T1DM

Question 1

What is the definition of T1DM ?

Answer 1

A condition characterized by
hyperglycemia due to a relative or absolute deficiency of insulin.

Question 1

What are the classical symptoms of T1DM?

Answer 1

• Osmotic symptoms
• Weight loss
• Fatigue
• Blurred vision
• Infections

Question 2

What is the acute presentation of T1DM ?

Answer 2

Diabetic Ketoacidosis is the
hallmark of insulin deficient (Type 1) diabetes.

Question 3

What is the ADA/WHO - 1996 dx criteria of diabetes mellitus?

Answer 3

• FPG greater than 7.0 mmol/l.
  *Symptoms of diabetes + random plasma glucose greater
  than or equal to 11.1 mmol/l.
• 2hPostprandial Glucose greater than or equal to 11.1 mmol/L.
• HbA1c 48 mmol/mol (6.5%) or above.

Question 4

What is the Pathogenesis of type 1 diabetes ?

Answer 4

Unifying hypothesis is that an environmental trigger – probably viral infection induces an
autoimmune response either via:
(A) Tissue damage/inflammation – release of Beta-cell antigens
(B) Molecular mimicry.
(c) Genetic susceptibility.

Question 5

What is the time course of T1DM development ?

Answer 5

• Genetic predisposition develop in the first 10 years of life.
• Overt immune reactions with normal insulin release follows from 10 to 15 years of life.
• Progressive lose of insulin release with normal glucose occurs from 15 to 20 years of life.
• Overt T1DM develops within 20-25 years.

Question 6

95% of T1DM patients have

Answer 6

Class II – HLA DR 3/4.

Question 7

What is insulinitis seen in the pathogenesis of T1DM ?

Answer 7

It is the GAD65 and IC antibodies mediated T-cell infiltration of
islets of langerhans leading to Locally produced cytokines damaging beta cells.

Question 8

What are the limbs of T1DM management ?

Answer 8

*Monitoring glycemic control
*Lifestyle modification
*Insulin replacement
*Islet replacement therapies
*Involvement of multi-disciplinary team