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IDDM – Why?

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I stumbled across a newly diagnosed type 1 diabetic patient recently and was suddenly bewildered. I understand the basics surrounding diabetes, but wondered why the destruction of insulin-producing pancreatic cells actually occurs.

Although the general cause can be down to immunology and/or genetics, I am perplexed by this sudden reduction in insulin production. How is it that the immune system suddenly decides to destroy the cells? There is also a classification of type 1 diabetes that is due to non-immunological islet destruction.

The risk of type 1 diabetes can be quantified through genetics. A study by Tillil and Köbberling (1987) did just that, by using families of 554 type 1 diabetics. However from what I have been reading the real reason is still unknown. I still do not fully understand why for some years the individual can produce insulin and then all of a sudden stop.

Environmental triggers have been reported to have increased the risk of IDDM however there appears to be limited evidence surrounding them. These triggers include viral infections, immunisations, diet, vitamin D deficiency and perinatal factors.

Immunosuppressants like azathioprine, mycophenolate mofetil and ciclosporin have been used to reduce the immunological response causing cell destruction. However this has only led to limited success with patients all requiring insulin treatment again within three years.

This classification of non-immunological type 1 diabetes (1b) is also interesting. It is known as idiopathic diabetes with a non-autoimmune cause. Despite the articles I’ve been reading, it still seems to be a mystery. Interesting.

Tillil H, Köbberling J. (1987). Age-corrected empirical genetic risk estimates for first-degree relatives of IDDM patients. Diabetes. 36 (1), p93-99.

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