Which type diabetes is HLA associated:
Correct Answer: Type I diabetes
Description: Answer is A (Type I Diabetes): 95% qt. Type I IDD,iI patients express either HLA DR3 or HLA DR4 or the heterozygous ILLA DR3/DR-1 couriviration. Vo HI I association is seen with Type II Diabetes Mellitus or NIDDM.- Harrison Diabetes Mellitus: Review (Robbins / Harrison) Parameters Type I (1DDM) Type H (NIDDM) Patho- physiological difference * Results from complete or absolute lack of insulin caused by a reduction in 13 cell mass.Q * Autoimmunitv Q is the major culprit - Autoantibodies are present (2 in blood (against * Results from insufficient insulin secretion relative to glucose load 'or' `insulin resistance' i.e. inability of peripheral tissues to respond to insulin. * Genetic Actor are the major culprit islet cells) - No autoantibodies Q - HLA DR3/DR4 are Q expressed in 95% of pt. - No HLA association Q - (Genetic factors are of low significance) Family Not significant Significant History (present in less than 15% of patients) (present in upto 90% of patients) Age < 40 years Q > 40 years Q Habitus Non obese Q ObeseQ Presentation Patient present with sudden onset of osmotic Patient present with a more gradual/insidious onsetQ symptoms in the form of polydipsia, Polyuria or of osmotic symptoms (may not he present) symptoms of ketoacidosis Many of them may be asymptomatic Q and are recognized when they develop one of the macrovascular or microvascular symptoms of diabetes like delayed healing of wounds with atherosclerosis or gangrene or peripheral neuropathy etc. Complication * Ketoacidosis prone Q * Ketoacidosis not prone Q (Non ketotic hyperglycemic coma) Laboratory parameters * Blood insulin is decreased * Blood glucagon High/ suppressible * Ketonuria: often present * Insulin levels are normal or may be increased (explained by insulin resistance) * Blood glucagon High/ resistant * Not present Pathology * Early insulitis * Marked atrophy and fibrous * No insulitis * Focal atrophy and amyloid * Beta cell depletion * Mild p cell depletion Insulin/ * Low * High C-peptide
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