Question

A 12-year-old boy presents with a blood sugar of 600. He is lethargic, and parents state he has had the flu. He has been fatigued and has lost 15 pounds in the last two weeks. This boy’s history is small for age, lack of focus at times, reoccurring bladder infections for the last six months, states his mouth is dry all the time, is often irritable, and has few interests or friends. The doctors’ notes state he has a diagnosis of autoimmune type 1 diabetes. As this is a new diagnosis, the parents are obviously very upset.

Question: Diagram and explain the rationale for the clinical manifestations of type 1 diabetes. Support your answer using specific facts, data and examples

Answer 1

Type 1 Diabetes Mellitus :

It is a form of diabetes where there is very little or no insulin production in the body due to AUTO IMMUNE destruction of beta cells of pancreas .

The auto immunity may be because of :

• Genetic predisposition ( eg : HLA DR3 ,DR4 expression etc.!)
• Immunological factors like presence of GAD antibodies etc.!
• Environmental factors like previous viral infection can trigger auto immunity.

For eg, In this case boy had a history of flu ( viral infection) which may have triggered auto immunity in him.

SYMPTOMS :

In type 1 Diabetes as there is complete destruction of beta cells in the body there is no insulin production. All the symptoms seen in type 1 Diabetes are either due to "HYPERGLYCEMIA" or " LOW INSULIN LEVELS" in the body.

First we'll the symptoms with which the boy presented to the clinic,later on we'll see other symptoms.

Weight loss :

Unexpected weightloss is seen in diabetic patients because :

• Though people take sufficient amount of food there's no insulin for uptake of glucose into the cells.So, body will start using the fats and protein present in the body leading to weight loss
• There's a lot of fluid loss from the body ( osmotic diuresis due to high conc of glucose in blood)

Dry mouth :

This is because of fluid loss from the body leading to dehydration.

There's lot of fluid loss from the body because whenever there's high level of glucose in the blood , kidneys start excreting it in urine. If glucose is being excreted in urine then the concentration of urine increases. Osmosis occur leading to increased volume of urine. (OSMOTIC DIURESIS)

This causes volume depletion in the body and causes severe dehydration .

Reoccurring infections :

In Diabetic people reoccurent infections are seen due to HYPERGLYCEMIA. High levels of glucose in blood exacerbates impairment in humoral immunity, leukocyte and lymphocyte function making them more susceptible to infections.

In this case,boy has reoccurring bladder infections for the last 6 months. Not only UTIs they've others like ear,nose,throat,skin and soft tissue infections also.

SORRY FOR INCONVINIENCE, I'LL EXPLAIN REMAINING ANSWER IN COMMENTS :)