Diabetic diseases have long been classified as either type 1 or type 2, but the new research conducted in Scandinavia now indicates that such classification is over-simplistic. Published in The Lancet Diabetes & Endocrinology, this study reveals five distinct subtypes of diabetes and opens doors for more nuanced and personalized treatment strategies.

Simply, diabetes is when the glucose present in the blood is too high because of impaired functioning of insulin- a hormone in charge of regulation of glucose in the body. Type 1 diabetes occurs after the immune system attacks cells which produce insulin inside the pancreas, leading to a complete inability to produce this essential hormone. It most often presents with symptoms at young age and needs continuous insulin therapy.

Type 2 diabetes, on the other hand, is characterized by insulin resistance, where the body produces insulin but does not use it effectively. This type is generally linked to obesity, sedentary lifestyles, and genetics and often manifests in adulthood. While these classifications have guided treatment for decades, the new research divides diabetes into five distinct clusters, each with unique characteristics, risks, and management needs.

5 Cluster of Diabetes

1. Severe Autoimmune Diabetes (SAID)

This form of diabetes is very similar to the original concept of type 1 diabetes. This subtype is due to an autoimmune attack that destroys beta cells responsible for insulin production, leaving the body incapable of producing insulin. It usually occurs in younger people and necessitates tight blood sugar control and insulin therapy.

2. Severe Insulin-Deficient Diabetes (SIDD)

The other extreme type, but not autoimmune, is SIDD. This condition generally affects younger, nonobese people whose bodies do not produce enough insulin because the beta cells are damaged. Individuals diagnosed with SIDD are at the highest risk for complications, including blindness. Generally, treatment consists of insulin therapy, possibly combined with other orally taken medication.

3. Severe Insulin-Resistant Diabetes (SIRD)

SIRD is characterized by a significant resistance to insulin, often linked to obesity. People with SIRD struggle to use the insulin their body produces, resulting in poor blood sugar control. This subtype is associated with a higher risk of kidney disease, and current treatment options are less effective, emphasizing the need for new approaches to manage this group.

4. Mild Obesity-Related Diabetes (MOD)

This presents as a milder form of diabetes associated with obesity. Although these patients have some degree of insulin resistance, this is not as marked as it is in SIRD. Lifestyle interventions including weight loss and physical activity are particularly important in managing MOD, combined with conventional medications for diabetes.

5. Mild Age-Related Diabetes (MARD)

The most prevalent subtype, typically occurring in the elderly. It is less severe than other forms of diabetes, with fewer major complications. Lifestyle changes and oral medications, such as metformin, often are used to keep blood glucose levels within normal limits.

Also Read: What Is Type 3 Diabetes? Insulin Resistance In The Brain That Could Trigger Alzheimer’s

What This Means for Diabetes Management

These five subtypes show that diabetes is complex, and one treatment fits all may not be applicable. In type 2 diabetes, metformin is currently the first drug prescribed to the majority of patients, and then other drugs are added if required. It might not be appropriate for all people, particularly for subgroups such as SIRD, who require more intensive therapies on insulin resistance.

Identifying these subtypes will also enable clinicians to direct appropriate treatments based on the specific risk profiles. For example, those classified as SIDD should have an earlier screen and preventive interventions to avoid blindness. In turn, SIRD may require specific interventions for renal protection.

This study represents a step forward, but it also opens up new questions. Researchers are exploring whether factors such as genetic markers or blood pressure measurements could further refine these subtypes. Furthermore, it is unclear whether a patient's classification might change over time, and so treatment plans need to be flexible and adaptive.

Therefore, findings in this field do not herald a need to completely change the type 1 and type 2 diabetes scheme currently in practice; they rather work as a guideline to develop individualized, high-precision and successful treatment systems in the years to come for the millions dealing with diabetes in today's times.

Diabetes is no longer just about type 1 or type 2. Five distinct subtypes have been identified, and the chronic condition's complexity has now opened the door to a new era of personalized care.

Novel subgroups of adult-onset diabetes and their association with outcomes: a data-driven cluster analysis of six variables. The Lancet Diabetes & Endocrinologyl. 2018

We always believe we are getting enough vitamins as long as we are having a balanced diet, taking the occasional multivitamin supplements, and generally feeling alright. But then out of the blue, more and more people are constantly tired. Hands numb, memory felt foggy, and simple tasks start to feel more difficult than they should be. Like most people I was also experiencing similar symptoms and so I went and got a routine blood test done, my doctor dropped a bombshell- my blood work was excellent but still vitamin B12 levels were deficient!

What most amazed me? My levels were technically within the "normal" limit. That's when I found out that vitamin B12 deficiency isn't always apparent—it can sneak up on you, even if your blood tests are all okay. And the effects? They can be serious, from taking a toll on your nerves to impairing your brain function. If you’ve ever dismissed fatigue or brain fog as just a part of life, it’s time to take a closer look at this essential nutrient.

Vitamin B12 is important to the overall health of the body, and its deficiency usually goes undetected until it has created irreparable harm. The majority of individuals believe that being within the normal range indicates that they are protected, but studies reveal otherwise. Even those who are within the normal range for vitamin B12 levels are showing cognitive impairment and neurological issues. This presents an imperative question: Are we ignoring the actual effect of the deficiency of vitamin B12?

Vitamin B versus Vitamin B12

The use of 'vitamin B' is to define a group of water-soluble vitamins whose functions serve to keep many different body functions. Of these, vitamin B12 (cobalamin) is unique in serving as an integral part of the production of red blood cells, DNA formation, and the nervous system. All other B vitamins are predominantly derived from animal food sources, a fact that leads to concerns from vegetarians as well as persons with absorptive problems.

Hidden Dangers of Vitamin B12 Deficiency

Deceptive as it takes, Vitamin B12 deficiency will gradually make one manifest its full blown effects when most often taken for granted with nonspecific unhelpful clinical findings or at worse, overlooked with wrong diagnosing. This impressive Massachusetts General Hospital case featured a 62-year-old male patient who developed two months before presentation with alarming neurological and bodily manifestations of paresthesias, walking impairment, jaundice, and dyspnea. What did they discover?

A severe deficit in vitamin B12. If not treated, advanced B12 deficiency can cause permanent neurological damage, depression, paranoia, and even dementia.

Who Is at Risk?

B12 deficiency is most prevalent among older adults, but other populations are also at risk. Some of the most important risk factors are:

Strict Vegetarian or Vegan Diets – Because B12 occurs naturally only in animal foods, vegetarians who do not eat meat, eggs, and dairy might have difficulty obtaining sufficient B12 from diet.

Weight-Loss Surgery – Certain operations, like gastric bypass, can inhibit the body's uptake of vitamin B12 from food.

Digestive Disorders – Certain disorders, including celiac disease, Crohn's disease, and atrophic gastritis, can impede B12 absorption.

Long-Term Use of Acid-Reducing Medications – Commonly prescribed for heartburn, these drugs reduce stomach acid, which is needed to absorb vitamin B12 efficiently.

Aging – As people grow older, their stomach acid production decreases, making it harder for the body to extract B12 from food.

Symptoms of Vitamin B12 Deficiency

Vitamin B12 deficiency can take on a wide variety of symptoms, which can appear gradually or abruptly. Among the most typical symptoms are:

• Numbness or tingling in hands, legs, or feet
• Problems with walking and balance
• Weakness and fatigue
• Anemia
• Tongue inflammation or swelling
• Decline in cognitive function, memory loss, and confusion

Since these signs can be suggestive of other ailments, vitamin B12 deficiency frequently goes undetected or misdiagnosed.

'Normal' B12 Levels May Not Be Enough

One of the widespread myths is that if B12 levels are within the normal range, then nothing is wrong. But research indicates that even people with "normal" B12 levels may develop cognitive impairment and neurological dysfunction. A recent study revealed that even at the lower end of normal, individuals had evidence of slowed nerve impulse conduction and impaired spatial processing speed.

In the USA, deficiency is characterized as blood levels below 148 pmol/L. Nonetheless, research indicates that neurological manifestations can be present at higher levels, particularly if bioavailable B12 (Holo-TC) is diminished. This serves to reinforce the value of measuring functional B12 levels in preference to total B12 levels in the diagnosis of deficiency.

Link Between B12 Deficiency and Brain Health

Low B12 status is increasingly linked with cognitive impairment, memory loss, and dementia. Research has shown that deficiency in B12 is a causative factor for white matter injury in the brain and spinal cord, resulting in delayed nerve conduction. Elevated homocysteine due to low levels of B12 may also promote further brain shrinkage and neurodegenerative disorders.

Surprisingly, although B12 supplementation has the ability to correct such blood abnormalities as anemia, its effect on neurological symptoms is not as predictable. In a few instances, even with supplementation, slight neurological dysfunctions remain, emphasizing prevention and early detection.

Diagnosing and Treating B12 Deficiency

Because the symptoms of B12 deficiency are often subtle and nonspecific, diagnosis usually depends on a blood test for total B12, methylmalonic acid (MMA), and homocysteine. Individuals at risk—vegetarians, people with gastrointestinal disorders, and older individuals—should seek out B12 testing from their healthcare providers actively.

Treatment usually consists of dietary changes and supplementation:

Dietary Sources: Beef liver, clams, oysters, dairy foods, eggs, and fortified cereals are good sources of B12.

Oral Supplements: Use Standard B12 tablets or sublingual (under-the-tongue) tablets to ensure adequate levels.

B12 Injections: For serious situations or if there are absorption problems, intramuscular B12 injections are the answer.

Early detection of a vitamin B12 deficiency is important in order to avoid irreversible neurological harm. If you feel unusually tired, numbness, memory problems, or balance difficulties, ask your physician to check your B12 levels—despite the fact that they might be "normal." With ongoing research further emphasizing the intricacies of vitamin B12 metabolism, it is evident that trusting only on past definitions of deficiency can place many at risk.

B12 deficiency is far more prevalent than most people think and can be associated with profound health effects even when blood tests remain within so-called "normal" limits.

Your emotions play a bigger part in your health than you may realize. We have heard of the gut-brain relation and how your emotions influence your gut health. However, could your emotions also be responsible for bodily reactions like inflammation?

While there are many tips and tricks to reduce inflammation in your body, like eating well, exercising and other healthy activities, it still may not be enough. This could be because your feelings are affecting your body. Things like stress, worry, and bad memories can cause inflammation, just like eating junk food, as several studies explain (as explained later). This inflammation can make you feel bloated, tired, or keep you from reaching your fitness goals. It's important to remember that our emotions play a big role in our overall health, and sometimes, they need just as much attention as our physical health.

Things That Affect Inflammation

Unresolved Trauma

According to Nature Portfolio 2015 study, if you've had bad experiences in the past, and you haven't dealt with them, they can stay stuck in your body. To find this, they analyzed 25 studies involving thousands of people, focusing on three inflammatory markers, CRP, IL-6, and TNF-α. The results showed that adults who experienced childhood trauma had significantly higher levels of all three markers. Lots of people have experienced some kind of trauma, but they try to ignore it. It's like sweeping dirt under the rug; it's still there. To feel better, you need to face these old feelings and work through them. This can take time, but it's important for your health.

Chronic Stress

When you're always stressed, your body is always ready to fight or run away. A 2019 review in Psychoneuroendocrinology explains that this constant stress can hurt your health. If you're always stressed, your body feels it. You might feel ashamed of being stressed, but it's important to deal with it. Try to find ways to relax, like deep breathing or going for walks. Even little things can help. It's not easy to stop being stressed, but it's important to try.

Anxiety

According to a 2016 study published in the International Journal of Molecular Science, explains that inflammation is likely linked to anxiety and fear disorders. It's common for people with anxiety to have gone through a lot of stress. Stress can throw off your body's stress response system, which can then cause your body to become inflamed. This inflammation can reach your brain and increase things that cause damage.

Social Networks

Even though lots of people use social media, we don't know much about how it affects their bodies. According to a 2021 study published in Brain, Behavior & Immunity – Health, self-esteem does change the link between social media and inflammation. If people had low self-esteem, using social media was more strongly linked to higher inflammation. This was true even after considering other things like age, health problems, depression, and medicine.

By itself, social media use didn't directly cause higher inflammation. However, how you feel about yourself changes how social media affects your body. This shows that self-esteem is important for understanding how social media might affect your health.

Sleep is a cornerstone of health. When we sleep good, we feel good. However, people often view sleep as expendable, they trade it to work more hours, or spend time with loved ones, or any other recreational activity. While these things are important too, they should not come at the expense of your health as it can lead to other issues you may not be prepared for.

When we go to sleep, we hope to wake up and feel refreshed, as sleep is like a reset button for your body. Media has given us a view of waking up, where the person is happy and energetic as soon as they get out of bed, however that is not entirely right. Everyone feels a little sleepy when they first wake up. It's called sleep inertia, and it's normal. Think of it like your brain needing a few minutes to boot up.

The sleep foundation suggests that you may feel better after 15 to 90 minutes, which is due to sleep inertia. Sleep inertia is the grogginess and disorientation you may feel right after waking up. You may also have had a bad night's sleep, which may cause you to be tired in the morning. However, if you're getting plenty of sleep and still wake up tired every single day, that's different. This kind of tiredness, where you're always dragging, is a sign that something might be wrong. Don't just ignore it. Talk to your doctor to figure out why you're so tired all the time.

Could The Food You Eat Cause You To Wake Up Tired?

Eating spicy food right before bed can cause heartburn. The Cleveland Clinic explains heartburn is like a burning feeling in your chest, and it happens when stomach acid goes back up into your throat. This can make it hard to fall asleep, and if you do fall asleep, it can wake you up. So, if you eat spicy food late at night, you might wake up feeling tired and groggy. Try to avoid eating spicy meals close to bedtime. It's better to eat them earlier in the day so your stomach has time to digest them before you try to sleep.

Eating Sugary Foods

According to 2019 study published in American Journal of Lifestyle Medicine, eating sugary foods or drinks before bed can really mess with your sleep. When you eat sugar, your body gets a quick burst of energy. This burst of energy can make it harder to fall asleep because your body is wide awake. Also, if you do fall asleep, the sugar can cause you to wake up during the night. Try to avoid sugary snacks or drinks before bed. Instead, try a light, healthy snack if you're hungry. This will help you sleep better and wake up feeling more rested.

Other Lifestyle Habits That Cause Restless Sleep

Looking at your phone or tablet right before bed can keep you awake. The Cleveland Clinic explains that the bright light from these screens, called blue light, tells your brain it's daytime. This makes it hard to fall asleep. Also, looking at social media can make you feel worried or stressed. If your mind is racing with thoughts, you won't sleep well. Try to turn off your screens at least an hour before bed. Instead, try reading a book or listening to calming music. This will help you relax and fall asleep faster.

Your Mental Health Can Also Be A Reason For Poor Sleep

If you're worrying about things when you're trying to sleep, you won't sleep well. When you're stressed or anxious, your mind keeps going over and over the same thoughts. This makes it hard to relax and fall asleep. If you're having trouble sleeping because of stress, try doing relaxing things before bed. Things like taking a warm bath, meditating, or doing deep breathing exercises can help. If you're still having trouble sleeping, talk to your doctor. They can help you find ways to manage your stress and sleep better.