🔸Pathophysiology of Type 1 Diabetes

Question 1

The pancreas is a _________-peritoneal organ.

Answer 1

retro (it’s behind the stomach)

Question 2

What fasting labs and oral glucose tolerance tests are diagnostic of diabetes?

Answer 2

Fasting:

• normal: less than 100
• pre-diabetes: 100 - 125
• diabetes: greater than 126+

Oral glucose tolerance test:

• normal: less than 140
• pre-diabetes: 140 - 199
• diabetes: greater than 199

Question 3

An HbA1c greater than or equal to _____ is diagnostic of diabetes.

Answer 3

Diabetes ≥ 6.5%

normal < 5.6%
impaired 5.7-6.4%

Question 4

The incidence of type 1 diabetes in the general population is ______, while with a first-degree relative it is _______.

Answer 4

1: 300;
1: 20

Question 5

The monozygotic twin concordance rate is _______.

Answer 5

between 1:3 and 1:1

Question 6

What three autoimmune disorders are most common in those with type 1 diabetes?

Answer 6

Thyroid disorders,
Celiac,
Addison’s

Question 7

There are two alleles that are most likely to correlate with or predict type 1 diabetes: ____________. There are many other alleles –most often immune-related –that correlate with diabetes risk.

Answer 7

HLA; insulin production and metabolism

Question 8

What are the four major islet autoantigens that predict diabetes?

Answer 8

• ZnT8
• Islet antigen 2 (IA-2)
• GAA
• Mixed insulin autoantibody (mIAA)

Note: it is a little odd that antibodies predict development of T1-DM since it is predominantly a T-cell mediated process.

Question 9

What pattern of autoimmune destruction in the pancreas is typical in those with TI-DM?

Answer 9

Patchy –like vitiligo

Question 10

What is the accelerator hypothesis?

Answer 10

Based on the observation that the rise in TI-DM parallels the rise in obesity, the accelerator hypothesis posits that obesity stresses beta cells and increases likelihood of TI-DM.

Question 11

What is LADA?

Answer 11

Latent Autoimmune Diabetes of adulthood
→ a form of autoimmune diabetes presenting between ages 30 and 70 that has autoantibodies and six months of non-insulin requiring diabetes.

Question 12

True or false: TII-DM is strongly associated with certain HLA isotypes.

Answer 12

False. There is no strong evidence of HLA involvement in TII-DM.

Question 13

Family history is much higher in type ____ diabetes.

Answer 13

2

Question 14

A current trial indicates that giving ______________ can potentially delay TI-DM by 10 years.

Answer 14

oral insulin

Question 15

Abatacept blocks ____________.

Answer 15

the CD80/86 receptor needed to activate T-cell CD28 receptor

Question 16

People typically present with signs and symptoms of diabetes when ________ percent of the beta cells have been destroyed.

Answer 16

80 to 90

Question 17

What HLA is most associated with developing T1-DM?

Answer 17

HLA-DQB1 0302

Question 18

Decreased duration of ____________ has been shown to increase risk of T1-DM.

Answer 18

breastfeeding

Question 19

The country with the highest rate of T1DM is __________.

Answer 19

Finland

Question 20

What molecule mediates beta-oxidation of free fatty acids?

Answer 20

Hormone-sensitive lipase

Question 21

Parenteral insulin has not been shown to ____________.

Answer 21

delay onset of symptoms

Question 22

The majority type of cells in the pancreas are ___ cells.

Answer 22

β-cells