DM I Flashcards
What, broadly speaking, is DM?
Relative or absolute impairment if insulin secretion, along with varying degrees of peripheral resistance
What are the two most common drugs types that can cause DM?
Glucocorticoids
Atypical antipsychotics
What are the disease of the exocrine pancreas that can lead to DM II?
Hemochromatosis
Chronic pancreatitis
Pheochromocytoma
What is DM Ia and DM Ib?
Ia = autoimmune etiology Ib = Non=autoimmune
What are the three major factors that play a role in the pathogenesis of DM I?
- Genetic susceptibility
- Immune mediation
- Environmental triggers
What chromosome is the HLA haplotype that is suspected to play a role in the development of DM I on? What does this code for?
Chr 6 MHC class II on macrophages
What are the three HLA haplotypes that are associated with the pathogenesis of DM I?
DR3
DQB
DR4
What are the chances of developing DM I if you have an identical twin who has it? Non-identical twin?
50%
8%
What are the HLA associations for DM Ib?
There are none for Ib, only Ia
What type of hypersensitivity reaction is type Ia DM?
IV (T cell mediated)
What is insulitis?
Inflammation of the beta cells of the pancreas
What is the most sensitive antibody that can be seen with DM Ia? What is the sensitivity of this?
Glutamic acid decarboxylase antibody (GAD65)
80% ish sensitive
True or false: the risk of developing DM Ia is proportional to the number of antibodies present
True
What antibodies, besides GAD65, can be found in DM Ia? (3)
Insulin antibodies
Islet cell antibodies
Tyrosine phosphatase
True or false: antibodies that are found in DM Ia are found only after ssx present
False– before
True or false: defects in insulin secretion is detectable years before the onset of DM Ia
True
What are the perinatal factors that are suspected to play a role in the pathogenesis of DM Ia? (5)
- Maternal age over 25
- Smoking
- Neonatal resp distress
- Jaundice
- Preeclampsia
What type of diet is thought to predispose pts to DM Ia?
Cows milk, cereal
What is the role of Vit D in the pathogenesis of DM Ia?
May be protective
What are the two viruses that are thought to precipitate DM Ia?
Coxsackie
Enterovirus
Most cases of DM I occur in what age group?
Less than 19 yo
True or false: DM I is more common in developed countries
True
What are the tests that can be used to diagnose DM I?
- Oral glucose tolerance test
- Check C-peptide levels (will be low)
True or false: DM II is more common in children than DM I
True
What happens to bicarb and pH values with DKA?
Both decreased
What causes the hypotension and tachycardia with DKA?
Dehydration 2/2 hyperglycemic enuresis
What are the basic ideas when treating DKA?
- Volume resuscitation
- Correct hyperglycemia
- Lytes
What are the treatment goals of DM I?
- Normoglycemia (HbA1C)
- Normal growth
What are the two major long acting insulins?
Glargine
Detemir
What are the rapid acting insulins?
Lispro
Aspart
Glulisine
(“there is no LAG with rapid insulin”)
What is the intermediate acting insulin?
NPH
What is the onset time for rapid, short, intermediate, and long acting insulin?
- Within 30 mins
- within 1 hour
- within 2
What are the total requirements for insulin for DM I? Basal requirements?
- 6 units /kg
0. 25 units/Kg
What is the use, MOA, and side effects of Pramlintide?
Amylin analogue for DM I, that slows gastric emptying, promoting satiety, and slowing glucagon release
What is Amylin?
Peptide that is usually released with insulin which increases satiety by slowing gastric emptying, decreasing glucagon
Are Amylin derivatives such as Pramlintide a replacement or an adjuvant therapy for insulin?
Adjuvant
What are continuous glucose monitors?
SQ device that reposts BG levels every few minutes
What are the two types of transplants that can be performed to cure DM I?
Pancreatic or islet cell transplants
True or false: NEVER stop insulin with DM I
True (DKA is bad, M’kay)
Acanthosis nigricans is more specific to type I or II DM?
DM II
