6. Pathogenesis of Type I DM Environment ? Viral infection ? Genetic HLA-DR3/DR4 Severe Insulin deficiency ß cell Destruction Type I DM Autoimmune Insulitis
7.
8. Pathogenesis of Type II DM Environment Obesity ? ß cell defect Genetic ß cell exhaustion Type II DM Insulin resistance Relative Insulin Deficiency IDDM Abnormal Secretion
9. Comparison Type 1 Type 2 Clinical onset <20 years onset >30 years normal weight obesity decreased blood insulin normal or increased blood insulin anti-islet cell antibodies no anti-islet cell antibodies Genetics ketoacidosis common ketoacidosis rare human leukocyte antigen (HLA)-D linked No HLA association Pathogenesis autoimmunity, immunopathologic mechanisms insulin resistance severe insulin deficiency relative insulin deficiency Islet Cells insulitis early no insulitis marked atrophy and fibrosis focal atrophy and amyloid deposits severe beta-cell depletion mild beta-cell depletion