What's Type 4 Diabetes?

From health.usnews.com

The Centres for Disease Control and Prevention defines diabetes as a chronic (long-lasting) health condition that affects how your body turns food into energy. We are most familiar with prediabetes, Type 2 diabetes, Type 1 diabetes and gestational diabetes. 

But there have been more variations of diabetes discovered. Two newer diabetes diagnosis are MODY (maturity onset diabetes of the young) and LADA (latent autoimmune diabetes in adults). In fact, they are so new that they are often misdiagnosed.

The Most Common Types of Diabetes

As a review, here’s a brief summary of the most common types of diabetes:

• Type 1 diabetes is an autoimmune condition. People diagnosed with Type 1 diabetes must take insulin because their immune system has attacked the insulin producing cells in the pancreas blocking production of insulin.
  
• Type 2 diabetes is a condition in which the body becomes resistant to using insulin properly and efficiently. Over time people with Type 2 diabetes may stop making enough insulin, becoming insulin deficient. Type 2 diabetes is associated with genetic and lifestyle factors.
  
• Gestational diabetes is a temporary condition where higher levels of hormones during pregnancy lower the body’s sensitivity to insulin leading to blood sugar levels that are out of target range.
• • Maturity onset diabetes of the young (MODY) is yet another type of diabetes that is directly attributable to a genetic condition. MODY occurs before 25 years of age.
    
  • Latent autoimmune diabetes in adults (LADA) is considered an “other type of diabetes” because it doesn’t follow the same metabolic path as Type 1 or Type 2 diabetes but has characteristics of bot. People who are diagnosed with LADA tend to be over age 35 and have a family history of autoimmunity, but they continue to produce some insulin naturally in contrast to Type 1 diabetes.
    
  • Type 3 diabetes is an anomaly, often linked with Alzheimer’s disease. This type is not an official diabetes diagnosis, nor is it currently used in the health care system. The theory is that insulin resistance in the brain is part of the progression with Alzheimer’s disease.

  But could there be more types of diabetes on this growing list?

• Type 4 Diabetes

  Sit back and read on because there is yet another new diabetes to add to this list, referred to as “Type 4” Diabetes. Type 4 diabetes is not diabetes as we know, and it isn’t an official diagnosis yet. But there are some findings in mice that have revealed an interesting twist to a potentially new diabetes diagnosis.

  Unlike Type 2 diabetes or Type 1 diabetes, “Type 4” diabetes is not associated with excess body weight or a deficiency of insulin. Rather, the condition is connected to age related insulin resistance in lean, older mice which appears to be caused by a variation in the accumulation of certain immune system cells.

• By comparing the immune systems of healthy mice, obese mice with Type 2 diabetes and certain lean, older mice with “age-related diabetes,” researchers at the Salk Institute discovered the older, lean mice had abnormally high levels of T-regulatory immune cells accumulating in fat tissue. This condition was leading to unnatural accumulations of internal fat in areas such as the liver causing insulin resistance similar to Type 2 diabetes. Importantly, blocking the accumulation of T-regulatory cells in older mice prevented the development of this “Type 4” diabetes.

  The concern is that if this same insulin resistance pathway is occurring in older, lean humans, their diabetes may go undiagnosed because they don’t have the “standard” obesity risk factor for Type 2 diabetes even while the researchers have already identified an effective treatment. The work to survey older people who may experience this variation of diabetes is underway.

  At this moment in time, we aren’t able to make any solid recommendations on how to prevent changes in T-regulatory cells that are associated with Type 4 diabetes. Even though this potential Type 4 diabetes is unrelated to an increase in body weight, we continue to recommend following a healthy lifestyle, no matter what age. With all the more common types of diabetes, a healthy lifestyle is part of the equation of diabetes management.

  Healthy lifestyle includes:
  

  • Engaging in physically active.
  • Following a healthy, balanced eating plan.
  • Maintaining a healthy weight.

  https://health.usnews.com/wellness/articles/whats-type-4-diabetes
  

What Is Type 4 Diabetes?

From healthline.com

You’ve probably heard of type 1 and type 2 diabetes. According to the Centres for Disease Control and Prevention (CDC), more than 34 million Americans have diabetes — but the actual number might be much higher. A 2015 study with mice indicates that diabetes might be underdiagnosed in older adults who don’t have overweight or obesity. While not an official classification of diabetes, researchers are calling this type 4 diabetes.

Type 4 diabetes isn’t an autoimmune condition like type 1 diabetes, and it’s not linked to weight like type 2 diabetes. Instead, this potential type of diabetes may be linked to the aging process. Research into this condition is ongoing, but scientists have already uncovered some connections.

Types of diabetes

Diabetes is often thought of as having two distinct types, though gestational diabetes is also quite common. All types of diabetes cause high blood sugar because your body has trouble producing insulin, a hormone that moves and stores sugar.

Most common types

• Type 1 diabetes. Type 1 diabetes is most commonly diagnosed in children and teenagers. It’s an autoimmune condition. When you have type 1 diabetes, your immune system attacks the cells in your pancreas responsible for making insulin.
• Type 2 diabetes. Type 2 diabetes happens when your body stops responding to the insulin your pancreas makes. Over time, your pancreas also stops producing enough insulin. It’s generally linked to a combination of genetic and lifestyle factors.
• Gestational diabetes. This type of diabetes is a response to the hormonal changes that happen during pregnancy. The hormones made in the placenta can lower your body’s sensitivity to insulin. This may result in high blood sugar during pregnancy.

Type 1, type 2, and gestational diabetes are very common, but they’re not the only types of diabetes. There are several other types of diabetes, and a few that are not officially classified as types.

Specific diabetes due to other causes

• Mature onset diabetes of the young (MODY). This type of diabetes occurs due to a genetic change, and runs in families. Children with the genetic change will often develop this form of diabetes by the time they are 25.
• Neonatal diabetes. Neonatal diabetes is generally diagnosed in children under 6 months old. It’s an inherited condition that’s different from type 1 diabetes because it’s not an autoimmune condition. Instead, children with this condition are born with a genetic change that affects their ability to produce insulin.
• Diabetes caused by other conditions. This type of diabetes is caused by conditions including cystic fibrosis, pancreatic cancer, or pancreatitis that damage the pancreas’ ability to produce insulin.
• Steroid-induced diabetes. This type of diabetes can happen when you take steroids that affect hormone production in your body.

Other terms you may hear

While these aren’t official types of diabetes, you may sometimes hear these terms when talking about diabetes. They include:

• Monogenic diabetes. This includes both MODY and neonatal diabetes, and refers to any type of diabetes that’s caused by genetic changes.
• Type 3c diabetes. This is sometimes used to refer to diabetes caused by other conditions, such as cystic fibrosis and pancreatic cancer.
• Latent autoimmune diabetes in adults (LADA). This is sometimes referred to as type 1.5 diabetes. Some experts think of it as a subtype of type 1 diabetes. While it is an autoimmune disease like type 1, LADA progresses more slowly. It’s often misdiagnosed as type 2 diabetes because you may still be able to produce insulin for some time.

Recent discussion of new types

Recently, some researchers have suggested that two additional types of diabetes might exist. These aren’t yet official diabetes types or diagnoses, but that might change as more information becomes available.

• Type 3 diabetes. Type 3 diabetes is used to explain the theory that insulin resistance might cause Alzheimer’s disease, a form of dementia. A 2018 research review showed that people with type 2 diabetes are more likely to develop Alzheimer’s disease. Experts are still investigating this link.
• Type 4 diabetes. Type 4 diabetes is the proposed term for diabetes caused by insulin resistance in older people who don’t have overweight or obesity. A 2015 study with mice suggested this type of diabetes might be widely underdiagnosed. This is because it occurs in people who aren’t overweight or obese, but are older in age.

Causes

Scientists are just beginning to study type 4 diabetes, so they don’t yet have a lot of concrete information about what causes it.

A 2015 study with mice showed that the condition referred to as type 4 diabetes is linked to an excess of immune cells called regulatory T cells. Researchers have a theory that this is linked to the aging process, but studies in humans are still needed.

Symptoms

Type 4 diabetes has many of the same symptoms as other types of diabetes. However, because it generally appears in people with a moderate weight, doctors may not suspect diabetes. Common symptoms include:

• fatigue
• increased thirst
• increased hunger
• blurry vision
• sores that don’t heal
• frequent urination
• unintentional weight loss

Many of these symptoms are also linked to other conditions and might not always indicate diabetes.

It’s a good idea to make an appointment with a medical professional if you’ve been experiencing any of these symptoms. A doctor can review your symptoms and order any tests they think are needed.

Treatment

Type 4 diabetes isn’t officially a diagnosis yet. Many things about this condition, including treatment, are still being studied. However, according to Salk Center FAQ, researchers are hopeful that they will be able to develop an antibody medication. This could help reduce the number of regulatory T cells in the body and treat type 4 diabetes.

Until this medication is developed, your doctor will probably treat type 4 diabetes with the same medications prescribed to people with type 2 diabetes.

Many of the lifestyle recommendations for people with type 2 diabetes aren’t effective for people with type 4 diabetes. For example, weight loss is a common recommendation for people with type 2 diabetes. This isn’t effective for people with type 4 diabetes. They generally already have moderate weight and increased weight loss doesn’t reduce the number of regulatory T cells.

Prevention

Right now, studies in mice show that type 4 diabetes appears to be linked to the aging process. More studies in humans need to be done to support this theory. Until we know the results of these studies, we won’t know if there is any way to prevent the condition.

Where to find help

Getting medical care is important no matter what kind of diabetes you have. Talking with a medical professional about your symptoms is often the first step toward diagnosis. If you have a primary care physician, they may be a great place to start, but they might not be your last step. Other great ways to get help include:

• Contacting an endocrinologist. Endocrinologists are doctors who specialize in hormonal conditions such as diabetes. If you have insurance, your insurance provider might also be able to direct you to a local specialist.
• Finding a local diabetes education program. Diabetes education programs can help you learn to manage your condition. Educational specialists can help you make a plan and give you the tools you need to live well with diabetes. 
• Talking with a dietitian. A dietitian can develop eating plans for you that will help keep your blood sugar under control. They’ll show you how to make food choices that will help you feel better. You can search for local professionals in this guide.
• Visiting the American Diabetes Association (ADA) website. The ADA has a wealth of resources for people with diabetes, including educational information for people who have just been diagnosed.

The bottom line

Insulin resistance is a hallmark of type 2 diabetes, and is often connected with having obesity. However, Type 4 diabetes shows that this isn’t always the case.

Studies in mice have shown that the aging process can cause the body to produce too many regulatory T cells. These cells can lead to type 4 diabetes.

These results still need to be studied in humans. Finding evidence of this same pattern in humans could lead to increased diagnosis and the development of new treatments for diabetes.

https://www.healthline.com/health/diabetes/type-4-diabetes