What’s Your Diabetes “Type”? Gestational, MODY, and Steroid-Induced

It’s somewhat staggering to consider that approximately 26 million people in the United States have diabetes. That’s about 8% of the population. But what’s more, an estimated 79 million people (probably more) have prediabetes and are at increased risk for developing Type 2 diabetes.

By and large, most people who have diabetes have Type 2. But diabetes isn’t just one disease. There are many variants of it. Last week we looked at Type 1, Type 2, and LADA, or Type 1.5. This week, let’s look at a few more.

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Gestational diabetes
Gestational diabetes mellitus (GDM) is a type of diabetes that occurs during pregnancy, usually developing around the 24th week.

Facts
• GDM affects about 18% of pregnancies.

• Hormones from the placenta block the action of the mother’s insulin, causing insulin resistance, which increases the demand for insulin.

• Without enough insulin, blood glucose levels rise, leading to GDM.

• If left untreated, these high blood glucose levels can affect the baby, leading to macrosomia, or a “big” baby. Other potential complications for the baby include breathing problems, low blood sugar, jaundice, and obesity and Type 2 diabetes later in life.

• The mother may have complications too, such as high blood pressure and a high risk for developing Type 2 diabetes.

• Risk factors for GDM include a family history of diabetes, being overweight, being over the age of 25, and being black, Hispanic, Asian, or American Indian.

• GDM treatment consists of following a meal plan, getting physical activity, checking blood glucose levels with a meter, and, in up to 20% of cases, taking insulin.

• Women can lower their risk of getting GDM by eating healthfully, staying active, and reaching a healthy weight before becoming pregnant.

The US Preventive Services Task Force recommends that all pregnant women be screened for gestational diabetes after 24 weeks. Screening consists of drinking a glucose drink and having your blood checked an hour later. A blood glucose below 140 mg/dl is considered to be “normal.” If your blood glucose is higher than this, you’ll then have a glucose tolerance test to determine if you have gestational diabetes.

Maturity-onset diabetes of the young
Otherwise known as MODY, this type of diabetes is a rarer type of diabetes that results from mutations in a number of different genes.

Facts
• MODY typically first occurs during adolescence or young adulthood, but it can be diagnosed in adults, too.

• Gene mutations limit the pancreas’ ability to produce insulin, leading to high blood glucose.

• MODY accounts for 1% to 5% of diabetes cases in the US.

• Many people with MODY are diagnosed as having either Type 1 or Type 2 diabetes. For example, a person may be diagnosed as having Type 1, but he still produces some insulin or tests negative for antibodies. Or he may be told he has Type 2 diabetes, but he is at a healthy weight and doesn’t have signs of insulin resistance.

• MODY runs in the family, so if you are diagnosed with this, your family members should get tested.

• MODY can be treated with an eating plan or diabetes pills (usually sulfonylureas).

Steroid-induced diabetes
If you are taking steroids to treat or manage a medical condition, such as lupus, asthma, rheumatoid arthritis, Crohn disease, or inflammatory bowel disease, you are at risk for developing diabetes.

Facts
• Steroids (corticosteroids), such as prednisone, help to reduce inflammation, and they work by mimicking cortisol, a hormone produced by the adrenal glands.

• Steroids increase blood pressure as well as insulin resistance, part of the “fight or flight” syndrome.

• If you take steroids and develop a dry mouth, increased thirst, increased urination, fatigue, and/or blurry vision, let your provider know and get checked for diabetes.

• If you have this type of diabetes, you may need to take medicine, and you’ll likely need to follow an eating plan, exercise, and check your blood sugar.

• Steroid-induced diabetes may go away once you stop taking the steroids, but some people will develop Type 2 diabetes, and that will require lifelong management.

If you are prescribed steroids, especially long-term (more than a few months), talk with your provider about your risk for developing diabetes and discuss strategies for helping to prevent it.

There are other, less common types of diabetes, as well. What’s important is to know your family history of diabetes and to report any symptoms that I’ve mentioned to your health-care provider. There’s no cure for diabetes, but some types can be prevented. Remember, too, that diabetes is manageable and people today are living long, healthy lives with the condition.

  • Joe

    I had not heard of steroid-induced diabetes before. I assume athletes who abuse steroids are at risk for this as well?

  • Laura

    Re:MODY
    NO not all types of MODY can be treated with diet and/or oral mess. Even within the same type of MODY, treatment can be very different depending on the individual. Example, MODY 2, treatment varies, there are some that no medication is needed, some use mealtime insulin, some only need basal insulin and some use insulin just like a type 1 would.

  • acampbell

    Hi Joe,

    The “steroids” I referred to are glucocorticoids. These are different than steroids that athletes might take to “bulk up.” Those are called anabolic steroids, and while they have some very serious side effects, diabetes is not one of them (with the exception possibly of human growth hormone).

  • acampbell

    Hi Laura,

    I didn’t mean to imply that all cases of MODY can be treated with meal planning or diabetes pills, although a good many cases can. As you point out, some cases of MODY must be managed with insulin.

  • Mike

    I had astma and they gave me steroids to control
    It.

  • Bonnie Lu Brehm

    You just informed me of a very important developement. While being treated for Asthma the PA seemingly overdosed me and I ended up getting Diabetes 2, he wouldn’t admit it that he did just that until after a year went by and I couldn’t sue him anymore.

    But now its opened up a whole new aspect as I got my asthma from a ceiling falling down on me while working for the State of New York, I was employed as a State worker at the time, one thing led to the other and all my medications for my Asthma have been paid by Workers Compensation.

    I’m going to now write a very important letter to my lawyers and make a print out of your information here so they see where I’m coming from, with any luck I won’t have to pay for my medication for my Diabetes anymore as I have always been put on steroids especially Predisone for my severe Asthma attacks. Its pretty much a given I’m on it about every 3 months or so.

    Thank you for bringing this to my attention. I’m going to see about my GP and my specialist writing letters on my behalf also stating it is more than a possibility that I got the damn disease because of the Steriods I have been given to combat my Asthma attacks.

  • Consuelo

    How about injections of cortisone? I had several injections in my ankle at an office visit for pain that would not go away three months after a car accident. I have always had the feeling that it pushed me over from pre to diabetic.

  • Becky

    I have always been thin, no high blood pressure, high cholesterol,insulin resistance, or living relatives with diabetes. I had GDM with all pregnancies and was never tested afterward to see if it had gone away. At age 49 I had an A1c of 7 and was told I had pre-diabetes and to watch the sugar. At age 56 after taking steroids for a bad cough,I was told I had Type 2 with an A1c of 7. After diet, exercise and oral meds had no affect on glucose, I was diagnosed with Type 1 and put on insulin. I did not test positive for anti-bodies and do not need basal insulin. I spike after meals but fasting glucose is always good. I take pre-meal insulin to keep my diabetes under control. A1c is now 5.6. Do you think I have some form of MODY? How would I know?

  • acampbell

    Hi Consuelo,

    Cortisone is a steroid injection so yes, it’s possible that your injections affected your blood glucose levels.

  • acampbell

    Hi Becky,

    It sounds like you may have MODY, but I certainly cannot diagnose you. Because you are thin, do not require a lot of insulin, and did not have antibodies, it seems to indicate MODY. Does diabetes run in your family? Your doctor can confirm MODY through gene testing, so you should speak with him or her about getting this done if you want to be sure of your diagnosis.

  • Becky

    My maternal grandfather had type 2 due to obesity. My paternal grandmother also had some form of diabetes, though she never had to take insulin and wasn’t diagnosed until she was in her 70’s. That’s all. My parents, siblings, children, cousins, aunts or uncles, nieces and nephews so far have not developed diabetes even though many are overweight.
    Since MODY is genetic, I would think one of them would have been diagnosed by now, especially the women during pregnancy. I am the only one who had GDM. I will ask my doctor, but I have an HMO and doubt they will authorize genetic testing.

  • Jennie

    I’ve read a lot about steroid induced diabetes being type 2, but I have high titre of Gad antibodies, which suggests that I have LADA. I have low BMI, exercise, no cardiovascular risk markers. On prednisone for newly diagnosed rheumatoid arthritis. Anyone else have this experience and how we’re you treated? Sounds similar experience to Becky.

  • Renee

    Wow! I was on steroids for my asthma but weaned myself off of them about two years ago. My sugar has always been good, sometimes a little high, but nothing serious. I’ve had several cortisone shots this year for pain and now I’ve been diagnosed as Type 2.

    Is it possible to reverse this?