Diabetes Type 1 Flashcards
DM Type I definition; prevalence
an absolute deficiency of insulin; 10-20%
DM is characterized by the following:
- Hyperglycemia
- Major abnormalities in glucose, fat, and protein metabolism
- Complications related to poor glycemic control
Differential DX: T1DM and T2DM
T1DM: Immune
-Usually not overweight (
DM Risk in kids:
1/500!!
Dx Criteria for T1DM
1) A1C > or = 6.5%
2) FPG > or = 126 mg/dL
3) 2 hr pp glucose > or = 200 mg/dL
4) Random glucose > or = 200 mg/dL (AND CLASSIC SX the 3 P’s)
Hemoglobin A1C;
What is it,
how often measured,
age variations
Hgb A1C is a glycoprotein formed when glucose binds to Hgb A in the blood.
Measured 3-4 x/year
Toddlers can have a higher goal range (
Goals in T1DM management
1) Normal growth and development
2) avoid symptomatic hyper and hypoglycemia
3) intervene early for high glucose and rising A1C
4) provide realistic expectations
5) prevent burnout
6) prevent metabolic deterioration in adolescence
7) Tx behavioral issues
8) provide positive medical experiences
What is insulin?
peptide hormone; manufactured by B cells of pancreas. transports glucose into muscles and other tissues
Insulin’s affects on organs:
1) stimulates muscle fibers to protein synthesis
2) stimulates liver cells to take up glucose; synthesize glycogen
3) acts on fat cells/ fat synthesis
4) inhibits enzyme production leading to glycogen breaking
Insulin synthesis storage and secretion: describe briefly the “life” of insulin
produced in B cells> mRNA translated as single chain precursor “preproinsulin” > peptide removed> proinsulin> within ER, exposed to several peptidases to EXCISE the C Peptide> generates mature form of insulin> stored as B granules
General Tx options for T1DM:
1) SQ Insulin
2) Conventional Insulin Rx
3) Intensive Insulin Rx
When mixing insulin, which goes into syringe first?
REGULAR first
Rapid-Acting Insulin: Names MOA When to give Onset, duration Other items to know
- ASPART/Novolog; GLULISINE/Apidra; LISPRO/ Humalog
- Action more closely matches pp increases in glucose
- Rapid action (5-15 minutes), short duration (3-5 hrs)
- Admin 15 min AC
- Clear insulin
- decrease frequency of hypoglycemia
Short-Acting Insulin: Names When to give Onset, duration Other items to know
- REGULAR/ Humulin R/ Novolin R
- inject 30-60 minutes AC to minimize MISMATCHING
- Onset (30-60 min); Duration (6-12 hrs)
- only IV insulin used to Tx DKA
Intermediate-Acting Insulin: Names MOA When to give Onset, duration Other items to know
- NPH
- administered 1-2x/day
- slow onset (1-2 hrs) and long duration (10-24 hrs)
- CLOUDY (draw into syringe 2nd)
- *Taken at HS to counteract dawn phenomenon
Insulin Mixes: Names MOA When to give Onset, duration Other items to know
-Humalog 75/25 or 50/50; Novolog 70/30; Humulin 70/30 or 50/50
=intermediate + rapid or short (premixed)
Use within 15 min of / just after a meal: Humalog and Novolog mixes.
Use 30-60 min before meal (given at least BID): Humulin mixes
-Usually admin BID with each dose intended to cover 2 meals + snack
-more difficult to achieve complete glycemic control using fixed combos
Long-acting Insulin: Names MOA When to give Onset, duration Other items to know
-GLARGINE/Lantus, DETEMIR/Levemir
=”peakless” background insulin replacement
-onset: 1 hour; duration: 6-24 hours
-given QD or BID when used as basal Rx
-slower, more prolonged duration than NPH
Insulin:
Initial dosing for Non-DKA pt
Prepubertal: 0.25-0.5 u/kg/d
Pubertal: 0.5-0.75 u/kg/d
Insulin:
Initial dosing for Post-DKA pt
Prepubertal: 0.75 u/kg/d
Pubertal: 1 u/kd/d
Dividing Insulin Dosing (TDD) TID Regimen
TID: 2/3 TDD given before breakfast (2/3 as NPH and 1/3 as rapid-acting)
