rewrite this title A New Diabetes Category Has Emerged

• Type 5 diabetes affects a very specific group of people — This condition appears almost exclusively in young men living in low- and middle-income countries who have been chronically undernourished since early childhood. These individuals often have a body mass index (BMI) below 19, yet present with dangerously high blood sugar levels.

What sets them apart is that despite these extreme glucose elevations, they don’t develop ketosis or ketonuria — conditions usually present in Type 1 diabetes. This unusual presentation often results in misdiagnosis and inappropriate treatment.

• Findings show this disease isn’t caused by insulin resistance — Through metabolic testing in 73 Asian Indian men, researchers showed that Type 5 diabetes results from a severe deficiency in insulin production, not resistance to insulin.2 These patients produced far less insulin than healthy individuals or even those with Type 2 diabetes.

• This form of diabetes has gone largely unrecognized in Western medicine — Despite being first documented in Jamaica in 1955, malnutrition-related diabetes was dropped from the World Health Organization’s official classification system in 1999.

As Dr. Meredith Hawkins, professor of medicine at Albert Einstein College of Medicine, Bronx, New York, told Medscape Medical News, this was a key oversight. “They frequently ask, ‘Why is it we see so much of it and yet never read about it in textbooks?’ Turns out those textbooks are written in the West, where it is not encountered.”3

• This change means doctors need to rethink diabetes entirely — If you’re a lean person with diabetes — or you work with underserved communities — this discovery matters. Misdiagnosis could mean the difference between stabilizing blood sugar safely or triggering dangerous episodes of hypoglycemia. With this new recognition, more health care providers will be trained to spot Type 5 early, preventing years of mismanagement and health decline.

• Early malnutrition likely causes lasting damage to insulin-producing cells — Although formal treatment guidelines have not yet been developed, Hawkins hypothesized that protein deficiency in childhood damages the pancreas, limiting its ability to secrete insulin even decades later.

She suggested that nutritional therapy, including higher protein intake and correction of micronutrient deficiencies, could improve insulin function, but emphasized that more research is needed to confirm this.

• A working group is now developing diagnostic and treatment protocols — With the IDF’s recognition, a new global mandate has been issued to develop formal diagnostic criteria and therapeutic guidelines for Type 5 diabetes.4 Hawkins stated that the aim is to complete these guidelines within two years, and they will be based on the unique features of this population.

• The participants with Type 5 diabetes had extreme metabolic differences compared to Type 2 patients — What made the lean diabetes group stand out was their unique combination: very low insulin production but unusually high sensitivity to insulin in the liver and muscles.

This flips the Type 2 diabetes model upside down, where the body produces insulin but stops responding to it. In these lean patients, the issue isn’t resistance — it’s that their pancreas simply can’t make enough insulin to begin with. Despite this, their bodies absorb sugar from the bloodstream efficiently, just not quickly enough to keep blood sugar under control.

• Glucose absorption rates were more than twice as high in Type 5 than in Type 2 — Researchers found that lean diabetics with Type 5 had a glucose uptake rate of 10.1 mg/kg per minute. By contrast, those with Type 2 had a rate of only 4.2 mg/kg per minute. That’s more than double the speed at which their cells were pulling glucose out of the bloodstream.

This explains why these patients don’t need high insulin doses for glucose transport — it’s their limited insulin output that’s the problem, not cellular resistance.

• They also had far less liver and belly fat compared to Type 2 diabetics — Excess liver fat is a hallmark of Type 2 diabetes and a major contributor to insulin resistance. But in this study, the Type 5 group had significantly lower levels of liver fat and visceral fat — the fat packed around organs — than the Type 2 group.

This means their fat tissue isn’t inflamed or blocking insulin from doing its job. Instead, the underlying issue points back to the pancreas’ diminished capacity to release insulin in the first place.

• The research confirms that Type 5 diabetes has its own metabolic fingerprint — This study eliminated other explanations, including Type 1 autoimmunity, rare genetic forms of diabetes and pancreatic damage, and showed that these men represent an entirely distinct clinical population.

Their blood sugar problems aren’t caused by fat buildup or inflammation. They’re the result of lifelong malnutrition impairing pancreatic development, leading to poor insulin secretion despite otherwise healthy metabolic systems.

1. Eliminate vegetable oils and processed foods to reduce mitochondrial stress — Start by removing vegetable oils and the foods that contain them from your diet. These include canola, soy, corn, sunflower, safflower and even many “natural” salad dressings, sauces and snacks. These oils contain linoleic acid (LA), which damages your mitochondria — the parts of your cells that generate energy.

If your cells can’t make energy, they can’t support insulin production or blood sugar balance. Stick with traditional fats like grass fed butter, tallow, and ghee. Avoid chicken and pork as well, as they tend to be high in LA.

2. Rebuild your carb tolerance using a structured reintroduction approach — Carbohydrates play a key role in supporting your mitochondrial function. Glucose, derived from carbohydrates, serves as your cells’ preferred fuel source for energy production. The key is to choose the right types and amounts of carbohydrates.

If you’ve been avoiding carbs or have gut issues, don’t just start eating whole grains and fiber-rich vegetables. That will backfire and feed harmful bacteria. Instead, begin with easy-to-digest carbs like whole fruit and white rice. Over time as your gut heals, add root vegetables and starchy carbs, then finally introduce fiber. Most adults need 250 grams of carbs daily for proper energy production.

3. Repair your gut before increasing fiber — When your gut barrier is damaged, what’s commonly called “leaky gut,” fiber becomes dangerous. It feeds bacteria that release endotoxins, which worsen inflammation and insulin dysfunction. If you’ve had irritable bowel syndrome, bloating, or a long history of antibiotic use, focus on carbs from whole fruits and white rice, and, when your gut is ready, gradually add in root vegetables, then legumes, additional vegetables and well-tolerated whole grains.

4. Lower your toxin load from plastics and EMFs — Xenoestrogens from plastics and pervasive EMFs sabotage your cellular energy. That includes your pancreas and your gut. Store food in glass or stainless steel, avoid cling wrap and plastic bottles and minimize your use of wireless devices, especially in your bedroom. Reducing your daily exposure to these environmental toxins improves your mitochondrial output, which directly supports insulin production.

5. Use sunlight and niacinamide to restore cellular energy — Daily sun exposure helps your mitochondria generate melatonin, which protects them from oxidative damage. Aim for morning or late afternoon sunlight, and avoid harsh midday sun until you’ve been off vegetable oils for at least six months.

I also recommend niacinamide — 50 milligrams three times a day — which boosts NAD+, a coenzyme essential for cellular energy. Together, these two steps help restore healthy insulin function and overall metabolic resilience.