So far, six types of maturity-onset diabetes of the young have been identified; they are labeled MODY1 through MODY6. Each type of MODY represents a specific, usually inherited, genetic defect affecting insulin secretion. MODY is treated very much like Type 2 diabetes — with diet and exercise, often in combination with blood-glucose-lowering pills, insulin, or both. Researchers can now test the children of adults with MODY and detect genetic predispositions for MODY before the children develop high blood glucose, allowing early intervention and possibly delay of the onset of diabetes.
The goal in any diabetes treatment is to keep blood glucose and blood pressure levels as close to normal as possible. Chronically high blood glucose levels can damage many parts of the body, including the eyes, kidneys, nerves, and cardiovascular system. In women who are pregnant, high blood glucose can cause macrosomia, or a baby that is larger than normal. High blood pressure can also do widespread damage to the body’s organs. However, studies have shown that “tight” blood glucose and blood pressure control lowers the risk of complications significantly.
Blood glucose level can be monitored at home with a blood glucose meter. The American Diabetes Association (ADA) recommends that most people with diabetes aim for the following treatment goals: When using a meter that gives whole blood glucose levels, the target goal before a meal is between 80 mg/dl and 120 mg/dl. When using a meter that gives plasma glucose levels, the target goal before a meal is between 90 mg/dl and 130 mg/dl. (Whether a meter gives whole blood glucose values or plasma glucose values should be indicated in the literature that comes with the meter.) People who use insulin are generally advised to check their blood glucose level more frequently than those who don’t.
Another blood test that helps to evaluate blood glucose control is the glycosylated hemoglobin (HbA1c) test. This blood test is usually done in a doctor’s office or medical laboratory, although there are some home tests on the market. The ADA recommends that people with diabetes in general aim for an HbA1c reading below 7%, while individuals and their doctors consider aiming for readings even lower than the general goal of below 7%. Measuring HbA1c every 3–6 months is recommended.
Blood pressure is usually measured at the doctor’s office, although some people monitor their blood pressure at home. The ADA treatment goal for blood pressure is below 130/80 mm Hg.
Acute complications of diabetes include hypoglycemia (low blood glucose), diabetic ketoacidosis (a life-threatening condition characterized by high blood glucose, ketones in the blood and urine, and dehydration), and hyperosmolar hyperglycemic state (a life-threatening condition characterized by very high blood glucose and dehydration). Long-term complications include atherosclerosis (hardening and narrowing of the arteries), neuropathy (nerve damage), retinopathy (eye disease), and nephropathy (kidney disease).