Biology and Natural History of Type 1 Diabetes Mellitus.

Type 1 diabetes mellitus is a clinical condition characterized by insufficient insulin production due to progressive loss of pancreatic islet ß-cells mediated by an autoimmune response. This deregulation of the immune system is caused by the action of genetic, epigenetic, and environmental factors in varying combinations for each individual. Although the inflammation of the islets with immune cell infiltration, known as insulitis, is an important element in pathogenesis, other factors are necessary for disease initiation. Associations with variants of HLA and other genes related to immune system function, mainly haplotypes HLA-DR3-DQ2 and HLA-DR4-DQ8, are more evident. The influence of polymorphisms and epigenetic modifications, as well as the microbiome, is convincing proof of the existence of a complex interaction between genetic, immune, and environmental factors in the etiology and pathogenesis of this metabolic disorder. Loss of selftolerance to autoimmunity is a critical point in the development of the disease, and regulatory T cells play a key role in this process. Thus, any failure of these cells, either due to an insufficient number or altered expression of cytokines and transcription factors, may be the trigger for the onset of the disease. The protective action of regulatory T cells is controlled by gene expression that is modulated by epigenetic modifications, including the dysregulation of noncoding RNAs. This review takes an updated approach to the natural history of type 1 diabetes, focusing on the factors involved in the etiology and pathogenesis.

Diabetes melitus juvenil associado à cetoacidose em gato / Juvenile Diabetes mellitus associated with ketoacidosis in a cat

Descreve-se neste relato uma forma rara de apresentação do diabetes mellitus juvenil associado ao quadro de cetoacidose diabética em gato. O animal com seis meses de idade foi atendido com histórico de poliúria, polidipsia, polifagia e perda de peso. Ao exame clínico verificou-se apatia, êmese, anorexia, depressão e ataxia. Realizou-se exames complementares (hematológicos, bioquímicos e urinálise). Os achados sanguíneos foram policitemia e leucocitose por neutrofilia. Enquanto na bioquímica observou hiperglicemia e aumento significativo nos valores das enzimas AST e ALT. Na urinálise observou-se glicosúria, cetonúria e proteinúria. Os achados clínicos e os exames laboratoriais foram fundamentais para confirmar o diagnóstico de diabetes mellitus juvenil em gato.

The present paper aimed to report a rare presentation of juvenile diabetes mellitus associated to diabetic ketoacidosis in a cat. A six-moth old crossbred cat was attended with clinical history of polyuria, polydipsia, polyphagia and weightloss. Clinical examination revealed apathy, emesis, anorexia, depression and ataxia. Hematology revealed polycythemia and leukocytosis by neutrophilia. Biochemistry showed hyperglycemia and relevant increase in the enzyme levels of AST and ALT. In urinalysis observed glycosuria, ketonuria and proteinuria. The clinical and laboratory findings were essential to confirm the diagnosis of juvenile diabetes mellitus in a cat.

Diabetes melitus juvenil associado à cetoacidose em gato / Juvenile Diabetes mellitus associated with ketoacidosis in a cat

Descreve-se neste relato uma forma rara de apresentação do diabetes mellitus juvenil associado ao quadro de cetoacidose diabética em gato. O animal com seis meses de idade foi atendido com histórico de poliúria, polidipsia, polifagia e perda de peso. Ao exame clínico verificou-se apatia, êmese, anorexia, depressão e ataxia. Realizou-se exames complementares (hematológicos, bioquímicos e urinálise). Os achados sanguíneos foram policitemia e leucocitose por neutrofilia. Enquanto na bioquímica observou hiperglicemia e aumento significativo nos valores das enzimas AST e ALT. Na urinálise observou-se glicosúria, cetonúria e proteinúria. Os achados clínicos e os exames laboratoriais foram fundamentais para confirmar o diagnóstico de diabetes mellitus juvenil em gato.(AU)

The present paper aimed to report a rare presentation of juvenile diabetes mellitus associated to diabetic ketoacidosis in a cat. A six-moth old crossbred cat was attended with clinical history of polyuria, polydipsia, polyphagia and weightloss. Clinical examination revealed apathy, emesis, anorexia, depression and ataxia. Hematology revealed polycythemia and leukocytosis by neutrophilia. Biochemistry showed hyperglycemia and relevant increase in the enzyme levels of AST and ALT. In urinalysis observed glycosuria, ketonuria and proteinuria. The clinical and laboratory findings were essential to confirm the diagnosis of juvenile diabetes mellitus in a cat.(AU)

Diabetes mellitus juvenil: a experiência de familiares de adolescentes e pré-adolescentes / Juvenile diabetes: the family's experience with diabetic adolescents and pre-adolescents

This study aimed at investigating the experience of taking care of adolescents and pre-adolescents with type 1 diabetes from the standpoint of their family members. A phenomenological approach, i.e. a type of qualitative analysis aimed at understanding the meaning of life experiences, was used. Ten parents (9 mothers and 1 father) were interviewed at a teaching hospital in the interior of São Paulo state. The experience of taking care of a child with diabetes emerged from the converging points reported under 3 main themes: the universe of the disease; personal relationships; reflections on the experience. The participants described their difficulties and the strategies they use for keeping the family together besides providing support to the children. They believe they have to accept and face the challenges, besides motivating their children in order to ensure their safety and quality of life. The data obtained show the need for professional support as well as for a space for discussing themes of interest, both for the children with diabetes and for their families.

Transient bilateral diabetic cataracts in a Brazilian Terrier puppy

A case of a Brazilian Terrier puppy presenting diabetic lens opacity that restored transparency after insulin therapy and control of blood glucose levels is reported. This entity has been rarely reported in human beings and has not been reported in dogs before. The rapid glycemic control may have been responsible for the transparency recovery.

Relata-se o caso de um cão jovem, terrier brasileiro, apresentando opacidade lenticular diabética bilateral, a qual regrediu, sendo reassumida a transparência do cristalino após a terapia com insulina e controle dos níveis glicêmicos. Essa afecção tem sido reportada raramente em indivíduos da espécie humana, mas não há relatos de sua ocorrência em cães. O rápido controle glicêmico pode ter sido o responsável pela recuperação da transparência.

Transient bilateral diabetic cataracts in a Brazilian Terrier puppy

A case of a Brazilian Terrier puppy presenting diabetic lens opacity that restored transparency after insulin therapy and control of blood glucose levels is reported. This entity has been rarely reported in human beings and has not been reported in dogs before. The rapid glycemic control may have been responsible for the transparency recovery.

Relata-se o caso de um cão jovem, terrier brasileiro, apresentando opacidade lenticular diabética bilateral, a qual regrediu, sendo reassumida a transparência do cristalino após a terapia com insulina e controle dos níveis glicêmicos. Essa afecção tem sido reportada raramente em indivíduos da espécie humana, mas não há relatos de sua ocorrência em cães. O rápido controle glicêmico pode ter sido o responsável pela recuperação da transparência.