Type 1 Diabetes Flashcards
What is diabetes?
- metabolic disorder
- resistance to action of insulin or insufficient insulin secretion
- major clinical manifestation is hyperglycemia
- can cause long term damage/failure of many organs
What is insulin and its function?
- anabolic hormone secreted by pancreas beta cells
- major function is regulating glucose homeostasis
- stimulates glucose uptake/storage by cells
- suppresses hepatic glucose production
What is glucagon and its function?
- polypeptide hormone secreted by alpha cells
- hypoglycemia stimulates glucagon release
- glucagon stimulates hepatic glucose production and release
How is glucose supplied to the body during the fasting state?
- liver supplies glucose; does not need insulin
- increase in hepatic glucose production
- glycogenolysis
- gluconeogenesis
Aside from the liver, where else in the body is glucose metabolized?
Which require insulin for glucose uptake and which do not?
- skeletal muscle (requires insulin)
- adipose tissue (requires insulin)
- brain (insulin NOT needed)
Diagnostic Criteria for Pre-Diabetes:
- FPG
- Random/Casual Glucose
- OGTT
- FPG 100-125 mg/dL
- Random 140-199 mg/dL
- OGTT 140-199 mg/dL
Diagnostic Criteria for Diabetes Mellitus:
- FPG
- Random/Casual Glucose
- OGTT
- FPG >126
- Random >200
- OGTT >200
What is the HgbA1c? What is the goal level for DM pts?
- average level of hyperglycemia over previous 3 months
- goal <7%
What is type 1 diabetes?
- eventually develop absolute insulin deficiency
- beta cells destroyed
- formerly insulin dependent DM
What must type 1 diabetics have as part of treatment?
can’t survive without insulin
When is type 1 DM most commonly diagnosed? How many cases are there in the US?
- 20-25% of cases before age 5
- most between 5 and 15, another peak at 40
- 30,000 new cases per year
- 12-14 cases per 100,000
What are possible etiologies of DM 1?
- genetic predisposition
- autoimmunity (destruction of beta cells)
- environmental exposures/triggers (infections, chemicals)
Sxs of DM 1
- polydipsia
- polyphagia
- polyuria
- weight loss
Are there antibodies in DM 1?
- present 85%
- infiltration of islet cells and decrease in islet cell mass
Basal Insulin Therapy
- insulin needed to regulate hepatic glucose production and normalize fasting plasma glucose
- insulin necessary if one does not eat
Bolus Insulin Therapy
-insulin needed to control rise in plasma glucose after eating
What types of insulin have the fastest onset?
-humalog, novolog
What types of insulin are long acting?
- detemir (Levemir)
- glargine (Lantus)
How can insulin be administered?
- continuous subQ insulin infusion pump
- multiple daily injections
How does MDI insulin therapy work?
- requires basal insulin once or twice/day
- premeal, bolus insulin and plan for adjusting insulin for varying food intake
- correction scale for high blood glucose
Screening Guidelines for Type 1
-no routine screening currently recommended
Clinical Presentation of Type 1
- polyuria, polydipsia, polyphagia
- weight loss
- dehydration
- ketonuria, glucosuria
- blurred vision
- N/V/abdominal pain
What lab evaluation should be done for diabetes?
- A1c, fasting lipid profile
- liver function tests
- test for urine microalbumin
- serum creatinine, electrolytes
- estimated GFR
- TSH
What are components of diabetes management?
- self-monitoring blood glucose
- medical nutrition therapy, physical activity
- pharmacotherapy
- psychological therapy
- tx of co-morbidities and prevention/tx of complications
