Diabates Type I Flashcards
1
Q
what is HbA1c?
A
- hemoglobin A1c (aka glycosylated hemoglobin) tells us an average BG over the life of a RBC which is 8-12 weeks
- accurate bc the amount of glucose that combines with Hb (or glycates the hemoglobin) is directly proportional to the amount of sugar in the system at that time
- GOLD STANDARD for assessing glucose control over previous 6-8 weeks
- CGM download is becoming the new gold standard –> tell you percentage of time you are at blood sugar target range
2
Q
pathophys of T1DM
A
- autoimmune dz
- causes destruction of beta cells
- leads to absolute insulin deficiency
- beta cell destruction can be slow or rapid
- can be associated with other autoimmune disorders
- usually slow in adults but rapid in kids
- in children, by the time we pick it up most of their beta cells are destroyed
3
Q
markers of autoimmune destruction
A
- islet cell antibodies
- insulin antibodies
- glutamic acid decarboxylase 65 (GAD 65)
- protein tyrosine phosphate
4
Q
frequency and average age of onset
A
- frequency: 5-15% of all cases –> this is the most common metabolic disease of childhood!!
- age: diabetes usually presents in children age 4 and older; peak onset = 11-13. Can present in adulthood (presentation at this age tends to be less aggressive with hyperglycemia without DKA)
5
Q
presentation of T1DM
A
- usually present with polyuria, polydipsia, polyphagia
- other sxs = weight loss, fatigue, nausea, muscle cramping, blurred vision
- at presentation, pts typically in DKA or on the verge
6
Q
dx of T1DM
A
-BG elevated. if they have even 3 of the sxs associated with T1DM along with BG >200mg/dl, this is DIAGNOSTIC!!
7
Q
management of T1DM
A
- INSULIN
- NPH only if someone doesnt have insurance
- Determir (levamir) is good in pregnancy (category B)
- NEED BASAL INSULIN along with insulin for meals
- NPH and levamir for basal insulin
- Tresiba is the drug with the longest half life so its great for basal insulin
8
Q
New insulins
A
- Tresiba U100 or U200 (has ultra long half life - 24hrs)
- Glargine U300 (Toujeo)
- Humalog U200
- Afrezza ultra fast acting (starts acting in 5 mins)
- Umalog U200 = good for people taking large volumes
9
Q
adjunct to insulin
A
- primlintide (symlin): synthetic analogue of amylin
- affects post prandial glucose values by slowing gastric emptying, inhibiting glucagon production in the liver and appetite suppression –> leads to less post meal hyperglycemia and potential for weight loss
10
Q
amylin
A
- neuroendocrine hormone cosecreted from beta cells with insulin
- if you are missing amylin, you are also missing suppression of glucagon
- amylin produces less post meal glucose spikes and people feel fuller faster
11
Q
honeymoon period of DM dx
A
-pts body is still making insulin so their needs are less than they eventually will be
12
Q
calculating total daily dose
A
- 0.3-0.5 x weight in kg as starting total daily dose
- if pt is 120 lbs, weight = 120/2.2 = 55kg
- half of the TDD will be the basal insulin and half will be used for meals
13
Q
calculating how much insulin you need per meal
A
- rule of 500
- divide 500 by TDD –> if we decide that TDD is 16u, then 500/16 = 31 –> this means that you need 1u insulin for every 31gm of carbohydrate
14
Q
calculating units insulin needed for various BGs
A
BG . Units insulin (for food) <210 . 2u 211-320 . 3u 321-430 . 4u >431 . 5u
15
Q
modifiable risk factors
A
C ontrol your glucose, blood pressure and cholesterol!
E arly treatment of foot, eye, kidney, and heart problems
N o
S moking
E ducation about diabetes, nutrition and exercise
