1. Diabetes Mellitus Type I

2. Insulin-dependent / Type I DM • require insulin • autoimmune attack on β-cells • symptoms : when 80% to 90% of β-cells are destroyed

3. Glucose tolerance test • 75 g of glucose after overnight fast • blood glucose every 30 minutes • Diabetics: • 140 mg/dL (initial) • > 200 mg/dL (follow up) • Normal • 70 to 90 mg/dL (initial) • ± 140 mg/dL (follow up) • False-positives may result

4. Signs / Symptoms • 3 P’s: • polyuria • polydipsia • Polyphagia • FBS: 140 mg/dL (7.8 mmol/L) • ketoacidosis

5. Metabolic changes in Type I • Hyperglycemia • Ketoacidosis • Hypertriglyceridemia

6. Major metabolic events in DM Decrease Increase Insulin Glucagon Breakdown of tissue proteins Lipolysis Free fatty acids in plasma Gluconeogenesis Glycogenolysis Glucose uptake by tissues Hepatic output of ketone bodies Hepatic output of glucose Hyperglycemia Ketoacidosis

7. Insulin secretory capacity Acute stress “Honeymoon period” Clinical threshold Ketoacidosis 12 13 14 Years of autoimmune destruction of β-cells

11. Treatment of Type I • Insulin treatment • standard treatment • intensive treatment