T1DM Flashcards
Self tolerance: process of selecting T cells that
express MHC and can bind appropriately
do not recognize self antigens
self tolerance: process of deleting cells that
don’t bind to MHC
recognize self
naive T cells are moved where to await exposure to antigens
peripheral lymph nodes
genetic markers present at birth in T1DM
DR3-DQ2 or DR4-DQ8
immune markers (antibodies) are present
AFTER onset of autoimmune process
metabolic markers present at what point in T1DM
once enough beta cell damage occurs (before symptomatic)
examples of metabolic markers for T1DM
A1C, blood glucose, C peptide
associated autoimmune diseases for T1DM
addison’s disease
graves/hashimotos
celiac disease
gonadal insufficiency
basal insulin alone is only used in
T2DM patients
Total daily dose =
basal insulin + bolus insulin
insulin needs for children
more insulin sensitive; lower dose needed
insulin needs for ESRD
insulin cleared by kidneys; lower kidney clearance = lower insulin needed
insulin needs for T2DM
more insulin resistance = higher dose needed
insulin needs in elderly
high risk for hypoglycemia; lower insulin dose
correction factor
amount blood glucose will drop with 1 unit of insulin
what T cells cause direct destruction in T1DM
CD8
What T cells create antibodies in T1DM
CD4
Other genetic alternations/mutations that increase risk of T1DM
polymorphisms on promoter of insulin gene
T helper cells that are interferon gamma positive and secrete IL-8 and IL-12
autoimmune antibodies in T1DM
islet cell antibodies
antibodies to glutamic acid decarboxylase
Insulin autoantibodies
IA-2A
Autoantigen ZnT8
after exogenous insulin administration, patients can develop which antibodies
insulin autoantibodies
Criteria to consider testing for antibodies in an adult patient who is newly diagnosed with diabetes
Two or more of the following:
Age of onset < 50Y
Acute symptoms
BMI < 25
Personal or FHx of autoimmune disease
All T1DM patients will be treated with
insulin
basal dose is what percent of TDD
40-50%
bolus insulin is what percent of TDD
50-60%
Calculation for correction factor (CF)
1800/TDD
carbohydrate: insulin ratio
number of carbs covered by 1 unit of insulin
calculating carbohydrate: insulin ratio
500/TDD
calculating bolus on board
insulin taken - insulin taken x (hours since last bolus/active insulin time)
