While diabetes is often linked to known types and risk factors, not everyone fits into those categories. Some people develop diabetes due to medications, surgery, or pancreatic damage. Credentialled Diabetes Educator Carolien Koreneff explains in more detail.

Medications

Some medications can increase diabetes risk. While treating serious health conditions is critical, it’s also important to understand how they can trigger diabetes. This is also known as medically-induced diabetes.

Antipsychotics

Atypical Antipsychotic Agents are commonly used to treat mental health conditions such as schizophrenia and psychosis. These medications can increase hunger leading to overeating, weight gain and insulin resistance. Some can also reduce insulin production, leading to higher glucose levels. However, even before these drugs were introduced, diabetes was more common in people with schizophrenia and some other mental health conditions. If you use an antipsychotic medication, it is important to be monitored closely by both a psychiatrist and an endocrinologist.

Beta blockers

Certain heart conditions, high blood pressure, and even glaucoma are treated with beta blockers. However, they have been linked to the development of diabetes and can also hide the signs of hypoglycaemia (low blood glucose levels or BGLs).

Beta blockers are very important in treating certain heart conditions and are not associated with an increased risk of the development of hypos.

Please discuss any concerns you have with your doctor, before making any changes.

Corticosteroids

Corticosteroids, often called steroids, are hormones that help reduce inflammation and suppress the immune system. They are used to treat allergies, asthma, autoimmune diseases, and inflammation. They can also reduce the side effects from treatments such as chemotherapy.

Steroids can raise blood glucose levels as they block the action of insulin, causing insulin resistance. They also cause the liver to release extra glucose into the bloodstream.

Steroid injections may cause a quick rise in glucose levels lasting three to 10 days, while oral steroids cause a slower rise. Inhaled steroids, like asthma puffers, do not affect BGLs.

Long-term steroid use increases the risk of diabetes. Always discuss the benefits and risks with your doctor.

Diuretics

Thiazide diuretics help lower blood pressure by removing excess fluid from the body. They are also used to reduce heart problems. Older studies suggested thiazides might increase diabetes risk, but this

risk is reduced in lower doses. As thiazides significantly reduce your risk of heart failure, their benefits outweigh any potential impact on blood glucose levels. Never stop taking them without talking to your doctor.

Statins

Statins lower cholesterol and reduce the risk of heart attacks and strokes. High doses may slightly increase diabetes risk, but they are especially important for people with diabetes to prevent heart complications. Talk to your doctor about the benefits and risks of these medications.

Secondary diabetes

Some people develop diabetes due to damage to the pancreas by other causes. These include surgery, cancer and infections such as pancreatitis.

We refer to this type of diabetes as secondary diabetes or type 3c. The treatment of this type of diabetes depends on the cause and the extent of the damage.

Type 3 and type 3c diabetes

The American Diabetes Association and the World Health Organization use type 3 diabetes to cover a wide range of various types of diabetes, including genetic insulin issues and diseases of the pancreas.

The NDSS groups these types as “other diabetes”. The term can be confusing because some use the term type 3 diabetes to describe a possible link between insulin issues in the brain and Alzheimer’s disease; however, this is not an official diagnosis.

Type 3c diabetes happens when the pancreas is damaged and can’t produce insulin, often due to some of the following medical conditions.

Cystic fibrosis

Cystic fibrosis can scar the pancreas and prevent the production of enough insulin. Although the pancreas still makes insulin, it is not enough to keep blood glucose levels within a normal range. People with cystic fibrosis may also develop insulin resistance due to steroid treatment and have a higher risk of developing diabetes during pregnancy, needing insulin treatment.

Haemochromatosis

Haemochromatosis, also referred to as bronzed diabetes because of the effect on the skin, is a condition where too much iron is absorbed in the body. The risk of diabetes is increased due to extra iron that is stored in the liver and pancreas, which affects insulin production.

Pancreatitis

Pancreatitis is the inflammation of the pancreas that can reduce insulin production. It can be acute or chronic. Chronic pancreatitis can be genetic, but is commonly due to gallstones or excessive alcohol use, this can also lead to scarring of your pancreas’ tissues.

This is called fibrosis, and can lead to the pancreas no longer being able to make enzymes and hormones such as insulin. Chronic pancreatitis is the most common cause of type 3c diabetes.

Pancreatic cancer

Pancreatic cancer can cause cells in your body to become resistant to insulin, resulting in an increase in blood glucose levels. This can also stop the beta cells of the pancreas making more insulin to deal with any insulin resistance. This results in the development of diabetes. About 50% of people diagnosed with pancreatic cancer also have diabetes.

Surgery

Surgery puts stress on your body which can raise your blood glucose levels and increase insulin resistance.

Pancreatectomy

A pancreatectomy, the removal of part or all of the pancreas, may be needed because of cysts, cancer, or severe long-term pancreatitis. This surgery often leads to type 3c diabetes. If part of the pancreas remains, it may still produce enough insulin to keep glucose levels in the target range.

But if the entire pancreas is removed, diabetes is almost certain, and most people will need insulin injections.

Whipple’s procedure

The Whipple procedure is a complex, but life-saving surgery used to treat tumours and other conditions in the pancreas, small intestine, and bile ducts. Depending on how much of the pancreas has to be removed, type 3c diabetes may develop.

Diagnosing type 3c diabetes

Type 3c diabetes can be hard to diagnose, and many people are mistakenly diagnosed with type 2 diabetes instead. To diagnose type 3c, your doctor will need to

confirm damage to your pancreas and rule out other types of diabetes. This is done using pancreas-specific blood tests and imaging scans.

Managing type 3c diabetes

Treatment depends on how much of the pancreas is damaged or removed. If some function remains, management is similar to type 2 diabetes. If the pancreas no longer works or is fully removed, insulin treatment similar

to type 1 diabetes is often needed. Regular glucose monitoring is essential to determine if the treatment is working for you. A healthy diet and exercise are key for managing all types of medically- induced forms of diabetes.

If your entire pancreas is removed, you may also need enzyme replacement therapy, to help you absorb important nutrients from your food.

Many people with pancreatic cancer will also need pancreatic enzyme replacement therapy (PERT) as your pancreas will not start making enzymes again. If you have symptoms despite taking PERT, consult your healthcare provider.