Type 1 diabetes mellitus

Type 1 diabetes results from destruction of the insulin-secreting cells of the islets of Langerhans. This destruction is auto-immune in nature - i.e. it is brought about by the body's own natural defences, but directed against one of its own tissues. The liability to develop Type 1 diabetes is to some extent inherited, but

Fig. 10.1 A sufferer from Type 1 diabetes mellitus in the early days of insulin therapy, before (left) and after (right) treatment with insulin. Reproduced from Bliss (1983).

amongst identical twins (who have the same genetic complement), if one has Type 1 diabetes, only around 40% of their twins will have the disease.1 Thus, something in the environment must set the disease process in motion. There are a number of theories about what this trigger might be, including a belief that the trigger is a viral infection. Some people also believe that a traumatic episode can trigger off diabetes. However, none of these theories is proven. What is clear is that the metabolic changes in Type 1 diabetes essentially represent a deficiency of insulin, and can largely be treated by injection of insulin. Type 1 diabetes is not a very common disease; it is present in about 0.5% of the population in the United Kingdom, and rather less in warmer parts of the world. However, the incidence of Type 1 diabetes is increasing in some parts of the world, including the United Kingdom and particularly Scandinavia.

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