In this lecture we're going to discuss,
Insulin Dependent Diabetes Mellitus Type 1 or Type 1 Diabetes.
So type 1 diabetes is a metabolic disorder of hyperglycemia and ketosis.
It results from a deficiency of insulin production in the pancreas.
It's the most? the most common age of presentation
for patients with type 1 diabetes is around 5 to 7 years of age.
And then also, patients can present in adolescence.
And the rate of type 1 diabetes in the developing world
is much less than it is in a developed world.
And in the United States, the risk is on the rise.
This is much like other autoimmune disease.
So let?s go through the pathophysiology of type 1 diabetes.
It's both a environmental and a hereditary condition.
Identical twins, for example, only have a 50% chance
of developing diabetes type 1 if the sibling has it.
Likewise, if two siblings were not identical have it
there's about a 10% risk for the second child to have the disease.
And if a parent has the disease, there's around to 3 to 5% chance.
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.
So this figure here on the slide encapsulates in a sense what?s going on.
From the start of life, the first thing that?s really responsible
is genetic configuration of the patient at the individual.
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.
Then some sort of environmental phenomenon happens
which predisposes them to developing the disease.
Then they have a trigger,
this could be a viral infection or something going on with them.
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.
That?s where that little green cross is.
At that time the number of pancreatic cells
which is started at the hundred percent starts to decline.
Once 80% of the pancreatic islet cells are gone,
that patient is going to start developing the symptoms of diabetes.
The lower squiggly line is this patient?s glucose over time.
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.
Once it rises to the point where they're having symptoms,
they're gonna present with diabetes.
So let?s go through this more carefully and in detail
in terms of how we manage patients with diabetes.