T1 L16 Type I diabetes mellitus

Question 1

Describe the genetic predisposition of TIDM

Answer 1

0.5% background risk
1-2% if mother is affected
3-6% if father is affected
6% if sibling is affected
36% if monozygotic twin is affected

Question 2

What genetic tests can help discriminate between type I and type II diabetes?

Answer 2

GRS2

Question 3

What is the pathophysiology of type I diabetes?

Answer 3

Beta-cell events trigger an autoimmune response
Antibodies to insulin or GAD tend to appear first
Other beta antibodies then follow:
-IA2, Zn2+ transporter 8
Selective immune beta-cell destruction

Question 4

What are some autoimmune triggers?

Answer 4

Viral infection e.g. coxsackie
Endoplasmic reticulum stress
Cytokines

Question 5

Describe the progression to type I diabetes

Answer 5

Genetic predisposition –> environmental trigger –> insulitis –> pre-diabetes –> diabetes

Question 6

What other conditions are associated with type I diabetes?

Answer 6

Coeliac disease
Hypothyroidism
Grave's disease
Addison's disease
Hypogonadism
Pernicious anaemia
Vitiligo
Autoimmune polyglandular syndrome

Question 7

What are the symptoms of type I diabetes?

Answer 7

Lethargy
Polyuriea
Blurred vision
Candida infections
Weight loss ketosis / ketoacidosis
Death

Question 8

What is used to diagnose type I diabetes?

Answer 8

Age of onset
Rapidity of onset
Phenotype
Past medical history
Family history
Weight loss
Ketosis
GAD / IA2 / Zinc transporter 8 antibody positive
C-peptides

Question 9

How can peptide hormones be given?

Answer 9

Subcutaneously
Inhaled
Mucous membranes

Question 10

What are the types of insulin?

Answer 10

Primary structure
Duration of action
Strength

Question 11

What are some injection sites for insulin?

Answer 11

Lower abdomen
Upper outer thights
Upper outer arms
Buttocks

Question 12

What factors can affect blood glucose levels?

Answer 12

Diet
Injection site
Temperature
Exercise
Illness
Stress
Alcohol
Menstrual cycle