Type 1 Diabetes (Juvenile Diabetes): Basics

00:01 In this lecture we're going to discuss, Insulin Dependent Diabetes Mellitus Type 1 or Type 1 Diabetes.

00:08 So type 1 diabetes is a metabolic disorder of hyperglycemia and ketosis.

00:17 It results from a deficiency of insulin production in the pancreas.

00:21 It's the most? the most common age of presentation for patients with type 1 diabetes is around 5 to 7 years of age.

00:30 And then also, patients can present in adolescence.

00:34 And the rate of type 1 diabetes in the developing world is much less than it is in a developed world.

00:43 And in the United States, the risk is on the rise.

00:47 This is much like other autoimmune disease.

00:49 So let?s go through the pathophysiology of type 1 diabetes.

00:55 It's both a environmental and a hereditary condition.

01:01 Identical twins, for example, only have a 50% chance of developing diabetes type 1 if the sibling has it.

01:10 Likewise, if two siblings were not identical have it there's about a 10% risk for the second child to have the disease.

01:18 And if a parent has the disease, there's around to 3 to 5% chance.

01:23 So it's not really following any one easy genetic inheritance pattern and there, it does seem to be something about the environment as well.

01:31 So this figure here on the slide encapsulates in a sense what?s going on.

01:37 From the start of life, the first thing that?s really responsible is genetic configuration of the patient at the individual.

01:45 If they have those genes and there's certain HLA types for example which put people at increased risk for diabetes, they're going to be at increased risk.

01:54 Then some sort of environmental phenomenon happens which predisposes them to developing the disease.

02:03 Then they have a trigger, this could be a viral infection or something going on with them.

02:09 They could have some problem or something in their diet, for example, that predisposes them to developing an autoimmune response towards the islet cell of their pancreas.

02:21 That?s where that little green cross is.

02:23 At that time the number of pancreatic cells which is started at the hundred percent starts to decline.

02:30 Once 80% of the pancreatic islet cells are gone, that patient is going to start developing the symptoms of diabetes.

02:39 The lower squiggly line is this patient?s glucose over time.

02:43 Obviously, there?s a little bit of daily fluctuation but then as that pancreatic cells start to disappear, there?s less insulin handling this patient?s glucose and the glucose starts to rise.

02:56 Once it rises to the point where they're having symptoms, they're gonna present with diabetes.

03:03 So let?s go through this more carefully and in detail in terms of how we manage patients with diabetes.