There are a range of conditions and susceptibilities that can lead to other forms of diabetes.
FORMS OF DIABETES – MODY
Maturity-onset diabetes of the young (MODY) is a group of diabetic syndromes that do not usually require insulin therapy. These are caused by a variety of genetic mutations and transmitted in an autosomal dominant fashion. They usually present in childhood and are discussed in the section that relates to childhood diabetes.
LIVER AND PANCREATIC DISEASE
Chronic pancreatitis can lead to an impairment of glucose tolerance or frank diabetes in almost half of sufferers. Histological features include blockage of pancreatic ducts, cysts, fibrosis and inflammation. Typically one-third of those with diabetes secondary to chronic pancreatitis require insulin therapy. Insulin dose requirements are usually low due to the absence of insulin resistance. Diabetic complications also appear to be less common in this group of patients. Surgical pancreatectomy can lead to the development of diabetes if more than 90% of the gland is removed. Pancreatic carcinoma can present
with Type 1 or Type 2 diabetes. Weight loss despite effective treatment, particularly in older patients, should raise suspicion. Acute pancreatitis, secondary to gallstone disease or alcohol excess, typically only causes a transient rise in blood glucose.
Haemochromatosis (bronzed diabetes) is an autosomal recessive condition that results in excessive iron absorption and iron deposits in liver, pancreatic islets, skin and pituitary gland. The clinical features are liver cirrhosis, diabetes and excessive skin pigmentation. Serum ferritin concentration is raised. A secondary form of this condition is seen in β- thalassaemia due to excessive blood transfusions. Cystic fibrosis patients are increasingly surviving to adulthood. Diabetes is a common complication of this condition. Insulin is often required although a sulphonylurea drug may suffice in the early stages.
E236 – Other Forms of Diabetes – www.diabetic.today