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Type 1 Diabetes Mellitus – Hyperglycemia

by Carlo Raj, MD
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    00:01 Let’s talk about type I, epidemiology: early age.

    00:05 Remember when I say early, we’re not talking just infants, huh? Even 20, 22, 24, young.

    00:12 With type I, insulin or non-insulin dependent? Good, insulin dependent.

    00:19 Weight usually normal, they won’t be obese; genetic predisposition, 50 percent amongst twins.

    00:28 HLA, definitely know about DQ, also know about DR3 and 4, those links you definitely want to know; pathophysiology, ah, autoimmunity.

    00:41 So, apart from genetic, which could be a component, autoimmune disease.

    00:45 What if you have autoimmune disease of the thyroid, what’s that called? I’m sorry, I can’t hear you.

    00:53 Good, Hashimoto.

    00:54 Autoimmune disease of the adrenals, what’s that called? Addison’s.

    00:59 Autoimmune disease of the pancreas, what’s this called? Type I diabetes.

    01:03 Put those together, give me diagnosis… polyglandular endocrinopathies… do not forget that.

    01:11 Polyglandular? poly - many glands, these three… thyroid, pancreas, adrenal pathology… endocrinopathy.

    01:23 Carbohydrate intolerance with hyperglycemia.

    01:26 Clinical PPP… polyphagia, polyuria, polydipsia; acute complication… DKA.

    01:35 Now, with the autoimmune disease, I told you that for the most part, your patient walking through that door with type I diabetes doesn’t have insulin.

    01:46 Hence, pump, right, the insulin pump becomes your only alternative.

    01:51 Theoretically, if there was a time in which you can actually measure your autoimmunity, you’d find the phenomenon in type I diabetes called insulitis.

    02:04 Some immunologists will call type I diabetic a type II hypersensitivity.

    02:11 Many immunologists will call type I diabetic a type IV hypersensitivity.

    02:19 Destruction of pancreatic beta cells resulting in complete lack of insulin… insulitis.

    02:22 It’s a reaction that’s occurring early on, an autoimmune destruction of your beta islet cells.

    02:29 Immune-mediated process, type II, type IV, they will not have you choose between the two, but usually, you-you’ll be referring to type IV.

    02:38 Often detectable antibodies directed against pancreatic islet cells.

    02:41 You tell me what kind of hypersensitivity that is.

    02:43 That’s a type II.

    02:46 And here, the anti-islet cell antibody here, you must know the exact detail, a glutamic acid decarboxylase 65… auto antibodies.

    02:59 Patient require insulin at all times to prevent hyperglycemia and therefore, not present with DKA.

    03:06 That’s your patient, the bottom line, coming through that door.

    03:10 Theoretically, what happened prior… an autoimmune destruction of a beta islet cell, what do we call this? Insulitis, either type IV or type II hypersensitivity.

    03:20 In pathology, I will refer to type II hypersensitivity against glutamic acid decarboxylase.

    03:31 Which one of these is diabetic, which one of these is not and what are we looking at? On your left is non-diabetic.

    03:40 You notice here in the pancreas and islet cells, it’s all filled with these little vesicles that contain insulin.

    03:47 Hmm.

    03:48 On the right, we got a diabetic.

    03:50 You don’t find the same abundance of insulin, do you? No, you do not.

    03:55 Welcome to diabetic on the right with decreased concentration of insulin; on your left, non-diabetic with normal amounts of insulin.

    04:05 Where are you in the body? In the pancreas.


    About the Lecture

    The lecture Type 1 Diabetes Mellitus – Hyperglycemia by Carlo Raj, MD is from the course Pancreatic Disease & Diabetes.


    Included Quiz Questions

    1. HLA-DQ
    2. HLA-D6
    3. HLA-B27
    4. HLA-B17
    5. HLA-Q19
    1. Destruction of β islet cells of the pancreas
    2. Hyperplasia of of β islet cells of the pancreas
    3. Ectopic production of β islet cells of the pancreas
    4. Genetic mutation of β islet cells of the pancreas
    5. Differentiation of β islet cells of the pancreas
    1. GAD65
    2. TPO
    3. dsDNA
    4. sp100
    5. Histones

    Author of lecture Type 1 Diabetes Mellitus – Hyperglycemia

     Carlo Raj, MD

    Carlo Raj, MD


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