13/11/2025
It is World Diabetes Day today, my 47th with T1D.
I’d like to have a bit of a chat about the “other” forms of diabetes we don’t think about much.
We all (well, certainly on this page anyway), know about T1 (autoimmune Islet cell destruction and lack of insulin), and T2 (insulin resistance and elevated production of insulin in response, with eventual pancreatic exhaustion in some cases), and some of you might know about T3c (surgical or physiological destruction of the pancreas including the islet cells - cystic fibrosis related diabetes could fit under this classification).
There is a decent sized group of people with diabetes who are tricky to categorise.
Not antibody positive, not insulin resistant. Some of these folks are diagnosed in infancy, and a genetic cause is quite clear, but others are very commonly misdiagnosed as T1 or T2, depending on their age and body type.
These folks may well have monogenic diabetes or “mature onset diabetes of the young”.
Some of these people might in fact not need insulin, and may do very well on an older sort of medication (sulfonylureas), or may not need treatment at all, because their glucose is only slightly elevated and it never progresses toward complications.
The actor Halle Berry probably has a monogenic form of diabetes, as she does not always need insulin, and was diagnosed as a young woman in excellent physical shape. It has been postulated that she may have “Flatbush diabetes”, which is unique to people of African ancestry, and named after a region of New York. Sometimes they need insulin (illness, stress), often they do not.
My gripe with all this classification is that it allows governments and health systems to withhold potentially useful technology and medicine from entire groups. Would most people with T2D benefit from CGM - absolutely! Would adults with CF related diabetes and T3c benefit from subsidised CGM? Absolutely. Would folks with atypical T1 or T2 benefit from Medicare funded genetic testing? Absolutely.
Many of us (mostly T1s) are in a good spot with regard to accessing tech, and T2s are in a good spot regarding medicines (yay Ozempic - for many this is a game changer), but we still have lots to do.
