The answer is usually straightforward – type 1, type 2, or gestational diabetes, and most people fit easily into one of these categories. But not all. In this article we look at whether there are more than three types of diabetes, if you can have more than one type of diabetes, and whether your original diagnosis could have changed over time. Credentialled Diabetes Educator, Angela Blair, looks at the evidence and answers some of your most common questions.

Four main groups

Currently, diabetes is largely broken into four main groups: type 1 diabetes, type 2 diabetes, gestational diabetes and ‘other‘ classifications based on contributing factors such as another medical condition, or damage to the pancreas. 

But what if your diabetes doesn’t fit nicely into one of these groups? Type 2 diabetes, for example, is managed in a straightforward manner with lifestyle and medication at the start and over time the addition of more medication or insulin injections if necessary. People with type 2 diabetes comes in all shapes and sizes, and even ages. But for some people managing type 2 diabetes is frustrating as lifestyle changes and medication don’t produce the desired outcomes. 

This is where the sub-group Latent Auto-immune Diabetes in Adults (LADA) comes from. It is a form of type 1 diabetes but as diagnosis often happens in older adult years, people are often initially mis-diagnosed with type 2 diabetes. The diagnosis of LADA usually arises if a person needs insulin soon after diagnosis. It is estimated that one in 10 people have LADA but are misdiagnosed with type 2 diabetes, some research suggests this number may be higher. 

Unfortunately, there is no definitive go-to tool that differentiates a diagnosis between type 1 and type 2 diabetes, but there are some lab tests that look for certain markers of type 1 such as c-peptide and autoantibodies IAA, IA-2A, ICA, and GAD. These tests may be used to confirm LADA in a person where the diagnosis of type 2 diabetes is questionable. 

Six types of diabetes you may not have heard of 

While the following types of diabetes are rare, they still account for between 1-5% of all diagnosed cases. 

Maturity onset diabetes of the young (MODY), caused by a gene mutation, inherited and develops by 25 years of age irrespective of type 2 risk factors. It has characteristics of both type 1 and type 2 diabetes and is often misdiagnosed. People with MODY have a 50% chance of passing it on to any children they have. 

Neonatal diabetes diagnosed in babies less than six months of age. Although type 1 diabetes, the cause isn’t auto-immune instead it is caused by a change in a gene which affects insulin production. Children with neonatal diabetes often have an increased risk of developmental delay or epilepsy. 

Wolfram Syndrome is a rare genetic disorder that results in diabetes mellitus, diabetes insipidus, optic atrophy and deafness. It is often also associated with early onset dementia. 

Alström Syndrome is an even rarer genetic disorder that results in diabetes, loss of hearing, degeneration of the retina, joint and bone problems. It is treated the same way as type 2 diabetes. 

Type 3c diabetes is caused by damage or removal of the pancreas due to pancreatitis, cancer or cystic fibrosis. 

Medically-induced and Steroid-induced diabetes are often type 2 diabetes without the same risk factors for it such as age, family history or cultural background. In the case of medically-induced diabetes your treatment will depend on how much of your 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 usually needed.

Double diabetes

Another challenging type of diabetes is emerging – double diabetes. This is when a person diagnosed with type 1 diabetes develops insulin resistance, a key indicator of type 2 diabetes. Unhealthy weight gain is usually the main reason and it often means more insulin is needed. Medication used for insulin resistance can be prescribed. 

Let’s make it simple 

For most people the type of diabetes is clear. 

• Gestational diabetes is diagnosed during a pregnancy 

• Type 2 diabetes develops over a period of years as your pancreas stops producing insulin or the insulin you produce stops working effectively. Risk factors include age, lifestyle, and cultural background 

• Type 1 diabetes occurs when your body attacks your insulin-producing beta cells and you can no longer produce your own insulin. If you need insulin from the start, then you have type 1 diabetes 

• If you were managing your type 2 diabetes for many years on medication but eventually need insulin, you still have type 2 diabetes but you are ‘insulin requiring’.

Not sure which type you are? Ask your doctor which type they believe you have, and what are the best options for you to manage your diabetes. 

Treatments 

Start by embracing the value of healthy food choices, being physically active and looking after your emotional and mental health, regardless of the type of diabetes you have. If you don’t produce any insulin you will need to inject it. Medication that helps with insulin resistance and supports how the insulin works are beneficial. Keep up-to-date on new medications. 

The good news is that if you know more about your type of diabetes then your treatment, including medication, can be adapted to suit you rather than the type you have. 

The future 

A group of scientists in Finland and Sweden have suggested there are 11 clusters of diabetes rather than types. The clusters are based on age, signs and symptoms at diagnosis, weight, degree of insulin resistance, insulin production, or if the diabetes is auto-immune. They believe using this information to make a diagnosis will lead to more personalised treatments, rather than the one-size-fits-all treatment currently used. Whether this will be adopted internationally as a new way to classify diabetes remains to be seen. However, it’s good to know scientists around the world are investigating the best methods to manage diabetes. 

NDSS registration 

If your type of diabetes changes, make sure you have your NDSS registration updated. Your will need to complete a new registration form, as well as provide supporting documentation from your endocrinologist, doctor, nurse practitioner or credentialled diabetes educator. You should also inform your state or territory diabetes organisation so you will continue to receive the correct information relevant to you. For more information, please call the NDSS Helpline on 1800 637 700. 

Take a deeper dive into diabetes that has developed due to medications, surgery, or pancreatic damage here.