*1.3.2 Type 1 diabetes mellitus*

T1DM is characterized by deficiency in insulin secretion. Its cause is unknown; however, genetic susceptibility, environmental factors, immune system, and β-cells are implicated. The interaction of these causes immune-mediated beta cell destruction and hence partial/absolute insulin deficiency. There are four stages toward the development of T1DM symptoms: 1. multiple islet antibodies and normal glucose; 2. multiple islet antibodies, raised blood glucose, but no symptoms; 3. islet autoimmunity, raised blood glucose, and symptoms (when the islet cells have diminished to about 90% lost); and 4. long-standing T1DM. However, in sub-Saharan Africa, some patients do not have auto-antibodies, and so it can be confused with other types of diabetes. Management of T1DM can be challenging in Africa because of lack of laboratory support and access to insulin.
