Type I Diabetes Melitus/Autoimmune DM

Now termed type IA diabetes chronic autoimmune disease characterized by increased destruction of beta cells in the islets of Langerhans. may be inherited, 90% white diabetics carry HLADR3 or HLA-DR4 gene. but recent studies suggest susceptibility genes for type I DM is in the HLA-DQ region esp. in the coding of DQBeta chain. Inchain of HLA, substitution of aspartic acid(57th) increases risk for D beta M.

 Environmental influences include viral infections and early exposure to cows milk. Progressive inflammation of the islets of Langerhans leads to fibrosis and destruction of most beta cells. Hyperglycemia shows only after 80% of beta cells are destroyed. during inflammation, B cells act as APC and activates CD4+ and Th1 response. Ab like islet cell Abs(ICA), insulinoma Ag 2(anti-IA 2), anti insulin Ab, and antibodies to GAD are involved.

Lab Tests for Type IA DM

1.Glucose Tests-OGTT, FBS, Urine tests, etc. 2.Indirect Immunofluorescence(IIF)- detects antibodies to islet cells. Cumbersome to perform. 3.RIA and EIA- used to detect Abs to insulin, anti-IA2. Combined testing of RIA and EIA appears to be the most sensitive for type IA DM.

Treatment for Type IA DM

1.Injected Insulin

2.Immunosuppressive drugs(Cyclosporin A, azathioprine and prednisone)