Stethoscope, glucose meter and drugs

Type 4 Diabetes: Everything You Need to Know

We’ve all heard about type 1, type 2, and gestational diabetes… But have you heard of type 4 diabetes? This lesser known form of diabetes is just now beginning to be understood. In this article, you will learn all about what type 4 diabetes is if it is preventable, and how to manage it. Let’s dive in!

Stethoscope, glucose meter and drugs

What is type 4 diabetes?

Type 4 diabetes is a type of diabetes that is characterized by insulin resistance without the presence of overweight or obesity in older adults.

In the past, many healthcare professionals thought that insulin resistance and type 2 diabetes only occurred in individuals with excessive levels of body fat. However, we now know that is not true. But due to this weight stigma associated with a diabetes diagnosis, it is possible that those considered to be a ‘healthy weight’ may go undiagnosed. 

Because of this, we do not know the full statistics for type 4 diabetes. It has been estimated that about 20% of all newly diagnosed cases of diabetes in patients over the age of 65 should be classified as type 4 diabetes.

Causes

The discovery of this type of diabetes is still relatively new, so we do not yet fully understand its development or progression.

However, the generally accepted theory is that it is a result of the aging process. This age-related insulin resistance seems to be quite different physiologically than obesity-related insulin resistance.

Age-related insulin resistance, or type 4 diabetes, has been linked to excessive amounts of regulatory T cells, one type of immune cell in the body. These regulatory T cells accumulate as part of the aging process, unrelated to the amount of fat present in the body.

However, not all aging people go on to develop type 4 diabetes. More research needs to be done to determine what other underlying factors contribute to the development of this disease.

Symptoms

A woman measuring blood sugar with glucose meter

Since this type of diabetes is a result of insulin resistance, many of the common symptoms are going to be similar to those for type 2 diabetes, including:

  • Fatigue
  • Frequent urination
  • Increased thirst
  • Increased hunger
  • Unintentional weight loss
  • Poor wound healing
  • Blurry vision

Diagnosis

Many of the symptoms listed above can also be found with other conditions, making the diagnosis of age-related insulin resistance more difficult to pinpoint. On top of this, type 4 diabetes is not considered an official diagnosis yet.

If you have been experiencing any of the symptoms above, are considered to be at ‘healthy’ body weight, and are older than age 65, be sure to schedule an appointment with your doctor to run your bloodwork to assess for insulin resistance. 

You may be asked to undergo additional testing if your doctor suspects you have insulin resistance – or maybe even another condition.

Prevention

As of now, it appears that aging is the biggest risk factor associated with the development of type 4 diabetes. 

Since aging is unavoidable, more research needs to be done to determine if there are other risk factors for this disease. Once additional risk factors have been identified, strategies for prevention can be outlined.

What to do if you have type 4 diabetes

Type 4 Diabetes, glucose meter and sugar cubes against the pink background

We don’t know much about type 4 diabetes, but we do know that the symptoms are similar to other types of diabetes. However, managing type 4 diabetes can look a bit different compared to managing other forms of diabetes since the underlying physiology is different.

Many of the lifestyle changes that are typically recommended for those with type 2 diabetes are not effective for type 4 diabetes. Weight loss is not going to help someone who doesn’t need to lose weight, especially if they are in an older population. Additionally, weight loss has been shown to not lead to reductions in the regulatory T cell count that drives the disease. 

On the other hand, keeping your blood sugar balanced should be the main priority in order to alleviate your symptoms. This can be achieved through blood sugar monitoring and learning how to balance your meals or count carbs.

Since type 4 diabetes isn’t a diagnosis yet, there aren’t specific treatments. Some doctors will prescribe the medications that used to treat type 2 diabetes, which can help with blood sugar regulation but won’t address the underlying root cause.

Research is currently underway on this disease and potential treatments to reduce the regulatory T cell count and improve insulin resistance. 

Where to find more information

Endocrinologist examining a patient

If you think you may have type 4 diabetes, your first step should always be to contact your primary care provider for initial testing. You can ask for a referral to an endocrinologist who specializes in diabetes and other hormonal conditions.

You should also consider speaking with a registered dietitian (RD or RDN) who is a certified diabetes educator (CDE). Your dietitian will help you learn how to eat to regulate your blood glucose effectively and alleviate your symptoms.

For more information, you can read about insulin resistance and diabetes on the American Diabetes Association (ADA) website. Also check to see if there are diabetes education programs offered in your community

All of these tools together will help you to better manage your blood sugar so you can feel better and live a healthier and happier life.

The bottom line

Type 4 diabetes is a condition characterized by insulin resistance in people who are aging but do not have excess levels of body fat.

The current theory behind this form of diabetes connects an excess of regulatory T cells to the development of this disease. This accumulation is part of the aging process.

This form of diabetes likely goes underdiagnosed as it is poorly understood and thus, not yet an official diagnosis.

More research needs to be done in order to determine whether there are preventative measures that can be taken or special treatments that can better manage, or even cure, the disease.

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