3.16 Type 1 Diabetes

Question 1

What is type 1 diabetes?

Answer 1

An autoimmune condition in which insulin producing beta cells in the pancreas are attacked and destroyed by the immune system.
= insulin deficiency which leads to hyperglycaemia

Question 2

How long does type 1 diabetes have to be treated for?

Answer 2

Forever

Question 3

What are the 2 causes of autoimmune destruction of islets?

Answer 3

Environmental trigger

Genetic risk

Question 4

What is LADA?

Answer 4

Latent autoimmune diabetes in adults

• T1D can present later in life

Question 5

Why is it more difficult to diagnose type 1 later in life?

Answer 5

Slower onset

Many people have type 2

Question 6

What is monogenic diabetes (MODY)

Answer 6

Diabetes caused by a mitigation of a single gene which is passed on from an affected parent

Question 7

What diabetic ketoacidosis a feature of?

Answer 7

T1D

But also!!! Can be T2D

Question 8

Why do we measure C peptide for insulin levels

Answer 8

Proinsulin = C peptide + insulin

Patients may be taking insulin so c peptide accurate measure

Question 9

What are the 4 stages of type 1 diabetes?

Answer 9

Precipitating event

1. Overt immunological abnormalities, normal insulin release
2. Progressive loss of insulin release, glucose normal
3. Overt diabetes c peptide present
4. No c peptide

Question 10

Why is the immune bases important in T1D?

Answer 10

More likely to have more than 1 autoimmune problem

Risk of autoimmunity in relatives

Question 11

What is T1D caused by

Answer 11

Defect of innate and adaptive immune system
Primary step is the presentation of auto antigen
Exacerbated by release of pro inflammatory cytokines
CD4 + and CD8+

Question 12

Do people with T1D produce 0 insulin?

Answer 12

No
Some do produce some, but often not enough and with some have high insulin resistance so even though looks normal is not enough

Question 13

What allele affects risk level of T1D?

Answer 13

HLA-DR

Question 14

How do we diagnose T1D?

Answer 14

Clinical symptoms
Pancreatic auto antibodies
Insulin antibodies (IAA)
Glutamic acid decarboxylase antibody

Question 15

What are the symptoms of type 1 diabetes?

Answer 15

Polyuria
Nocturia
Polydipsia 
Blurred vision
Recurrent infections
Weight loss
Fatigue

Question 16

What are the signs of T1D?

Answer 16

Dehydration
Cache is
Hyperventilation
Smell of ketones
Ketonuira

Question 17

what are the effects of insulin insufficiency?

Answer 17

Proteinolysis of muscle —> aa
Increased hepatic glucose output
Lipolysis into glycerol and non esterified fatty acids (NEFA)

Question 18

Why the production of NEFAs bad?

Answer 18

NEFAs go to liver where they get broken down into 3 ketone bodies, acidity blood can lead to diabetic ketoacidosis

Question 19

How do we treat T1D?

Answer 19

Insulin

- maintain glucose