Type 1 DM

Question 1

How do T1 diabetics typically present?

Answer 1

• Usually made in childhood or adolescence, often after presenting with DKA or very high BG and ketonuria
• Can present at any age but because of variable prodrome of hyperglycemia, the diagnosis can be challenging in adults
• Suspected when FH of T1DM, thyroid dx, or other autoimmune dx

Question 2

What is the workup for T1DM?

Answer 2

• Measuring of 1 or more autoantibodies along with C-peptide
  
  • Islet cell autoantibodies (ICA), antibodies to insulin, antibodies to glutamic acid decarboxylase (anti-GAD), antibodies to tyrosine phosphatases IA-2 and IA-2B
  • 20% of insulin deficient adults are antibody negative

Question 3

Name the three rapid acting insulins

Answer 3

Insulin lispro

Insulin aspart

Insulin glulisine

Question 4

How quick do rapid acting insulins work?

Answer 4

25-30 mins

Question 5

How long do they last?

Answer 5

3-5 hours

Question 6

When do they peak?

Answer 6

30 mins – 1.5 hours

Question 7

Name the intermediate insulin

Answer 7

NPH

Question 8

How quick does NPH work?

Answer 8

1-2 hours

Question 9

How long does NPH last?

Answer 9

18-24 hours

Question 10

When does NPH peak?

Answer 10

2-4 hours

Question 11

Name the two main long acting insulins

Answer 11

Glargine and Determir

Question 12

How quick do the long acting insulins work?

Answer 12

Glargine: 4-6 hours

Determir: 3-4 hours

Question 13

How long do the long acting insulins last?

Answer 13

Glargine: 20-24 hours

Determir: 18-24 hours

Question 14

When do the long acting insulins peak?

Answer 14

Peakless

Question 15

What is the standard insulin concentration?

Answer 15

100 U/mL with vials containing 1000 U in 10mL

Question 16

How do you dose long acting insulins?

Answer 16

Generally administered once daily as an SC injection at bedtime in a regiment that includes primal rapid-acting insulin

Question 17

Which populations may require higher than average dosing of insulin?

Answer 17

Obese or insulin resistant patients, adolescents and in the latter part of pregnancy

Question 18

How would you advise a patient on insulin to monitor their glucose?

Answer 18

Capillary glucose monitoring 4x daily (10-30mins before meals and at bedtime)

Question 19

Discuss strategies for providing basal coverage in T1DM

Answer 19

NPH: twice daily

insulin detemir: once or twice daily

insulin glargine: once daily

Question 20

What percentage of the total daily dose of insulin should be covered by basal insulin?

Answer 20

40-50%

Question 21

How much can you increase the basal insulin dose by until target glucose levels are achieved?

Answer 21

5-10% daily

Question 22

How do you dose premeal boluses of insulin?

Answer 22

• Adjusted according to the BG, the anticipated carb intake and anticipated activity level
• Total premeal complement should roughly equal total base dose, with 1/3 given before or after each meal with rapid acting preferred but regular can be used as well

Question 23

How do pumps work?

Answer 23

• Provides 50% of total daily insulin as basal insulin and the remainder as multiple preprandial boluses of insulin, using a programmable pump
• Have advance features that allow patients to fine tune their basal and bolus does but requires diabetes education in order to utilize the pump to its full potential