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some of the diagnostic tests you may
encounter when diagnosing diabetes the
first time the first diagnostic test
that we've noted in this case was a
c-peptide Pro insulin which is produced
by the pancreas is cleaved into insulin
and c-peptide both are then secreted
from the pancreas into the bloodstream
when you see a high level of C peptide
in the in the blood usually this implies
that the body is producing insulin so in
response to high blood glucose the
pancreas will produce insulin and in
conjunction with it it will produce the
peptide a low level of C peptide implies
that there is a low or even absent level
of insulin produced by the body and this
is the type of manifestation that you're
likely to encounter in type 1 diabetes
ketone bodies acetoacetate and
beta-hydroxybutyrate as well as acetone
are the hallmarks of the metabolic
acidosis that is encountered in usually
type 1 but also potentially in type 2
diabetes when you see these ketone
bodies in the urine and more alarmingly
in the blood stream this usually implies
that the patient has a metabolic
acidosis due to the production of excess
ketone bodies it also implies a
decreased insulin State and is actually
one of the Emergencies associated with
diabetes mellitus that we will discuss a
little bit later in the lecture finally
some of the auto antibodies we mentioned
in the immune forms of type 1 diabetes a
gad65 and an ia 2 antibody can sometimes
also be used for confirmation of the
diagnosis of type 1 diabetes
interestingly enough antibodies to gad65
persists longer than those of two islet
cells in the case of ia 2 after the
development of diabetes and may be a
better test to diagnose immune related
type 1 diabetes in type 1 diabetes you
usually see this in the setting of
insulin deficiency
about 5% of the diagnosis of diabetes
are associated with type 1
diabetes underlying mechanisms are
destruction of insulin producing
pancreatic beta-cells and clinical
manifestations we can usually at around
80 to 90 percent destruction these as
mentioned can be autoimmune or immune
mediated they can be idiopathic or they
can be acquired from infiltrative
conditions such as hemochromatosis
typically it affects children and
adolescents in the age range of five to
fifteen there is an image that
accompanies the slide that shows a young
girl with the manifestations of
dehydration you can see her eyes sunken
inner orbits
she has pallor she's wasted and thin
which is a feature of her type 1
diabetes and if you look closely at her
rib cage you can see that the clinical
sign of intercostal recession this is
usually manifested by children who have
respiratory distress so in the setting
of this constellation of clinical
findings one would want to work up this
patient for the presence of diabetic
ketoacidosis autoimmune mediated type 1
diabetes is usually a disease of
children and young than adults but it
can occur at any age or body mass index
range the initial presentation ranges
from minor elevations in glucose levels
to diabetic ketoacidosis beta cell
destruction varies it is frequently more
rapid in children compared to adults
some patients with absolute incident
insulin deficiency have no evidence of
autoimmunity and have no other known
cause for beta cell destruction this is
quite rare and when this occurs these
patients are said to have idiopathic or
type 1 relieved diabetes mellitus
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