Title: Type 3 diabetes
1Type 3 diabetes
- Colin M Dayan
- Consultant Senior Lecturer
- University of Bristol
- Helen John Diabetes Specialist Nurse, Bristol
Royal Infirmary
2Type 3 diabetes
3Categories 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
4When 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
5Scenario 1 diabetes and drugs
- 52 year old woman
- BMI 25
- On steroids (pred 40mg) for thyroid eye disease
- Glycosuria and random blood glucose 15
6Scenario 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
7Diabetes and chronic pancreatitis
- Less ketosis
- More hypoglycaemia
- ? unusual
8Scenario 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)
9Scenario 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)
10Scenario 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
)
11Diagnostic Testing why do it?HNF1avery
sensitive to sulphonylureas
HbA1c ()
Years since diagnosis
(Pearson et al Diab Med 2000)
12Scenario 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
13Scenario 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)
14Scenario 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
15Other 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
16Diagnostic 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
17Diagnostic 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