Type 1 Diabetes Mellitus

Question 1

what is the pathogenesis of type 1 DM?

Answer 1

destruction of insulin producing cells in the islet of Langerhans (Beta cells)

Question 2

type 1 DM can either be due to _____ or _______ destruction

Answer 2

autoimmune
non-autoimmune

Question 3

genetically susceptible subjects, triggered by at least 1 environmental agents that progresses over months/years, but subject is asymptomatic and euglycemic.

Answer 3

autoimmune type 1 DM

Question 4

at what point are genetic markers present in type 1 DM?

Answer 4

at birth

Question 5

at what point are immune markers detectable in type 1 DM?

Answer 5

after the onset of the autoimmune process

Question 6

at what point are metabolic markers detected in type 1 DM?

Answer 6

when enough beta cell damage has occurred but before symptoms

Question 7

type 1 DM is one of the most common _____ diseases in _____

Answer 7

chronic

childhood

Question 8

what age are most type 1 DM cases diagnosed in the US?

Answer 8

19 or younger

Question 9

___% of patients are diagnosed with type 1 DM before age _____

Answer 9

45

10

Question 10

what will the presentation of type 1 DM present without?

Answer 10

without acidosis

Question 11

what are the top 3 clinical presentations of type 1 DM?

Answer 11

polydipsia
polyuria
weight loss

Question 12

what symptom will be present if they have type 1 DM that causes a yeast infection that grows with glucose?

Answer 12

perineal candidiasis

Question 13

what symptom will be present if hyperglycemia is longstanding?

Answer 13

cataracts

Question 14

with insufficient insulin, type 1 DM will lead to _____ or _____

Answer 14

ketonemia

ketonuria

Question 15

similar symptoms as the classic presentation, but more severe

Answer 15

diabetic ketoacidosis

Question 16

what are 3 symptoms that will be present in DKA?

Answer 16

fruity smelling breath
drowsiness/lethargy
nausea/vomiting

Question 17

what 2 criteria help distinguish type 1 DM vs type 2 DM?

Answer 17

type 1:
body habitus (thin)
not a strong family history

Question 18

what are 3 lab results that will present in type 1 DM?

Answer 18

pancreatic autoantibodies
low insulin
low C-peptide

Question 19

if a patient presents with classic symptoms of hyperglycemia, what random plasma glucose value will diagnose them with type 1 DM?

Answer 19

200 or higher

Question 20

for an asymptomatic patient, what should labs/other results be to diagnose them with type 1 DM? (3)

Answer 20

fasting plasma glucose: over 126
OR
post-OGTT: over 200
OR
Hbg A1c: over 6.5%

Question 21

what is the management for a patient with type 1 DM?

Answer 21

coordinate meals + activity with insulin replacement

Question 22

what is the glucose monitoring rule?

Answer 22

at least 4 times a day
OR
continuous glucose monitoring

Question 23

what is the standard glycemic target of HbA1C?

Answer 23

less than 7%

Question 24

what is the glycemic target of HbA1c for older patients, comorbidities, or limited life expectancy?

Answer 24

less than 8%

Question 25

what is the glycemic target of HbA1c during pregnancy?

Answer 25

less than 6%

Question 26

at minimum, how often should young patients with type 1 DM be seen?

Answer 26

every 3 months

Question 27

what should we watch for in patients with type 1 DM? (2)

Answer 27

hypoglycemia
weight gain

Question 28

what is available for emergency use in a patient with type 1 DM if they experience hypoglycemia?

Answer 28

glucagon injection