T1DM

Question 1

What is type 1 diabetes Mellitus?

Answer 1

Autoimmune condition in which insulin-producing beta-cells in the pancreas are attacked and destroyed

Question 2

What does T1DM result in?

Answer 2

Partial or complete deficiency of insulin production

Question 3

What occurs as a result of partial or complete insulin deficiency? What intervention is required?

Answer 3

Hyperglycaemia which requires life-long insulin treatment

Question 4

Outline the stages of development of T1DM

Answer 4

Begins with genetic predisposition, a precipitating event (virus/ stressful event) triggers the autoimmune process. This results in the loss of beta islet cells.

Question 5

Detail the immunological mechanism responsible for beta-cell loss in T1DM

Answer 5

Presentation of auto-antigen to auto reactive CD4 T lymphocytes. CD4 cells activate CD8 Tcells which express auto-antigen and pro-inflammatory cytokines, resulting in pre-islet fibrosis

Question 6

What alleles and genes increase the risk of diabetes?

Answer 6

HLA-DR, insulin gene SNPn

Question 7

What are some possible environmental triggers for T1DM?

Answer 7

Enteroviral infections, cows milk protein exposure, changes in microbiota

Question 8

What are the symptoms of T1DM?

Answer 8

Polyuria, nocturia, polydipsia, blurred vision, recurrent infections e.g. thrush, fatigue

Question 9

What are the signs of T1DM?

Answer 9

Dehydration, cachexia, hyperventilation, glycosuria, ketonuria, smell of ketones

Question 10

What are the effects of insulin deficiency?

Answer 10

Muscle breakdown, free NEFA, ketone body production

Question 11

What treatment is needed for T1DM?

Answer 11

require insulin for life to maintain glucose levels without excessive hypoglycaemia/hyperglycaemia and prevent acute metabolic decompensation and prevent microvascular and macrovascular complications

Question 12

Outline the process of islet cell transplantation as a method to treat T1DM

Answer 12

isolate human islet cells from pancreas of a deceased donor, transplant into hepatic portal vein.

Question 13

What do patients require following islet cell transplants?

Answer 13

life long immunosupression

Question 14

What can be done to improve survival of a pancreas graft?

Answer 14

simultaneous pancreas and kidney transplants

Question 15

What time period of glycaemia does a HbA1c reflect?

Answer 15

the last 3 months

Question 16

What are the limitations associated with a HbA1c test?

Answer 16

can be effected by erythropoeisis, altered haemoglobin, glycation and erythrocyte destruction