Difficult diabetes in teenagers

SummaryUntil recently all diabetes in young people was considered to be type 1 or autoimmune, with destruction of the pancreatic β-cells and absolute insulin dependence. Children with diabetes presented with osmotic symptoms or ketoacidosis, and treatment was essentially a practical management issue. Recently, however, obesity-related type 2 diabetes has emerged in children; genetic forms of diabetes have been identified; and with the rising prevalence of obesity, there is clinical overlap between types of diabetes. Accurate diagnosis is important because these different forms have specific treatments and have different complications. This article focuses on the presentations of type 1 diabetes in the obese teenager, type 2 diabetes mimicking type 1, and maturity onset diabetes of the young. An algorithm is suggested to help guide diagnosis and initial management. Finally there is a list of resources on where to go for further information.