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By the time a patient presents with polyuria, polydipsia and weight loss, the disease process has been running for years. Type 1 diabetes is not diagnosed at onset. It is diagnosed at the end. The mechanism is T cell mediated autoimmune destruction of pancreatic beta cells. Islet autoantibodies to GAD65, IA-2, ZnT8 and insulin appear long before any glycemic abnormality, and once two or more are present, progression to clinical disease is close to inevitable. Beta cell mass falls quietly, and hy
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