Type 1 Diabetes Mellitus Flashcards
What is type 1 diabetes?
- no or low levels of insulin being secreted by beta cells in the pancreas
- normally secondary due to chronic inflammation
How many people in the UK have T1DM, of which how many are children?
1 - 400
2 - 4000
3 - 400,000
4 - 4 million
3 - 400,000
- 29,000 are children
What is the annual incidence (new cases every year) of T1DM in the UK?
1 - 4%
2 - 14%
3 - 44%
4 - 64%
1 - 4%
Do all patients with T1DM have a family history of T1DM?
- no
- majority (85%) have no family history
What age does the peak incidence of T1DM occur?
1 - from birth
2 - 6 months to 5 y/o
3 - 16 y/o
4 - ?35 y/o
6 - in childhood
- 6 months to age 5
The peak incidence of T1DM occurs in childhood, between 6 months and 5 years of age. Are all patients diagnosed at this age?
- no
- 50% are diagnosed >18 years of age
In younger and older ages, are men or women more likely to be diagnosed with T1DM?
- men in younger ages
- women in older ages
Although most patients with T1DM (85%) do not have a family history of T1DM, there is a small genetic predisposition. What is the genetic predisposition in monozygotic twins?
1 - 3.6%
2 - 18%
3 - 36%
4 - >65%
3 - 36%
T1DM is a polygenic disorder. What does polygenic mean?
- poly = many
- genic = genetics/genes
- so lots of genes cause the phenotype
T1DM is a polygenic disorder, meaning there are a lot of genes that can cause the clinical phenotype. There are >40 loci (specific locations on chromosomes) linked with T1DM. Which 2 of the following are where the majority occur?
1 - HLA-DMA
2 - HLA-DR3-DQ2
3 - HLA-DR4-DQ8
4 - HLA-DMA-DQB1
- human leukocyte antigen = HLA
2 - HLA-DR3-DQ2
3 - HLA-DR4-DQ8
- HLA is the major histocompatibility complex (MHC) present on immune cells
- MHC-1 = CD8 and MHC-II - CD4 cells
- decreased risk linked with HLA-DMA and DQB1
What is the term given to the group of cells in the pancreas that secrete glucagon and insulin?
1 - islets of langerhans
2 - canniculi
3 - folliculi
4 - pancreatic islets
1 - islets of langerhans
The islets of langerhans is the term given to the group of cells in the pancreas that secrete glucagon and insulin. Which cells specifically secrete glucagon?
1 - alpha
2 - beta
3 - delta
4 - C cells
1 - alpha cells
- insulin = beta cells
The islets of langerhans is the term given to the group of cells in the pancreas that secrete glucagon and insulin. Which cells specifically secrete insulin?
1 - alpha
2 - beta
3 - delta
4 - C cells
2 - beta
In addition to secreting glucagon and insulin, the pancreas also posses Delta cells. What 2 molecules do these delta cells secrete?
1 - insulin
2 - glucagon
3 - somatostatin
4 - collagen
3 - somatostatin
4 - collagen
In the pancreas which cells are responsible for secreting GIT juices?
1 - alpha
2 - beta
3 - delta
4 - acinar cells through ducts
4 - acinar cells through ducts
Once beta cells have atrophied, is there any potential for regeneration of these beta cells?
- no
T1DM is an auto immune disease. What type of hypersensitivity is T1DM?
1 - type I hypersensitivity
2 - type II hypersensitivity
3 - type III hypersensitivity
4 - type IV hypersensitivity
4 - type IV hypersensitivity
- T cell mediated (CD4 and CD8)
- also called delayed type hypersensitivity
T1DM is an auto immune disease, caused by a type IV hypersensitivity. Which of the following are common antibodies that patients have?
1 - glutamic acid decarboxylase (GAD)
2 - zinc Transporter 8 (ZnT8)
3 - islet antigen 2 (IA2)
4 - all of the above
4 - all of the above
Organise the following in the correct order that make up the natural history of T1DM?
1 - pre-diabetes
2 - genetic preposition for developing T1DM
3 - diabetes
4 - insulitis (inflammation of islets of langerhans) triggered by environmental trigger
2 - genetic preposition for developing T1DM
4 - insulitis (inflammation of islets of langerhans) triggered by environmental trigger
1 - pre-diabetes
3 - diabetes
- during the process beta cell mass declines
Which of the following autoimmune diseases are associated with T1DM?
1 - hashimoto’s thyroiditis (hypothyroidism)
2 - coeliac disease (triggered by gluten)
3 - graves disease (hyperthyroidism)
4 - addison’s disease (adrenal insufficiency, lack of cortisol secretion)
5 - all of the above
5 - all of the above
What are the main symptoms of T1DM?
- thirst
- polyuria
- lethargy
- unintentional weight loss
- recurrent candidiasis (yeast infection)
- visual changes
- ketone breath (smells sweet like pear drops due to acetone)
- diabetic ketoacidosis (build up of ketones in the body that can be dangerous)
- coma and death
Does T1DM have a slow or rapid onset?
- rapid onset
- weight loss common
- T2DM will develop gradually over time