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

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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.

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

• 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.

• 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.

• 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.

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