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In this lecture we're going to discuss,
Insulin Dependent Diabetes Mellitus Type 1 or Type 1 Diabetes.
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So type 1 diabetes is a metabolic disorder
of hyperglycemia and ketosis.
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It results from a deficiency of insulin
production in the pancreas.
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It's the most common age of presentation for patients
with type 1 diabetes is around 5 to 7 years of age.
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And then also, patients can present in adolescence.
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And the rate of type 1 diabetes in the developing world
is much less than it is in a developed world.
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And in the United States,
the risk is on the rise.
00:47
This is much like other autoimmune disease.
So let's go through the pathophysiology of type 1 diabetes.
00:55
It's both a environmental
and a hereditary condition.
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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.
01:32
So this figure here on the slide encapsulates
in a sense what's going on.
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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.
01:55
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.
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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.
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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.
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Once 80% of the pancreatic islet cells are gone,
that patient is going to start developing the symptoms of diabetes.
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The lower squiggly line
is this patient's glucose over time.
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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.
02:57
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.