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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