Diabetes of Adults, where the process of autoimmunity is slow and they do not present as classic type 1 Diabetes, initially they respond to diabetes tablet, but after some time they become dependant on insulin.

The other place where the autoimmune profile tests can be helpful is children and adolescent with type 2 Diabetes. Modernisation , lack of exercise, easy availability and palatability  (!) of fast food all are to share  the responsibility along with the change of the environmental pollution etc. Typically the chid is obese and has family history of type  2 Diabetes(they are born with the gene).They will respond to healthy eating, regular physical exercise and a tablet called Metformin.

To see the pancreatic reserve of insulin at Diagnosis – C-Peptide test is a good indicator, it also helps us to differentiate type 1 from type 2 Diabetes. Type 1 diabetes will have less c-peptide reserve.