T1D

Question 1

When is the manifestation peak for T1D and whats a special form?

Answer 1

10-15 years

special: LADA (latent autoimmune diabetes of the adult)

Question 2

How does the insulin secretion, b-cell mass, glucose range and c peptide change in the course of disease?

Answer 2

Trigger occurs–>

1: Insulinitis: normal insulin secretion but slightly decreasing b-cell mass
2) Pre-Diabetes: Decreasing secretion, serum glu is in normal range
3) Diabetes: b-cell mass <15%, cPeptide +. manifestation of disease
4) no b-cells, cPep -

Question 3

With which diseases is T2D frequently associated?

Answer 3

celiac disease, hashimoto, M. Addison

Question 4

Criteria for Diabetes diagnosis (2 approaches, ranges..)

Answer 4

Symptoms (loss of weight. polyuria, polydipsia) and/or increased risk or plasma glucose

• > Approach using HbAc1 (>= 48mmol/mol = diabetes)
• > approach using venous plasma glucose (NPG >7mmol/l or 2h-GTT-PG >= 11,1mmol/l)

Question 5

Name features of T1D

Answer 5

1) autoimmune-mediated
2) idiopathic

immune/unknown destruction of b-cells, both result in insulin deficiency

Question 6

Name features of T2D

Answer 6

Insuline resistance and relative insulin deficiency

oral hypoglycaemic agents are effective in early phase

Question 7

What kind of other diabetes types exist?

Answer 7

MODY (monogenetic secondary diabetes)
Specific genetic defects, pancreatic disease, endocronopathies, chemical-induced, infection related

Gestational diabetes (pregnancy)

Question 8

What kind of high risk and protectivehaplotypes exist for T1D?

Answer 8

Determination of up to 50% risk for T1D -> DR3, DR4 (DRB1*0301)
Protective: DR2, DR6, DR7

Question 9

What abs can be identified in T1D?

Answer 9

anti-Insulin, GAD (glutaminaciddecarboxylase), Ia-A2 (ICA512), IAB2, ZnT8

Question 10

How can the risk of T1D be assesed and to what extend it is incerasing?

Answer 10

0,4% normal society
3-8% relatives (1st grade)
10-20% relatives with HLA-DR3/4 or 4/4 
17-30% +for one ab
40-70% +for 2 ab
70-100% +for >=3 ab

Question 11

What kind of therapy is used for T1D

Answer 11

Lifelong insulin
-> individualized glucose targets depending on hypoglycaemias and cognitive deficits
<= 6,5% HbAc1 til <7,5-8% HbAc1

Question 12

What kind of different insulins exist?

Answer 12

Basal Insulin (long acting: NPH, Detemir, Glargine)
Prandial insulin (short acting: aspart, lispro, regular)

Continous insulin therapy with a pump (CSII)

Question 13

What may be a healing strategy in T1D?

Answer 13

In mice: b-cell transplantation

generating stem cell b-cells from human ES or iPS cells