Diabetes Mellitus Type 5

In our pursuit of knowledge, we always say: if you’re not learning, you’re not living! Today, we bring you some game-changing, history-making news in the world of diabetes — Type 5 Diabetes is now officially recognized by the World Health Organization (WHO) and the International Diabetes Federation (IDF). Yes, you read that right — Type 5. Move over Type 1 and Type 2, the family just got bigger!

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Let’s continue.

This monumental decision was sealed on April 8 at the IDF’s World Diabetes Congress in Bangkok, Thailand — and for us in the global south, especially in low- and middle-income countries (LMICs), this moment matters deeply. It speaks directly to the realities we see on the ground. It validates stories that were once ignored. It opens doors for new treatment, deeper understanding, and hope.

 At the forefront of this revolutionary work is Dr. Meredith Hawkins, a trailblazer in global medicine and the visionary founder of the Global Diabetes Institute at Albert Einstein College of Medicine. Her tireless work since 2005 has finally led the world to acknowledge something that communities across Africa, Asia, and the Caribbean have long suspected: malnutrition-related diabetes is real, it is deadly, and it is unique.

Ok! Wait, before I go on forever because I'm overly excited, let me slow down and remind everyone what we are talking about. Diabetes Mellitus neh? This is a chronic metabolic condition where the body struggles with insulin — either not making enough or not using it effectively — leading to elevated blood sugar levels. Traditionally, we’ve known of:

Type 1: An autoimmune condition where the body attacks its own insulin-producing cells. Kills them and then the body can't make insuling at all. 

Type 2: Often linked to lifestyle and genetics, where the body resists insulin or doesn’t produce enough.  In simple language, the body makes insulin but the insulin can't seem to find its way into the cells. 

Gestational Diabetes: Occurs during pregnancy. The changes that pregnancy brings make the woman’s body to mimics someone that has diabetes even though the she did not have diabetes prior to the pregnancy and it usually resolves after delivery. 

Other rare forms: Like MODY and LADA:

• MODY (Maturity-Onset Diabetes of the Young). is a rare, inherited form of diabetes that usually shows up in teens or young adults — but unlike type 1, it doesn’t need insulin right away. It’s caused by a single gene mutation that affects how the body handles sugar. It often runs in families, and can sometimes be managed with just pills and lifestyle changes.

• LADA (Latent Autoimmune Diabetes in Adults) is sometimes called “type 1.5” because it has features of both type 1 and type 2. It shows up in adults, usually after age 30, and starts off looking like type 2 (mild, slow-progressing), but it’s actually an autoimmune condition like type 1 — the body is attacking its own insulin-producing cells. Over time, most people with LADA will need insulin.

Now enter the long-silenced sibling: Type 5 Diabetes, also known as Malnutrition-Related Diabetes Mellitus (MRDM).

What Makes Type 5 Diabetes Unique?

Type 5 diabetes is not just a variation of type 1 or type 2 — it’s a distinct entity with its own set of rules. It mostly affects young men in LMICs who are underweight (BMI < 19). They present with very high blood sugar and require insulin, but they don’t develop diabetic ketoacidosis (DKA), a hallmark of type 1. They are often misdiagnosed as type 1 and given aggressive insulin — which, as we now know, can be dangerously wrong.

The original documentation of this condition dates all the way back to Jamaica in 1955. It was even officially listed by the WHO in 1985, only to be dropped in 1999 due to “lack of evidence.” But thanks to Dr. Hawkins and her team, that evidence now stands tall.

The Science Behind It: Pathophysiology

Through advanced metabolic testing in India, Dr. Hawkins’ team found profound insulin secretion defects — the pancreas just doesn’t produce enough insulin. Lower glucose production and higher glucose uptake than seen in type 2 diabetes. Minimal fat around organs (low visceral fat and liver fat), which separates it from typical type 2 diabetes patterns. No ketosis, despite high sugar levels — this makes it biologically very different from type 1.

In simpler terms — Type 5 diabetes isn’t about insulin resistance, it’s about insulin deficiency in the context of chronic undernutrition. That’s a whole different ball game!

Alright, picture this, I hope I’ll make more sense this way ;

Your body runs on sugar (glucose) for energy — kind of like how a phone needs a charger to stay powered. But your body can’t use that sugar properly without insulin, which acts like the charger cable. Without insulin, the sugar just floats around in your blood instead of going into the cells where it’s needed.

So now, Type 1 Diabetes: The charger (insulin) is completely missing. Your body doesn’t make it at all. Type 2 Diabetes: The charger is there, but your phone (the body) isn’t responding properly — so the power doesn’t go through well. Type 5 Diabetes (the new one): The charger is too weak. The body is making insulin, but not nearly enough — because the factory that produces it (the pancreas) is worn out from years of hunger and malnutrition.

This type is mostly found in young, skinny people who’ve grown up with not enough food — especially protein and other nutrients. Their pancreas never properly functioned to its full capacity, and over time it just couldn’t keep up with the body’s needs.

The interesting fact about type 5 is that even though their blood sugar is high, they don’t show the usual warning signs doctors look for — like acid buildup in the blood called Diabetic ketoacidosis or DKA for short (which happens in type 1). That’s why they’re often misdiagnosed and treated with too much insulin, which can actually be dangerous for them.

This is very important to understand because that’s where we need to tread carefully, as mismanagement can be deadly.

Since we understand what is happening internally in the patient’s body then we can consider management in a way that speaks to giving Insulin cautiously and in small doses — overdoing can cause life-threatening hypoglycemia.(low sugar). The consideration of oral agents (pills) may be beneficial in combination with low-doses of insulin. High-protein, low-carbohydrate diets might help manage the condition better — but nutrition support must be tailored in a way that is mindful of the micronutrient deficiencies of that particular patient.

Unfortunately at this point we don’t have an official standardized treatment protocol, however a group of specialized professionals is currently developing full diagnostic and treatment guidelines, expected within the next two years.

Why does this matters and why are we celebrating!

For years, healthcare workers in LMICs would scratch their heads: Why do these patients not fit the usual diabetes profiles? Textbooks gave no answers. But now? The tide is turning. This recognition is more than just a label — it’s a lifeline. It means research funding. It means better training for clinicians. It means health policies that reflect our realities.

At Ndlalane Health, this is exactly the kind of global shift we live for — shining light into forgotten corners, giving voice to the voiceless, and affirming that science must serve everyone, not just the privileged few.

In closing.. 😏 it's been a while since I said this,  but yes: let's conclude,  thank you for reading up to this far,  lets summarize.. Type 5 diabetes is not just a new name. It’s a new era for equitable healthcare. Let’s spread the word, raise awareness, and educate our communities because when you know better, you treat better.

To Dr. Meredith Hawkins and all who’ve labored in the shadows to bring this truth to light — we salute you. This is what it means to uncage knowledge and let it fly.

Stay curious. Stay informed. Stay empowered.

Your favourite host — DocSakhi 

Ndlalane Health | Be In The Know.