Beyond Type 1 Diabetes: Could Your Child Have a Different Type?

Type 1 diabetes is an autoimmune condition in which the insulin-producing cells of the pancreas are destroyed, leading to high blood sugar. The only treatment is life-long replacement of insulin through injections or pump use. Although type 1 diabetes is the most common form of diabetes in children, there are other types of diabetes that can occur. It is important to figure out which type of diabetes your child has, given that treatment options and associated complications may vary. Autoantibodies should be checked at diagnosis: if positive, these confirm a diagnosis of type 1 diabetes. If negative, other types of diabetes should be considered.

Type 2 Diabetes

This type of diabetes is becoming more and more common in older children and adolescents. The pancreas continues to make insulin, but the body is resistant, leading to high blood sugar. Insulin resistance is most often seen in the setting of overweight or obesity. As the rates of overweight and obesity are rising in the general population, not every child who has more weight on their frame for how tall they are will have type 2 diabetes. Treatment options for type 2 diabetes include injected insulin, but oral options (such as metformin) or other injectable medications (such as GLP-1 receptor agonists) can be used.

Type 3c Diabetes (Pancreatic Diabetes)

This form of diabetes occurs in the setting of pancreatic disease and dysfunction of the exocrine pancreas (the part of the pancreas that makes enzymes important for digestion of nutrients). Pancreatic diabetes may occur in acute pancreatitis, chronic pancreatitis, trauma or surgery (such as TPIAT), and cystic fibrosis. Insulin insufficiency is the primary defect in these settings, so treatment often still includes insulin injections.

MODY

Genetic forms of diabetes, typically lumped under the name of MODY (maturity-onset diabetes of the young), can also occur in children. MODY should be considered in cases of very strong family history of diabetes or atypical features (such as presence of cysts in the kidney or liver). MODY can be diagnosed through genetic testing. Diagnosis is important as treatment options may vary (e.g. use of sulfonylureas) or medications may not be needed at all in certain cases. Diagnosis in a child can also influence treatment for their parents and other relatives.

Neonatal Diabetes

Diabetes after birth or in the first few months of infancy is called neonatal diabetes. This form of diabetes can have many causes including some of the genetic changes that cause MODY and others. Neonatal diabetes can be permanent or can be transient, meaning it will resolve over the course of weeks to months (but can recur later in childhood or adulthood). As with MODY, the exact treatment depends on the exact diagnosis, so genetic testing is important. 

If you are concerned about your child’s diagnosis or have questions about his or her treatment, consult your child’s doctor or ask for a referral to the Department of Endocrinology, Metabolism & Diabetes at Nationwide Children’s Hospital.