Beyond the Norm: "Atypical Diabetes"

Most people are familiar with two types of diabetes: type 1 and type 2. But few may be aware of another type — atypical diabetes mellitus, or ADM — that doesn’t fit the mold.

What ADM Is Not
To understand ADM, it’s helpful to know the basics of the more common forms of diabetes. Type 1 diabetes typically develops in children and teens. People with type 1 diabetes must take insulin each day to survive.

Jay Sher, M.D., a board-certified endocrinologist at Jersey Shore University Medical Center clarifies the differences between the two types: "With type 1 diabetes, the pancreas stops producing insulin, which is the hormone that helps the body use sugar, or glucose, for energy. The reason for this shutdown is that the body’s immune system attacks insulin-producing cells and destroys them. Therefore, all people with type 1 diabetes need insulin injections."

On the other hand, people with type 2 diabetes may or may not require insulin — their bodies still make it, although they can’t use it effectively. Although type 2 diabetes usually develops during adulthood, doctors are now finding it more often in children and teens, many of whom are overweight.

Dr. Sher continues, "The inability to use insulin effectively in type 2 diabetes is called insulin resistance. Insulin resistance is genetically determined and dramatically worsened by obesity. The other problems found in type 2 diabetes are an overproduction of sugar by the liver and insufficient insulin produced by the pancreas."

Not Quite Type 1 or Type 2
People with ADM don’t have typical type 1 or type 2 diabetes. They often develop high blood sugar quickly. They also may have high levels of certain acids in their blood. But as their disease progresses, it tends to look like type 2 diabetes.

People with ADM initially need to take insulin — but after some months, their blood sugar may return to normal. So unlike people with type 1 diabetes, they may not need lifelong insulin treatment. After initial treatment with insulin, they also don’t become seriously ill when they fail to take insulin.

Too Much Weight May Be a Factor
What causes ADM is currently a mystery. However, genes may play a role. Many people with ADM have a strong family history of diabetes.

Some researchers think extra pounds also may be an issue. Weight gain may speed up the onset of insulin- treated diabetes and contribute to the development of ADM.

At this point, ADM is not well understood. But doctors can advise those with type 1 diabetes to take steps that can lower their risk of developing insulin resistance — a hallmark of type 2. These include staying active and eating a low-fat, nutritious diet.