Diabetes Mellitus Type 1
People with diabetes have difficulty processing glucose, a sugar the body uses for energy. This results in rising blood levels of glucose, and eventual spilling into the urine. At the same time, however, the cells of the body are starved for glucose. In type I diabetes (childhood-onset, or insulin-dependant diabetes mellitus - IDDM) the pancreas is unable to make insulin, which moves glucose into cells.
Autoimmunity is a primary cause of Type I diabetes. Antibodies to pancreatic islet cells are present in 75% of diabetics, which results in the destruction of insulin-secreting beta cells. Viral infections (mumps, Coxsackie, CMV, and hepatitis viruses) appear to incite the development of autoimmune beta-cell destruction. Patients with certain autoimmune endocrine diseases (GravesÕ disease, HashimotoÕs thyroiditis, and idiopathic AddisonÕs disease) have an increased prevalence of IDDM.
Genetics plays an important role in Type I diabetes, although the mode of genetic expression is not clear. Associated genes are located on major histocompatibility complex on chromosome 6. HLA DR3 and DR4 are individually associated with increased risk factor of 4. If both susceptibility genes are present, the relative risk factor increases to 12. HLA B8 and B15 also associated with increased risk. The inherited defect causes an alteration in immunologic integrity, placing the beta cell at special risk for inflammatory damage. The mechanism of damage is autoimmune. The presence of a specific 64K protein which may be responsible for antibody formation.
Diet may play a role in Type I diabetes. Dietary nitrites cause beta cell damage, resulting in Type I diabetes. Breast feeding may provide a degree of protection against the disease while diets high in dairy products are associated with increased risk. Type I diabetes is also associated with childhood exposure to cowÕs milk.
Specific labs for diabetes include fasting blood glucose (for short-term status), Hemoglobin A1c level (long-term status), and urinalysis for glucose and ketones, C-peptide insulin levels may be ordered.
Additional tests include an oral glucose tolerance test (possibly with insulin levels, if diagnosis is questionable), and intravenous glucose test (for possible early detection of subclinical diabetes).
Autoimmune tests include: Islet-cell antibodies, T4 and thyroid antibodies. HLA-typing may also be considered.
Standard labs include electrolytes, venous pH, and CBC (WBC may be elevated),
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