Type I Diabetes Mellitus Flashcards Preview

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Flashcards in Type I Diabetes Mellitus Deck (23)
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What can cause type I DM?

1. Autoimmune destruction of the pancreas gland - beta cells are attacked by the innate immune response

2. Genetic predisposition - not all cases of monozygotic twins (30% concordance) - must be environmental element

3. Virus infection - hypothesis, molecular mimicry


What are the differences between type I and II DM?

Type I = insulin deficiency

Type II = insulin resistance


What is the major treatment for type I diabetes?



How was insulin manufactured before the 60s?

Dog and other animal pancreatic ducts where ligated

This destroyed the pancreatic gland and exocrine funciton

Islets were preserved - isolated islets and insulin


What is polyuria?

Large amount of urine produced by the body


What happens if sodium concentration is not correct in the body?

Cerebral oedema in hyposmolarity


What are the complications of type I diabetes?

1. Microvascular complications - endothelial damage caused by hyperglycemia

2. Macrovascular complications


What is the major target for type I diabetes?

Tight control of serum glucose concentration

Tight glucose control = risks associated with diabetes are reduced


What are the consequences of hypoglycemia?

Coma and brain damage


What are the microvascular complications of DM type I?

Diabetic retinopathy - vascular damage leads to angiogenesis causes retinal damage

Diabetic nephropathy - increases glomerular P and basement membrane thickens leading to loss of protein in the urine

Peripheral neuropathy - accumulation of sorbitol in cells (cannot leave via GLUT) and causes glycation of structural proteins like collagen


What are the treatments for diabetic nephropathy?

Control of blood pressure

Inhibition of renin-angiotensin system


What is a presentation of diabetic neuropathy in diabetic patients?

Foot ulcers


What are macrovascular complications in type I DM patients?


Ischaemic heart disease

Peripheral vascular disease - atherosclerosis


What are preventative measures patients can undertake to prevent peripheral vascular disease?

Management of risk factors like

Blood pressure
Cigarette smoking


What effect does strict control of glucose levels have on microvascular and macrovascular complications?

Microvascular complications decreased when glucose levels were strictly controlled

Macrovascular complications were not affected significantly when glucose levels were strictly controlled

If too controlled - hypoglycemia, pathogenesis worsened


What is the future of type I DM treatment?

Iselt cell transplantation

Stem cell transplantation


How does islet cell transplantation take place?

1. Receive pancreas from non-living donor

2. Digested using collagenase

3. Extract beta cells

4. Radiological access to the portal vein of the recipient - locate via US

5. Use a catheter to inject the solution - lodge and engraft in the liver

6. B cells will start to produce insulin


What are the risks of islet cell tranplantation?

Thrombosis of the portal vein


Immunosuppressants - cancer and metabolic syndrome


Which sources can be used for stem cell transplantation?

1. Human embryonic stem cells

2. Induced pluripotent stem cells


What are induced pluripotent stem cells?

Fibroblasts that have been reprogrammed through transcription


What are the steps to producing insulin in stem cell transplantation?

Have to differentiate the stem cells under the right circumstances to produce insulin

They express the reverse diabetic phenotype


What is important to do in stem cell transplantation?

Make sure the stem cells are not susceptible to injury by the autoantibodies that caused injury in the first place


What is a transcription factor in mature beta cells?