Type 5 diabetes is the newest branch of a disease most of us thought we understood. In 2025, the International Diabetes Federation formally recognized it as a distinct form. Its root cause is chronic undernutrition. Where type 2 diabetes often follows years of eating too much, type 5 follows years of having too little.
It shows up in lean, young people with a long history of poor nutrition, mostly in low- and middle-income countries across Asia and Africa. An estimated 25 million people live with it. For decades, most of them were misdiagnosed, and some were treated in ways that put their lives at risk.
The recognition is recent, and doctors are still writing the rules for how to diagnose and treat it. But the underlying science is solid, and it carries a lesson about nutrition and blood sugar that reaches well beyond the places where type 5 is most common.
Dr. Nandi’s Bottom Line
Type 5 diabetes is a real, newly recognized form of the disease, driven by long-term undernutrition rather than overeating. It mostly affects thin, young people in regions with chronic food shortages, so most readers here won’t develop it. The bigger takeaway is that nutrition shapes blood sugar from early life onward, in both directions. Eat enough quality food, know your numbers, and don’t assume a thin body means a healthy metabolism.
What Type 5 Diabetes Is, and Who It Tends to Affect
For most of medical history, we taught diabetes as a short list: type 1, type 2, gestational, and a few rarer forms. Type 5 is the latest addition to that list. The International Diabetes Federation voted to recognize it at its World Diabetes Congress in April 2025, after a group of researchers met in Vellore, India, earlier that year to agree on what the condition actually is.
The name is new, but the disease is not. Doctors first described it in Jamaica back in 1955, and the World Health Organization briefly classified it as malnutrition-related diabetes in 1985 before dropping the category in 1999 for lack of hard evidence. What changed is that researchers finally pinned down what makes it different.
The clinical picture is consistent. Type 5 shows up in lean people, usually with a body mass index under 18.5, typically before age 30, with a history of undernutrition that often reaches back to the womb. The International Diabetes Federation estimates it affects around 25 million people worldwide, mostly in parts of Asia and Africa where chronic food insecurity is common. Researchers at the Albert Einstein College of Medicine, who led much of the recent work, note that it’s more common than tuberculosis and nearly as common as HIV, yet it went almost 70 years without an agreed name.
Diabetes keeps turning out to be more varied than the textbook suggests. Even type 1 is now thought to be two distinct diseases, so a fifth category fits a pattern we’ve been seeing across the board.
Why a Malnourished Pancreas Makes Less Insulin
To understand type 5, it helps to know what the pancreas is supposed to do. It makes insulin, the hormone that moves sugar out of your blood and into your cells for energy. In type 1 diabetes, the immune system attacks the cells that make insulin. In type 2, the body still makes insulin but stops responding to it well. Type 5 is a third story.
The leading theory is that chronic undernutrition, starting before birth and continuing through childhood, interferes with how the insulin-producing cells of the pancreas develop in the first place. The organ never gets the raw materials to build its full capacity, so it makes too little insulin for life. Researchers see this as a developmental problem, which places it alongside other conditions that trace back to nutrition in early life.
The clearest evidence comes from a 2022 study in the journal Diabetes Care, led by endocrinologist Meredith Hawkins and colleagues at the Christian Medical College in Vellore, India. Using detailed metabolic testing, they studied 20 young men with this form of diabetes and compared them with people who had type 1, type 2, or no diabetes. They found that these patients had a serious shortfall in insulin production, yet their bodies still responded normally to the insulin they did have. That combination sets them apart. People with type 2 are usually resistant to insulin; people with type 5 are not.
Two other clues help doctors tell type 5 apart. These patients don’t carry the immune-system antibodies that mark type 1, and they don’t typically develop the dangerous acid buildup, called ketoacidosis, that can strike in type 1. It’s a small study, and the research is still young, but it lines up with nearly 70 years of clinical observation.
How Type 5 Gets Mistaken for Type 1, and Why That’s Risky
This is where a wrong label becomes dangerous. A thin young person with high blood sugar looks, to most doctors, like a classic type 1 case. The natural response is to start insulin, often at the doses type 1 requires. For someone with type 5, that can be a serious mistake.
Because people with type 5 still respond well to insulin, a standard type 1 dose can push their blood sugar dangerously low. In places where food is scarce and home glucose monitoring is a luxury, that kind of drop can be fatal. Dr. Hawkins has said that seeing young patients die from the wrong treatment is what drove her research in the first place.
Misdiagnosis isn’t unique to type 5. It also happens with the slower-moving adult form sometimes called type 1.5, which is regularly mislabeled as type 2. The pattern repeats: when the label is wrong, the treatment usually is too.
Managing type 5 calls for a careful hand. Patients may need only small amounts of insulin, or different approaches that encourage the pancreas to release more of its own. Rebuilding good nutrition is part of the treatment, not an afterthought. Since the condition is newly recognized, the International Diabetes Federation has launched a working group, chaired by Dr. Hawkins, to develop formal diagnostic criteria, build a global research registry, and train clinicians to recognize it. There’s no single agreed treatment guideline yet, which is what the group aims to change.
What Type 5 Means for You if Malnutrition Isn’t Your Risk
If you’re reading this with steady access to food, type 5 diabetes probably isn’t a personal risk. I want to be straight about that, because health headlines have a way of turning distant findings into needless worry. This is a disease of chronic deprivation, and it’s concentrated in parts of the world where that deprivation is common.
Still, the story holds a few lessons worth taking home.
The first is that body size doesn’t tell you everything about metabolic health. We tend to link diabetes with excess weight, but type 5 is a reminder that thin people develop blood sugar problems too, sometimes for reasons that have nothing to do with lifestyle. If you’re lean and you notice symptoms like constant thirst, frequent urination, or unexplained fatigue, you still deserve a proper workup.
The second is that nutrition shapes your metabolism early and for a long time. The same developmental biology that drives type 5 in extreme cases applies, in gentler form, to all of us. What a mother eats during pregnancy and what a child eats in the early years helps set the course for how their body handles blood sugar decades later. That’s a reason to care about nutrition long before any diagnosis is on the table.
The third is that food is foundational. Whatever your diabetes risk, steady blood sugar starts with eating enough of the right things. If you want a practical look at the options people reach for when they’re trying to manage blood sugar, I’ve compared two of the most common approaches side by side in another article.
My Personal RX on Nourishing Your Metabolism and Steadying Blood Sugar
Type 5 diabetes is an extreme example of a principle I come back to constantly in clinic: your metabolism is built, in large part, from what you eat. Most of us won’t face undernutrition that severe, but nearly everyone can do more to give their body the raw materials it needs to keep blood sugar steady. The goal isn’t a crash diet or a quick fix. It’s a daily pattern of eating and living that supports how your body handles glucose.
These are the habits I recommend to patients who want to protect their metabolic health, whatever their weight or family history. None of them replace care from your own doctor, especially if you already have a diagnosis. Think of them as the foundation everything else builds on.
- Eat enough protein, and eat it first.Β Protein steadies blood sugar and protects the lean muscle that helps your body use glucose. Build each meal around a solid protein source, and when you sit down, start with the protein and vegetables before the starch.
- Choose carbs that come with fiber.Β Whole foods like beans, oats, vegetables, and intact grains raise blood sugar more slowly than refined flour and sugar. You don’t have to cut carbs, just favor the ones packaged with fiber and nutrients.
- Give your metabolism daily backup.Β Even with good habits, the modern diet leaves gaps. I often point patients towardΒ MetaBurn, a supplement formulated to support healthy blood sugar, blood pressure, and cholesterol balance, as part of a broader plan to keep their cardiometabolic numbers in a good range.
- Mind the minerals that run your metabolism.Β Nutrients like magnesium and vitamin D help your body use insulin well, and many people fall short on them. A varied diet rich in leafy greens, nuts, and whole foods covers most of the bases.
- Follow a plan instead of chasing trends.Β Lasting metabolic health comes from a consistent approach, not the latest fad. My guide,Β Dr. Partha Nandi’s Protocol for Optimizing Your Health and Wellbeing, lays out the holistic habits I rely on to help patients build steady, lifelong health.
- Walk after you eat.Β A 10 to 15 minute walk after meals helps your muscles pull glucose out of your blood, which softens the spike that follows a meal. It’s one of the simplest tools you have.
- Protect your sleep.Β Short or poor sleep nudges blood sugar in the wrong direction and stokes cravings the next day. Aim for a consistent schedule and seven to nine hours when you can.
- Take the edge off chronic stress.Β Stress hormones raise blood sugar, and when stress never lets up, neither does that effect. Build in daily ways to wind down, whether that’s breathing work, a walk, prayer, or time with people you love.
- Know your numbers.Β Ask your doctor for a fasting glucose and an A1c, even if you feel fine and even if you’re thin. Catching a shift early gives you far more room to respond.
- Feed the next generation well.Β Since early-life nutrition helps set lifelong metabolism, the food you give children and the nutrition you prioritize during pregnancy are among the most powerful long-term investments in a family’s health.
When to See a Doctor
Diabetes of any type can be quiet at first, and its early signs are easy to write off as everyday tiredness or stress. You don’t need to panic over a single symptom, but it’s worth checking in with your doctor if you notice any of the following, especially if they persist or show up together.
- Constant thirst or a dry mouth that water doesn’t fix
- Needing to urinate often, including waking up at night to go
- Unexplained weight loss even though you’re eating normally
- Fatigue that rest doesn’t resolve
- Blurred vision or other sudden changes in eyesight
- Cuts, sores, or infections that heal slowly
- Tingling, numbness, or pain in your hands or feet
A thin build doesn’t rule diabetes out. If these symptoms show up in a lean young person, that’s a reason to get checked, not a reason to assume everything’s fine. A simple blood test can tell you where you stand, and the earlier you know, the more options you have.
References:
- Wadivkar, P., Jebasingh, F., Thomas, N., et al. (2025). Classifying a distinct form of diabetes in lean individuals with a history of undernutrition: An international consensus statement.Β The Lancet Global Health, 13(10), e1771βe1776. https://doi.org/10.1016/S2214-109X(25)00263-3
- Lontchi-Yimagou, E., Dasgupta, R., Anoop, S., et al. (2022). An atypical form of diabetes among individuals with low BMI.Β Diabetes Care, 45(6), 1428β1437. https://doi.org/10.2337/dc21-1957
- International Diabetes Federation. (2025).Β Type 5 diabetes.Β https://idf.org/about-diabetes/types-of-diabetes/type-5-diabetes/
- Montefiore Einstein. (2025).Β Einstein research leads to designation of new type of diabetes.https://montefioreeinstein.org/news/2025/04/08/einstein-research-leads-designation-new-type-diabetes
- Cleveland Clinic. (2025).Β Type 5 diabetes.Β https://my.clevelandclinic.org/health/diseases/type-5-diabetes
Frequently Asked Questions
What is type 5 diabetes in simple terms?
Type 5 diabetes is a form of diabetes caused by long-term undernutrition rather than by lifestyle or an immune attack. Chronic lack of nutrition, often beginning before birth, appears to limit how well the pancreas develops, so it makes too little insulin. The International Diabetes Federation formally recognized it in 2025.
What are the symptoms of type 5 diabetes?
The symptoms overlap with other forms of diabetes: excessive thirst, frequent urination, increased hunger, unexplained weight loss, and fatigue. What sets the typical patient apart is that they’re usually lean and young, often with visible signs of long-term undernutrition. Because those signs can mask the diabetes, the condition is easy to miss.
Can you get type 5 diabetes in the United States?
It’s very rare in high-income countries like the United States, because it’s tied to chronic food insecurity that begins in early life. The large majority of cases are in low- and middle-income countries in Asia and Africa. For most people reading this, type 5 is worth understanding but not a likely personal diagnosis.
How is type 5 diabetes different from type 1 and type 2?
Type 1 is an autoimmune disease in which the body destroys its own insulin-producing cells. Type 2 involves the body becoming resistant to insulin, often alongside excess weight. Type 5 differs from both: the pancreas makes too little insulin because of early undernutrition, but unlike in type 2, the body still responds normally to the insulin it has. That difference changes how it should be treated.
Is type 5 diabetes treatable?
There’s no single agreed treatment guideline yet, which is one reason the International Diabetes Federation set up a working group to create one. Care centers on careful, often low-dose insulin or other ways to support the pancreas, along with rebuilding good nutrition. Giving a standard type 1 insulin dose can be harmful, so accurate diagnosis comes first.
