*1.3.7 Non-Type 1 diabetes mellitus*

Because of lack of fancy laboratory support in sub-Saharan Africa like islet cell autoantibodies and molecular testing, it is sensible to know when to suspect a monogenic form of diabetes or non-type 1 diabetes. Symptoms of diabetes in the first six months of life are defined as neonatal diabetes, which is a rare type of monogenic diabetes due to single gene mutation. Symptoms are usually vague but physicians should be aware of the problem with high suspicion rate. A neonate with unexplained growth failure, dehydration, and irritability with frequent nappy changes (polyuria) although good appetite and frequent breast feeding should be subjected to a simple blood sugar measurement and urine ketones. Blood sugars levels more than 35 mmol/L are not usually a presentation of stress hyperglycemia. Communities with high consanguinity rate are prone to have this kind of gene mutations since most of

**Figure 1.** *Neonatal diabetes in sub-Saharan Africa.*

the cases are recessive. For example, in Sudan, a country with 45% consanguinity rate, 56% of neonatal diabetes were found to be caused by EIF2AK3 recessive variants causing the Wolcott–Rallison syndrome, which usually presents with skeletal abnormalities and liver dysfunction, while only 8.1% and 5.4% were caused by mutations in KCNJ11 and ABCC8 genes, respectively (*local unpublished data*). This is completely different from what has been reported from Western and Asian populations, where ABCC8 was the commonest cause of neonatal diabetes (**Figure 1**).

**Figure 2.** *Fibrocalcular pancreatitis causing diabetes and malnutrition.*

**Figure 3.** *Diabetes and malnutrition.*
