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Autoimmune destruction of pancreatic beta cells causing absolute insulin deficiency
Autoimmune destruction of pancreatic beta cells causing absolute insulin deficiency
Risk Factors
Family history of T1DM or other autoimmune diseases
Genetic predisposition with HLA-DR3 and HLA-DR4
Viral infections such as coxsackie B or enteroviruses
Environmental triggers including early exposure to cow’s milk
Other autoimmune conditions like coeliac disease or autoimmune thyroiditis
Aetiology
Autoimmune-mediated beta cell destruction in the islets of Langerhans
T cell–mediated cytotoxicity leading to loss of insulin production
Often precipitated by environmental factors in genetically susceptible individuals
Pathophysiology
Absolute insulin deficiency leads to hyperglycaemia
Increased lipolysis and ketogenesis result in ketoacidosis if untreated
Glucose cannot enter cells leading to catabolism and osmotic diuresis
Chronic hyperglycaemia leads to microvascular and macrovascular complications
Diagnosis
Polyuria polydipsia weight loss lethargy abdominal pain or vomiting
DKA features include Kussmaul breathing dehydration fruity breath
Capillary or venous blood glucose >11.1 mmol/L with symptoms
HbA1c ≥6.5 percent supports diagnosis
Urinalysis shows glucosuria and ketonuria
Low or undetectable C-peptide with positive autoantibodies
Differential Diagnosis
Type 2 diabetes mellitus in older or overweight children
MODY (maturity onset diabetes of the young)
Stress hyperglycaemia
Pancreatitis or steroid-induced diabetes
Other causes of glycosuria
Investigations
Capillary blood glucose and venous glucose
Urinalysis for glucose and ketones
Venous blood gas for pH and bicarbonate in suspected DKA
Insulin autoantibodies GAD and IA-2 antibodies
C-peptide to assess endogenous insulin
Routine screening for coeliac disease and thyroid dysfunction
Management
Subcutaneous insulin therapy using basal–bolus or pump regimen
Education on carbohydrate counting glucose monitoring and sick day rules
Acute DKA requires fluid resuscitation insulin infusion electrolyte monitoring
Continuous glucose monitoring systems may be used
Dietary support and psychological care
Long-term follow-up in a multidisciplinary diabetes clinic
Complications & Prognosis
Diabetic ketoacidosis
Hypoglycaemia and hyperglycaemia episodes
Microvascular complications such as retinopathy nephropathy neuropathy
Macrovascular complications in adulthood
Associated autoimmune conditions
With good glycaemic control prognosis is excellent but requires lifelong management
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