Endocrine System >
Type I Diabetes
“Complex metabolic disorder characterised by persistent hyperglycaemia (insulin deficiency)”
Risk Factors
- Family history of type 1 diabetes (strong genetic component)
Aetiology
- Absolute deficiency of insulin
Pathophysiology
- Autoimmune destruction of beta cells → absolute deficiency of insulin
- Increased hepatic glucose output
- Decreased glucose uptake into adipocytes
- Decreased glucose uptake in skeletal muscle
- Decreased glycogenesis in liver and skeletal muscle
Clinical Presentation
- Onset is usually adolescent but can occur at any age
- Presentation includes:
- Polyuria
- Polydipsia
- Age of onset younger than 50 years
- Rapid weight loss
- BMI below 25 kg/m2
Investigations
- Bloods:
- Main test – HbA1c > 48 mmol/mol
- Others:
- Random plasma glucose > 11 mmol/L
- Fasting plasma glucose > 7 mmol/L
- Oral glucose tolerance test 2h > 11 mmol/L
- Only measure diabetes-specific autoantibodies if patient had atypical features that don’t fit the usual presentation (e.g. >50 years old, BMI 25 kg/m2 or above)
- Imaging: n/a
- Special: n/a
Management
- Insulin therapy
Complications
- Diabetic ketoacidosis
- Diabetic foot
- Macrovascular complications:
- Increased risk of stroke
- Myocardial Infarction
- Peripheral vascular disease
- Microvascular complications:
- Diabetic retinopathy
- Diabetic nephropathy
- Diabetic neuropathy
- Erectile dysfunction