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F3 E4 Shea > DM 1 > Flashcards

DM 1 Flashcards

1
Q

B cell destruction

A

Type 1 DM

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2
Q

Progressive insulin secretory defect

A

Type 2 DM

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3
Q
  • Beta cells produce what 2 things?
  • Alpha cell produce what 1 thing?
A
  • Beta –> insulin & amylin
  • Alpha –> glucagon
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4
Q
  • Which age/race has highest incidence of T1DM?
  • Bimodal: peaks at what 2 ages?
  • Is it heritable?
A
  • Non-hispanic WHITE children/adolescents
  • 4-6 & 10-14
  • Risk increases if relatives have T1DM
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5
Q

What are the 2 types of T1DM?

A
  • Immune mediated (1A)
  • Idiopathic (1B)
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6
Q

Which type of T1DM?

  • Scandinavia / Northern Europe
  • Minnesota
  • Genes (HLA DR3-DQ2) & (HLA-DR4)
  • Environmental causes
  • B cell auto-immunity
A

Immune Mediated T1DM (1A)

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7
Q

Which type of T1DM?

  • Minority of pts have this type
  • Asian / African origins
  • PAX-4: a transcription factor essential for development of pancreatic islets
A

Idiopathic T2DM (1B)

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8
Q

Studies of 1st degree relatives of pts w/ type 1 DM show that the persistent presence of two or more ____, is an almost CERTAIN predictor of clinical hyperglycemia & DM.

A

auto-antibodies

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9
Q

What are the 5 circulating antibodies present at time of dx for T1DM?

A
  • Zinc transporter 8 (ZnT8)
  • Islet cells (ICA)
  • Glutamic acid decarboxylase 65 (GAD 65)
  • Insulin (IAA)
  • Tyrosine phosphatase IA2 (ICA-512)

(ZIGIT)

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10
Q

Presence of antibodies in T1DM facilitate the screening of which 2 patients?

A

◦Siblings of affected child

◦Adults with atypical features of T2DM

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11
Q

6 tests to dx T1DM

A
  • C-peptide
  • Glutamic Acid Decarboxylase Autoantibodies (GADA or Anti-GAD)
  • Insulin Autoantibodies (IAA)
  • Insulinoma-Associated-2 Autoantibodies (IA-2A)
  • Islet Cell Cytoplasmic Autoantibodies (ICA)
  • Zinc Transporter 8 (ZnT8 Ab)
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12
Q

Which test to dx T1DM?

◦Quantitative blood test for the connecting polypeptide that is cleaved prior to the formation of insulin

◦Levels generally match insulin levels in the body and can indicate how much insulin is being produced

◦Low levels of ______ and insulin usually point to T1DM

◦Level can be checked in the presence of exogenous insulin

A

C-peptide

  • low levels of C-peptide
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13
Q

Which test to dx T1DM?

◦Test for antibodies against a specific enzyme in the pancreatic β cells

A

Glutamic Acid Decarboxylase Autoantibodies (GADA or Anti-GAD)

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14
Q

Which test to dx T1DM?

◦Test for antibodies targeting insulin

A

Insulin Autoantibodies (IAA)

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15
Q

Which test to dx T1DM?

◦Test for antibodies against a specific enzyme in β cells

A

Insulinoma-Associated-2 Autoantibodies (IA-2A)

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16
Q

Which test to dx T1DM?

◦______sense blood glucose levels and express insulin accordingly

◦Test for a reaction between _____ antibodies from humans and a variety of _____ proteins from an animal pancreas

◦Older test not used frequently

A

Islet Cell Cytoplasmic Autoantibodies (ICA)

  • Islet cells (are all of the blanks)
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17
Q

Which test to dx T1DM?

◦Newer test for antibodies targeting an enzyme specific to β cells

A

Zinc Transporter 8 (ZnT8 Ab)

18
Q
  • A1C test measures average blood glucose of the past ___ months.
  • Advantage is no need to fast/drink anything.
  • Diagnosis is made of an A1C of ___ or greater.
A
  • 2-3 months
  • 6.5 or greater
19
Q

Should an A1C or blood glucose be used to dx type 1 DM in SYMPTOMATIC individuals?

A

Blood glucose

20
Q

Screening for Type 1 DM w/ an antibody panel is recommended in which 2 circumstances?

A
  • Clinical research study
  • 1st degree family member of a proband w/ type 1 DM
21
Q

The American Diabetes Association recommends that children under the age of 19 diagnosed with type 1 diabetes strive to maintain an A1C level < ____.

A

7.5

22
Q

What is the dx?

  • Fasting Plasma Glucose (FPG): 100-125
  • 2 hour plasma glucose: 140-199
  • A1C: 5.7 - 6.4
A

Pre-diabetes

23
Q

Type 1 DM

  • Polyuria, polydipsia, weight loss
  • Random plasma glucose of ____ or more
  • Plasma glucose of ____ or more AFTER an overnight fast
  • HbA1C of ___ or higher
A
  • Random: 200 mg/dL
  • Overnight fast: 126 mg/dL
  • A1C: 6.5
24
Q

Type 1 or 2 DM?

  • Ketonemia
  • Ketonuria
  • Islet autoantibodies frequently present
A

Type 1

25
Q

Type 1 or Type 2?

  • 40 y/o +
  • Polyuria, polydipsia, obese
  • Ketonuria/weight loss are UNCOMMON
A

Type 2

26
Q

What may be an initial manifestation of type 2 DM in many pts w/ few to no sxs?

A

Candida vaginitis

27
Q

Type 2 DM

  • Plasma glucose of ___ or higher after an overnight fast.
  • 2 hours after 75g oral glucose: dx value is ___ or more
A
  • Overnight: 126 mg/dL
  • 2 hour: 200 mg/dL
28
Q

Why do type 1 DM pts have blurred vision?

A

Lenses are exposed to hyperosmolar fluids

29
Q

T1DM sxs

  • Breath smells like what?
  • N/V/ abd pain
  • What respiratory symptom?
  • Weight loss
  • Lethargy
  • Stupor
A
  • Breath: acetone
  • Resp: Kussmaul breathing (hyper-ventilation)
30
Q

T/F

MOST patients do not meet targets for A1C, blood pressure, or lipids

A

True

31
Q

What % DO MEET targets for A1C, BP, lipids, and non-smoking status?

A

only 14%

32
Q

Is progress in CVD risk factor control improving or slowing down?

A

Slowing

33
Q

Primary Care setting for Type 1 DM

  • What is the tx plan?
A
  • Refer to hospital

or

  • Transport to ED for dx/tx w/ admission & exogenous insulin
34
Q

What is the pharmacotherapy for Type 1 DM?

  • Multiple formulations
  • Consider pt characteristics
  • Consider cost
A

Insulin

35
Q

The best injection regimen consists of what types of insulin?

A

Rapid & Long acting

36
Q

Inject or Bolus how soon before meals?

A

5 - 15 mins

37
Q
  • What is the total daily dose of insulin?
  • Basal is what % of Total Daily Dose?
A
  • TDD: 0.5 - 1 unit/kg
  • Basal: 40-50%
38
Q

How many carbs for 1 unit of insulin in each group?

  • Children 1-6
  • Older pre-pubertal children
  • Pubertal adolescents
A
  • Children 1-6: 20 g carbs
  • Pre-pubertal: 10-12 g carbs
  • Pubertal: 8-10 g carbs
39
Q

What are the 3 rapid-acting insulins?

Are they analogs?

A
  • Glusisine (Apidra)
  • Aspart (NovoLOG)
  • Lispro (HumaLOG)

YES

40
Q

What are the 2 short-acting insulins?

Are they analogs?

A
  • Humulin R (regular)
  • Novolin R (regular)

(LIN)

NO

41
Q

What are the 3 Intermediate insulins?

Are they analogs?

A
  • Humulin N
  • Novolin N
  • Novolin 70/30

(NPH)

NO

42
Q

What are the 3 long-acting insulins?

Are they analogs?

A
  • Glargine (Lantus)
  • Detemir (Levemir)
  • Degludec (Tresiba)

YES

F3 E4 Shea (12 decks)

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