Medical research

A new type of diabetes has been identified and it’s often misdiagnosed

Type 3c diabetes that arises from damage to the pancreas is often mistaken for type 2. This can lead to wrong medicines being prescribed.

Most people are familiar with type 1 and type 2 diabetes. Recently, though, a new type of diabetes has been identified: type 3c diabetes.

Type 1 diabetes is where the body’s immune system destroys the insulin producing cells of the pancreas. It usually starts in childhood or early adulthood and almost always needs insulin treatment. Type 2 diabetes occurs when the pancreas can’t keep up with the insulin demand of the body. It is often associated with being overweight or obese and usually starts in middle or old age, although the age of onset is decreasing.

Type 3c diabetes is caused by damage to the pancreas from inflammation of the pancreas (pancreatitis), tumours of the pancreas, or pancreatic surgery. This type of damage to the pancreas not only impairs the organ’s ability to produce insulin but also to produce the proteins needed to digest food (digestive enzymes) and other hormones.

However, our latest study has revealed that most cases of type 3c diabetes are being wrongly diagnosed as type 2 diabetes. Only 3% of the people in our sample – of more than two million – were correctly identified as having type 3c diabetes.

Small studies in specialist centres have found that most people with type 3c diabetes need insulin and, unlike with other diabetes types, can also benefit from taking digestive enzymes with food. These are taken as a tablet with meals and snacks.

Researchers and specialist doctors have recently become concerned that type 3c diabetes might be much more common than previously thought and that many cases are not being correctly identified. For this reason, we performed the first large scale population study to try and find out how common type 3c diabetes is.

Looking for type 3 diabetes

We also looked into how well people with this type of diabetes have their blood sugar controlled. To do this we analysed health records from over two million people in England. The records used were taken from the Royal College of General Practitioners Research and Surveillance Database. This database, mainly used for flu surveillance, contains the anonymised healthcare records of people of all ages for a sample of GP practices spread out across England.

We looked for cases of diabetes occurring after conditions which had caused damage to the pancreas including pancreatitis, pancreatic cancer and tumours, and pancreatic surgery. These cases of diabetes are likely to be cases of type 3c diabetes. The proportion of people with diseases of the pancreas who go on to develop diabetes is not clear but it does not happen in all cases, and there may be a long delay before the onset of diabetes.

To our surprise, we found that in adults, type 3c diabetes was more common than type 1 diabetes. We found that 1% of new cases of diabetes in adults were type 1 diabetes compared with 1.6% for type 3c diabetes.

People with type 3c diabetes were twice as likely to have poor blood sugar control than those with type 2 diabetes. They were also five to ten times more likely to need insulin, depending on their type of pancreas disease.

We found that the onset of type 3c diabetes could occur long after the onset of pancreas injury. In many cases more than a decade later. This long lag may be one of the reasons the two events are not often thought of as being linked, and the diagnosis of type 3c diabetes is being overlooked.

Correctly identifying the type of diabetes is important as it helps the selection of the correct treatment. Several drugs used for type 2 diabetes, such as gliclazide, may not be as effective in type 3c diabetes. Misdiagnosis, therefore, can waste time and money attempting ineffective treatments while exposing the patient to high blood sugar levels.

Our findings highlight the urgent need for improved recognition and diagnosis of this surprisingly common type of diabetes.

This article was first published on The Conversation.

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“My body instantly craves chai and samosa”

German expats talk about adapting to India, and the surprising similarities between the two cultures.

The cultural similarities between Germany and India are well known, especially with regards to the language. Linguists believe that Sanskrit and German share the same Indo-Germanic heritage of languages. A quick comparison indeed holds up theory - ratha in Sanskrit (chariot) is rad in German, aksha (axle) in Sanskrit is achse in German and so on. Germans have long held a fascination for Indology and Sanskrit. While Max Müller is still admired for his translation of ancient Indian scriptures, other German intellectuals such as Goethe, Herder and Schlegel were deeply influenced by Kalidasa. His poetry is said to have informed Goethe’s plays, and inspired Schlegel to eventually introduce formal Indology in Germany. Beyond the arts and academia, Indian influences even found their way into German fast food! Indians would recognise the famous German curry powder as a modification of the Indian masala mix. It’s most popular application is the currywurst - fried sausage covered in curried ketchup.

It is no wonder then that German travellers in India find a quite a lot in common between the two cultures, even today. Some, especially those who’ve settled here, even confess to Indian culture growing on them with time. Isabelle, like most travellers, first came to India to explore the country’s rich heritage. She returned the following year as an exchange student, and a couple of years later found herself working for an Indian consultancy firm. When asked what prompted her to stay on, Isabelle said, “I love the market dynamics here, working here is so much fun. Anywhere else would seem boring compared to India.” Having cofounded a company, she eventually realised her entrepreneurial dream here and now resides in Goa with her husband.

Isabelle says there are several aspects of life in India that remind her of home. “How we interact with our everyday life is similar in both Germany and India. Separate house slippers to wear at home, the celebration of food and festivals, the importance of friendship…” She feels Germany and India share the same spirit especially in terms of festivities. “We love food and we love celebrating food. There is an entire countdown to Christmas. Every day there is some dinner or get-together,” much like how Indians excitedly countdown to Navratri or Diwali. Franziska, who was born in India to German parents, adds that both the countries exhibit the same kind of passion for their favourite sport. “In India, they support cricket like anything while in Germany it would be football.”

Having lived in India for almost a decade, Isabelle has also noticed some broad similarities in the way children are brought up in the two countries. “We have a saying in South Germany ‘Schaffe Schaffe Hausle baue’ that loosely translates to ‘work, work, work and build a house’. I found that parents here have a similar outlook…to teach their children to work hard. They feel that they’ve fulfilled their duty only once the children have moved out or gotten married. Also, my mother never let me leave the house without a big breakfast. It’s the same here.” The importance given to the care of the family is one similarity that came up again and again in conversations with all German expats.

While most people wouldn’t draw parallels between German and Indian discipline (or lack thereof), Germans married to Indians have found a way to bridge the gap. Take for example, Ilka, who thinks that the famed differences of discipline between the two cultures actually works to her marital advantage. She sees the difference as Germans being highly planning-oriented; while Indians are more flexible in their approach. Ilka and her husband balance each other out in several ways. She says, like most Germans, she too tends to get stressed when her plans don’t work out, but her husband calms her down.

Consequently, Ilka feels India is “so full of life. The social life here is more happening; people smile at you, bond over food and are much more relaxed.” Isabelle, too, can attest to Indians’ friendliness. When asked about an Indian characteristic that makes her feel most at home, she quickly answers “humour.” “Whether it’s a taxi driver or someone I’m meeting professionally, I’ve learnt that it’s easy to lighten the mood here by just cracking a few jokes. Indians love to laugh,” she adds.

Indeed, these Germans-who-never-left as just diehard Indophiles are more Indian than you’d guess at first, having even developed some classic Indian skills with time. Ilka assures us that her husband can’t bargain as well as she does, and that she can even drape a saree on her own.

Isabelle, meanwhile, feels some amount of Indianness has seeped into her because “whenever its raining, my body instantly craves chai and samosa”.

Like the long-settled German expats in India, the German airline, Lufthansa, too has incorporated some quintessential aspects of Indian culture in its service. Recognising the centuries-old cultural affinity between the two countries, Lufthansa now provides a rich experience of Indian hospitality to all flyers on board its flights to and from India. You can expect a greeting of Namaste by an all-Indian crew, Indian food, and popular Indian in-flight entertainment options. And as the video shows, India’s culture and hospitality have been internalized by Lufthansa to the extent that they are More Indian Than You Think. To experience Lufthansa’s hospitality on your next trip abroad, click here.

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This article was produced by the Scroll marketing team on behalf of Lufthansa as part of their More Indian Than You Think initiative and not by the Scroll editorial team.