Diabetes mellitus, type 1
Diabetes mellitus, type 1
Updated: 01/21/2021
© Jun Wang, MD, PhD
General features
- Autoimmune islets β-cell destruction
- Usually insulin dependent
- Onset most often in childhood, may be sudden
- Ketoacidosis common if not treated with insulin
Key risk factors
- Genetics
HLA-DR3 or HLA-DR4 haplotype
Alteration of variable number of tandem
repeats (VNTRs) in the promoter region of insulin
- Possible risk factors
Viral infections
High socioeconomic status
Obesity
Vitamin D deficiency
Others: immunization, diet, etc
Key pathogenesis
- Autoimmune destruction of islet (insulitis)
- Progressive loss of functional islet cells
- Impaired metabolism in carbohydrate
- Subsequent multi-organ dysfunction due to hyperglycemia
Clinical presentations
- Classic presentations: polyuria, polydipsia, polyphagia, weight loss
- Presentations of complications: ketoacidosis, etc
- Non specific presentations: fatigue, nausea, blurred vision
Key Laboratory findings
- Elevated fasting glucose
- Impaired glucose tolerance
- Glycated hemoglobin (HbA1c): Long term monitoring
- Urinary albumin: in patient with diabetic nephropathy
- Reduced Insulin levels
- Low level of C-peptide
- Autoantibodies
- Tests for complications: ketone, etc
Pathological changes
- Reduced number of islet
- Insulitis (T-cell infiltrate)
Type 1 versus type 2
Managements
- Glycemic control and monitoring
- Insulin
- Balanced nutrition, exercise
- Immunizations
- Psychosocial support
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of endocrine pancreas
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