Type 1 DM importance:

Dr. Tanjim Ovee

MBBS, MSc (Leeds, UK), MD (Neurology)
Bangladesh

Pathogenesis:
 Positive for Auto antibody, C peptide: very low
 T-Cell Mediated autoimmune destruction of B cells.
 HLA DR 3, 4
Commonest Presentation: natural history:
 Age group: 10- 14 (Can happen any age)
 Commonest presentation:
 Polyuria (100%)
 Fatigue (60%),
 Weight loss (50%)
Polyuria causes polydipsia (Thirst)
Importance:
 Decrease life expectancy 15 years
 Death due to Macrovascular complications (MI)
 Add Metformin if BMI > 25
 Tight Glucose control:
Fasting: 5-7
RBS: 4-7

D/D of Polyuria, Polydipsia:

1. Dx: Primary Hyperparathyroidism
 High Calcium, Low Phosphate, PTH (Normal or High)
 X ray Skull: Pepper pot sign
2. Any cause of Hypercalcemia
3. Diabetes insipidus (Urinary serum osmolality, Water Deprivation Test)
4. Alcohol, Diuretics, Anxiety, Thyrotoxicosis
Age of Presentation:
  DI: 6 yrs (Cranial DI)
 1st week to 6 years (Nephrogenic DI)
 T1 DM: 10-14
Hypercalcemia causes:
 Out patient: Primary hyperparathyroidism
 In Patient: Maligancy: Myeloma, Metastasis, Small cell lung Ca.
 Other rare: Sarcoidosis, TB, Histocytosis, Thiazide