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5.2: Starvation in Abundance, 23 year old female, Alcohol consumption,…

- - - - Loss of central and peripheral tolerance leads to peripheral infiltration of self-reactive T cells
        
        Activation of self-reactive T cells in peripancreatic nodes in response to Ags released from damaged islets
        
        Destruction of pancreatic beta cells by Th1 cells (release IFN-gamma and TNF) and CD8+ CTLs (direct cytotoxicity)
        
        Perpetuated islet damage
        
        Progressive beta cell destruction and loss of insulin release
        
        Absolute insulin deficiency
        
        Decreased muscle and fat uptake of glucose via GLUT4 (insulin mediated)
        
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        Increased adipocyte hormone-stimulated lipase (HSL) activation and FFA release
        
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        Increased adipocyte lipolysis, muscle proteolysis and liver glycogenolysis
        
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        Decreased liver glycogenesis
        
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        Increased liver gluconeogenesis
        
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        Insulin
        
        Further investigations: C-peptide, antibodies
    - - Unclear role in autoimmune process
      - Further investigations: IAA, IA-2A, GADA, ZnT8