Susan Fones is a 34 year old teacher who comes in every 6 mo…

Susan Fones is a 34 year old teacher who comes in every 6 months for her cleaning.  She was diagnosed with diabetes as a child and gives herself an insulin shot daily.  She is concerned about her bleeding gums and has noticed mobility of her lower anterior teeth.  She reports an extremely dry mouth and a burning tongue.  She has taken her insulin today at 6:00 AM and indicates that its peak action occurs between 2 and 3 hours after injection.   Which of the following etiologic factors is related to the development of this type of diabetes?