April 25, 2019, 01:38:33 pm

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Diagnosis & Classification

A diagnosis of Diabetes can be unnerving for anyone. Usually, simple blood sugar tests for morning fasting & post prandials (after meals) at 1 hr or 2 hr are used to diagnose & predict outcomes. If doubts persist, these tests can be repeated until the doctor / patient team is satisfied. Further confirmation can be had by getting the Hb-A1c test done (more information here). The attached chart is the suggested diagnosis criteria to an expert committee in 2001. (Source).


At the time that these suggestions were made, Upper Limit Normal (ULN) A1c was considered as 7.0 %. This has since been revised to 6.3 %. Once the diagnosis is confirmed it is also imperative to ascertain the type of diabetes afflicting the patient. 

Here’s a brief explanation of the several types.  

Gestational Diabetes (GD) : This is the type of diabetes that strikes about 8-10 % of women during pregnancy. The treatment usually relies on insulin injections if the BG (Blood Glucose) does not normalize. High blood sugar in the mother is very dangerous for the growing foetus, as it depends solely on the mother's blood supply for its own nourishment. Usually GD resolves soon after the delivery on its own. Once the big "D" rears its ugly head during pregnancy, the woman can be considered to be at potential risk for getting the full blown version later in life. Even the babies born from such pregnancies are considered to be susceptible to the disease during their lifetime.  
Type 1 Diabetes (T1) : is also known as Juvenile Diabetes, because it usually strikes during the childhood years. This is an Auto-Immune disease, in which the Auto Immune System of the body, malfunctions and causes the onset of T1. Usually the afflicted children come under some kind of viral attack. The makeup of the virus/es is similar to that of the beta cells of the pancreas. In a case of mistaken identity, the auto immune system not only attacks the invading virus but also the pancreatic beta cells. The attacked beta cells degenerate and are not able to make and secrete insulin for the remainder of the life cycle. T1s have therefore to rely on exogenous insulin injections to survive.  
Type 2 Diabetes (T2) : This form of diabetes is also known as Mature Onset diabetes and normally strikes a person in the middle ages - mostly after the late 30s. This form of diabetes is more common and is mostly a combination of reduced insulin secretion capacity and (IR) Insulin Resistance. Where and which cells within the body have IR and to what extent, determines the person's diabetic imprint, and response to therapy. In majority of the cases, the BG can be well managed with lifestyle changes and sometimes oral medication. In extreme cases, a combination therapy or exclusive use of injected insulin is advised.  
Type 1.5 (LADA) : Of late, 2 mid-way strains of diabetes have evolved. These forms of diabetes are understood to lie between T1 & T2, and therefore designated as T 1.5. LADA stands for "Latent Auto Immune Diabetes in Adulthood". LADA, is also an Auto-Immune disease, but it lies dormant during childhood and begins to appear only late in life. In simpler words LADA is T1 appearing in adult years. As opposed to T2, these persons also cannot secrete any insulin just like the T1s and have to depend on exogenous insulin to manage BG.  
Type 1.5 (MODY) : Just like LADA, this is a variety thought to lie in between T1 & T2. MODY stands for "Mature Onset of Diabetes in the Young". These cases are that of young people getting afflicted by T2 diabetes very early in life. They suffer from part faulty insulin secretion and part IR just like the T2s. Most cases can be managed by lifestyle changes and oral medication. In some rare cases insulin needs to be injected. Due to their young age, these type of patients can many times cause a dramatic reversal of their conditions, provided that their lifestyle and/or medical intervention is maintained. An increasing number of youngsters have been joining the MODY group of late, indicating the fast pace at which diabetes variants are spreading in the global population.