Type 3 diabetes

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Type 3 diabetes

• Colin M Dayan
• Consultant Senior Lecturer
• University of Bristol
• Helen John Diabetes Specialist Nurse, Bristol
  Royal Infirmary

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Type 3 diabetes
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Categories of Type 3 diabetes

• Reversible eg drug induced, pregnancy
• Pancreas disease
• Monogenic diabetes
• Syndromes with diabetes eg DIDMOAD, stiff man
  syndrome
• Syndromic/genetic severe obesity
• Severe insulin resistance

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When does correct diagnosis influence treatment?

• Different treatment some monogenic diabetes
  which responds to sulphonylureas better than
  insulin or no insulin rediagnosis of family
  members. Venesection in haemochrom.
• Explain other associated feature eg deafness,
  malabsorption, developmental delay, muscular
  appearance
• Explain unusual response to treatment eg
  recurrent hypoglycaemia in pancreatic disease

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Scenario 1 diabetes and drugs

• 52 year old woman
• BMI 25
• On steroids (pred 40mg) for thyroid eye disease
• Glycosuria and random blood glucose 15

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Scenario 2 diabetes and the liver

• 55 yr old man, BMI 24 and falling
• Abnormal LFTs
• Blood glucose 13, no ketones
• EtoH 50u/week
• (Intermittent abdominal pain)
• Diagnosis chronic pancreatits, panc CA,
  haemochromatosis

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Diabetes and chronic pancreatitis

• Less ketosis
• More hypoglycaemia
• ? unusual

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Scenario 3 thin Type 2 diabetes in young people

• Aged 25
• BMI 25, HbA1c 6.2
• Caucasian
• No insulin for 3yrs
• HDL gt 1.2
• Diabetes diagnosed lt 25yrs in 2 generations
• Glycosuria (low renal threshold)
• MODY HNF-1?, (HNF-4?, Glucokinase mild)

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Scenario 3 thin Type 2 diabetes in young people
(vs Ty1)

• Aged 25
• BMI 25, HbA1c 6.2
• Caucasian
• No insulin for 3yrs
• HDL gt 1.2
• Diabetes diagnosed lt 25yrs in 2 generations (14)
• Panc autoAb negative (5-10)
• C-peptide present 3 yrs after dx (5)

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Scenario 3 thin Type 2 diabetes in young people
vs Ty2

• Aged 25
• BMI 25, (4) HbA1c 6.2
• Caucasian (30)
• No insulin for 3yrs
• HDL gt 1.2 (lt8)
• Diabetes diagnosed lt 25yrs in 2 generations (?80
  )

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Diagnostic Testing why do it?HNF1avery
sensitive to sulphonylureas
HbA1c ()
Years since diagnosis
(Pearson et al Diab Med 2000)
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Scenario 4 Type 1 diabetes in non-caucasians

• 28yr old Somali man
• Diagnosed with diabetes 2 years ago
• BMI 24.5
• Treated with insulin poor compliance
• Type 2 diabetes

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Scenario 5 Diabetes and Deafness

• 31yr old woman with bilateral hearing aids and
  newly-diagnosed diabetes 2 years ago
• Now on insulin
• BMI 27, short
• Mother had diabetes
• Mitchondrial diabetes
• (Also assoc lactic acidosis, myopathy,
  encephalopathy, stroke-like syndrome)

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Scenario diabetes from birth

• 26yr old man
• Diabetes since 1 week old
• Learning difficulties and epilepsy
• KCNJ11 Kir 6.2
• May respond to high dose SUs

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Other associations to watch out for..

• Muscular women
• Renal cysts, dysplasia, urgenital dysplasia
• Optic atrophy, DI
• Cushings, acromeg,
• Megalblastic anaemia
• Hypertension
• Stiff legs, falls

• Partial lipdystrophy
• HNF-1?
• Wolfram syndrome
• Rogers syndrome (thiamine)
• Phaeo
• Stiff Man syndrome

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Diagnostic Genetic Testing in UK

• Monogenic Diabetes
• Glucokinase, HNF1?, HNF4 ?, (Diagnostic Exeter)
• MIDD (Diagnostic Exeter other UK labs)
• Neonatal diabetes (Research Salisbury/Exeter)
• Monogenic Diabetes
• Prader Willi, Cystic fibrosis (many UK labs)
• Wolfram syndrome (Research Birmingham)
• ISPAD rare diabetes collection (Research Exeter)

For info www.diabetesgenes.org
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Diagnostic Genetic Testing in UK

• Contact
• Helen John, MODY link nurse (Bristol Royal
  Infirmary)
• 0117 9282892
• Helen.john_at_ubht.nhs.uk

For info www.diabetesgenes.org