EXAM #2: TYPE I DM

Question 1

What drugs can induce DM?

Answer 1

1) Glucocorticoids

2) Atypical antipsychotics (Clozapine)

Question 2

What causes DM-I?

Answer 2

Destruction of pancreatic beta cells resulting in ABSOLUTE insulin deficiency

Question 3

What is the difference between DM-Ia and Ib?

Answer 3

Ia= autoimmune 
Ib= no underlying autoimmune disease

Question 4

What HLA antigens are associated with DM-I?

Answer 4

HLA- DR3, DR4, and DQB

Question 5

What chromosome are the HLA antigens located on that lead to DM-I susceptibility? What does this region code for?

Answer 5

Chromosome 6

*Codes for MHC-II on macrophages

Question 6

What mediates the autoimmune etiology of DM-Ia?

Answer 6

• Inappropriate adaptive immune response directed against pancreatic B-cells
• Specifically, T-cell mediated

Question 7

In DM-Ia, what antibody is positive in the majority of patients?

Answer 7

Glutamic acid decarboxylase (GAD65)

*Also, insulin, islet cell, tryosine phosphatase

Question 8

If a patient has a sibling with DM-Ia, what can you do to determine their likelihood of developing DM-I?

Answer 8

Measure antibodies= more positive antibodies–>increased likelihood

Question 9

When does the disease process that leads to DM-Ia start?

Answer 9

Months to years prior to diagnosis

Question 10

At what age are the majority of DM-I cases diagnosed?

Answer 10

Under 19 y/o

Question 11

How is DM diagnosed?

Answer 11

1) Oral glucose tolerance test– give glucose and then check serial blood sugars
2) Classical presentation of DKA
3) Antibodies
4) C-peptide (low)

Question 12

What are the necessary components for the diagnosis of DKA?

Answer 12

1) Hyperglycemia
2) Low bicarbonate
3) Low serum pH
3) Serum ketones

Question 13

How is DKA treated?

Answer 13

1) Fluid replacement
2) Insulin to correct hyperglycemia
3) Replace electrolytes

*Search for underlying cause

Question 14

What are the treatment goals in treating DM-I?

Answer 14

1) Normoglycemia
2) Normal HbA1c
3) Normal growth in children
4) Treatment of cardiac risk factors

Question 15

What are the basal/long-acting insulins?

Answer 15

Glargine
Detemir

*These are used to meet basal insulin needs

Question 16

What are the rapid/short-acting insulins?

Answer 16

Lispro
Aspart
Glulisine

*These are used to treat meal or stress needs

Question 17

What is the total insulin requirement in DM-I?

Answer 17

0.6 units/kg bodyweight

Question 18

How much of the daily total insulin requirement should be “basal” insulin?

Answer 18

0. 2-0.3 units/kg bodyweight

* The remaining bolus insulin is divided amongst the number of meals per day and dosed prior to oral intake

Question 19

What is the best way to mimic both basal and bolus insulin requirements?

Answer 19

Insulin pump

Question 20

What type of insulin is used in an insulin pump?

Answer 20

Short/rapid acting only

Question 21

What is the MOA of Pramlitide?

Answer 21

Amylin mimic that:

1) Slows GI transit
2) Decreases glucagon
3) Decreases appetite

*Provides better postprandial control of blood sugar

Question 22

What does CGMS stand for?

Answer 22

Continuous Glucose Monitoring System

Question 23

What is the goal HbA1c?

Answer 23

6.5-7%

Question 24

What is the BP goal?

Answer 24

Less than 130/80

Question 25

What are the cholesterol goals in DM-I?

Answer 25

• LDL less than 100

- HDL greater than 45