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Special forms of diabetes: what needs to be considered during therapy
Health experts say almost seven million diabetics live in Germany. Most of them suffer from type 2 diabetes. The majority of people are also known to have type 1 diabetes and gestational diabetes. But there are other special forms of diabetes. These can be triggered by medication or viral infections, among other things.
Diseases are often treated incorrectly
Type 1 diabetes, type 2 diabetes, gestational diabetes - these metabolic diseases are known to most people. However, many laypersons and even general practitioners often do not know that there are also special forms of diabetes. Because these forms are not correctly diagnosed or mistaken for other types of diabetes, they are still treated incorrectly. The German Diabetes Society (DDG) points this out in a communication. The experts explain how the rarer diabetes subgroup is recognized and what needs to be considered during therapy.
Permanently increased blood sugar level
"The causes of a special type of diabetes are diverse and can range from genetic diseases to hormonal disorders and infections," explains DDG President Professor Dr. med. Monika Kellerer.
The rare forms of diabetes are "sometimes referred to as" type 3 diabetes ", even if this is not an officially recognized name in Germany," writes the Diabetes Information Service Munich on its website.
"The practice guideline" Definition, classification and diagnostics of diabetes mellitus (2017) "of the German Diabetes Society summarizes these rare forms in the group" Other specific types of diabetes "", it continues there.
They have essentially the same characteristic as the "classic" diabetes diseases - a permanently elevated blood sugar level that urgently needs to be regulated.
"However, taking into account the respective underlying disease, which is why the therapies can differ considerably," says Kellerer. If in doubt, affected patients should contact a specialist practice or a specialized clinical department.
Cortisone therapies as a common trigger
According to the DDG, cortisone therapies, for example for rheumatism, asthma, Crohn's disease and other inflammatory or oncological diseases, are among the most common triggers of the special form of diabetes.
"The good news here is that diabetes can completely regress if the cortisone is sneaked out," says Kellerer. "Patients should clarify with their treating physicians whether a change in medication is possible."
In general, the higher the cortisone dose and the longer the duration of therapy, the greater the risk of developing diabetes.
Patients who are obese, have a family history or have long-term blood sugar levels of HbA1C above 5.7 percent are particularly at risk.
"If it is not possible to omit cortisone or if the blood sugar levels do not normalize after tapering, the therapy, like in type 2 diabetes, is initially based on a change in diet and more exercise," says Kellerer. This is followed by antidiabetic drugs in tablet form and finally insulin.
Cystic fibrosis often causes diabetes
Special forms of diabetes also include a disturbed glucose metabolism, which develops as a result of the rare inherited disease cystic fibrosis.
From the age of 26, according to the experts, every second cystic fibrosis patient additionally suffers from diabetes, women significantly earlier and more often than men.
"Then life expectancy also depends on diabetes treatment," explains Professor Dr. Andreas Neu, Vice President of the DDG.
Because diabetes in cystic fibrosis patients often has no recognizable symptoms, patients from the age of ten should be screened for diabetes annually.
But: "Blood tests with the HbA1c value alone do not always provide reliable results," says Neu. A sensible addition is, for example, fasting blood sugar tests.
Nutrition plays a vital role
There are peculiarities in the treatment, although the following generally applies: the underweight the patient, the greater the risk of diabetes. "It is therefore advantageous to help cystic fibrosis patients to have a higher body mass index," says Neu.
Affected people must be fully nourished, including with regard to salts and carbohydrates. "In many practices, patients are still classified as type 2, who then learn to eat a low-calorie diet," says Neu.
This is extremely problematic for people with impaired pancreatic function and underweight in terms of life expectancy.
According to the guideline, cystic fibrosis patients with diabetes should receive insulin, but so far only three quarters of the patients do so.
"The rest are treated dietetically or with oral antidiabetic drugs," explains Neu. However, the guidelines advise against the poorer effectiveness of tablets.
According to the DDG, diabetic cystic fibrosis patients, unlike type 1 diabetes patients, only get along well with insulin at mealtimes. They often only needed additional basal insulin after years.
The so-called "MODY diabetes" types ("Maturity Onset Diabetes of the Young"), which are based on different genetic defects and are passed on from generation to generation, are among the more common special forms of diabetes.
These defects cause the beta cells in the pancreas to stop working properly and consequently insulin production is restricted.
"The patients are usually of normal weight, which is why they are sometimes wrongly diagnosed with type 1 diabetes," explains DDG expert Professor Dr. Dirk Müller-Wieland.
"Genetic tests provide information, including the exclusion of antibodies that are present in type 1."
This is especially important for therapy. After all, MODY diabetes patients can first be treated well with exercise and a high-fiber diet, then with tablets. Insulin therapy is only required in later stages.
The cause decides on therapy
But other categories must not go unnoticed either. For example, viral infections can trigger diabetes in the third group; other triggers include malfunctions of the immune system, hormonal disorders or Down syndrome.
And acute inflammation of the pancreas leads to permanent diabetes in the third group in 15 percent of cases.
"If gallstones are the cause of the inflammation, the diabetes can regress after it has been removed," says Professor Dr. Baptist Gallwitz.
Chronic pancreatitis, often due to alcohol abuse, triggers diabetes in about half of the cases.
"The exact special form of diabetes - and consequently also the therapy - ultimately decides the cause," says DDG media spokesman Gallwitz. (ad)
Author and source information
This text corresponds to the requirements of the medical literature, medical guidelines and current studies and has been checked by medical doctors.
- German Diabetes Society (DDG): Often misunderstood: special forms of diabetes - triggers can be drugs, viral infections, cystic fibrosis or genetic defects, (accessed: August 6, 2019), German Diabetes Society (DDG)
- Diabetes information service Munich: RARE FORMS - "TYPE-3-DIABETES", (accessed: August 6, 2019), Diabetes information service Munich