15/04/2025
TYPE 5 DIABETES
Despite my involvement as a specialist in diabetes for over 15 years, I never cease to be amazed by the resurgence of new information on newer types of diabetes. I recently came across Diabetes Type 5, an entity, I had not heard of before.
Type 5 diabetes, previously known as malnutrition-related diabetes, has now been officially recognised, during the recent International Diabetes Federation’s (IDF’s) World Diabetes Congress, held in Bangkok, Thailand. In January 2025.
Type 5 Diabetes was first described in Jamaica in 1955 and was labelled as malnutrition-related-diabetes. It is seen mostly in young men in low- and middle income, who have a body mass index (BMI) < 19 kg/m2 .
People with this form of diabetes have a defect in insulin secretion and therefore have a lower total insulin secretion.
The patients are typically young and thin, which will make one suspect that they had type 1 diabetes, which can be managed with daily insulin injection. However, insulin did not help these patients and in some cases, caused very low blood sugar level.
They are often misdiagnosed as having type 1 diabetes, but there are some clear differences between type 1 and 5:
1.People with type 1 diabetes develop ketones in their urine (ketonuria) or have high ketones level in their blood (ketosis) when their glucose level are high. People with type 5, however, did not develop high ketones despite high blood glucose levels.
2. People with type 1 diabetes have high insulin requirements, but patients with type 5, needs much smaller dose of insulin. High insulin dose can prove fatal in some of the patients.
When compared to type 2 diabetes, these patients phenotypically look different. People with type 2 diabetes are typically obese, as commonly seen in the Mauritian population, and accounts for the majority of diabetes cases in developing countries. People with type 2 have significantly higher visceral adipose tissue and fatty deposition in their liver compared to people in the type 5 group.
Though there are no clear guidelines yet about how to treat these patients, it has been suggested that a very small amount of insulin combined with oral medications may be the most effective way. Furthermore, it is proposed that their nutrition should include much higher amounts of protein and lower amounts of carbohydrates.