Type 1 DM Flashcards
what is insulitis?
lymphocytic infiltration of islets in type 1 diabetes, eventually the cells are destroyed and inactivated (islet are pancreatic cells that secrete insulin)
what condition do pure type 1 DM pts almost always start with?
insulitis
definition of Type 1 DM
lack of insulin due to autoimmune destruction of pancreatic beta cells
where is type 1 DM more common? what vitamin is linked to this type of DM?
higher latitudes than closer to the equator (young people who move from lower latitudes to higher ones are more likely to acquire the risk); vitamin D
what do you also want to look for in a patient with type 1 DM?
another autoimmune disease (hadleys note says islet cell antibodies and glutamic acid decarboxylase are present in most patients with type 1 DM)
describe the onset of type 1 DM
generally kids and young adults; acute
what are type 1 DM pts (sometimes) low c peptide levels due to?
low insulin production (destroyed beta cells)
what do you give a type 1 DM for tx? how do they monitor for dose adjustments?
exogenous insulin; they do finger stick blood sugars (FSBS) to monitor
what diabetic markers are present in DM 1 patients but not type 2?
immunologic markers (islet cell antibodies and anti glutamic acid decarboxylase)
what is latent autoimmune diabetes of adulthood? are these patients normal weight or obese? what is the end tx?
its a form of diabetes that usually occurs in young adults; more of a type 1 DM that is often misdiagnosed as DM type 2 bc C peptide levels are normal early in the disease and slower progression of islet cell destruction; pts are usually normal weight; end tx is exogenous insulin
what are the two main types of “Type 1.5” diabetes?
latent autoimmune diabetes of adulthood (LADA) and maturity onset diabetes of youth (MODY)
what is maturity onset diabetes of youth? what age people usually get it? what are these pts sensitive to?
a patient who has insulin regulation or secretion defect problems (not an autoimmune problem); young adults and genetic component; patients are sensitive to sulfonylureas but usually progress to needing insulin
what is the honeymoon effect?
once a type 1 pt starts getting exogenous insulin, the pancreas will stop secreting whatever insulin it can (gets a rest) but after it rests for awhile/hyperglycemia levels return to normal, it will kick back in and make more insulin than it did before. so we decrease the pts insulin or completely stop exogenous insulin during this time
what is the usual strategy of treating a type 1 DM pt?
first - basal bolus (basal glucose production is steady so the insulin levels the pt administers also needs to be steady)
second- administer extra insulin to account for post-prandial glucose spikes
what lab level is measured to indicate insulin synthesis?
peptide C
what is “regular” insulin?
it mimics the body’s native form of insulin; short acting
how do rapid acting insulins work?
there are two spots on the B peptide that have single amino acid substitutions; this allows the peptide to break into monomers and be absorbed quicker than regular human insulin
what is the intermediate acting insulin? what patient population is it typically used in?
NPH (regular insulin mixed with protamine); it is cheaper and may be used in older patients
how are long/ultralong acting insulins created?
amino acid substitutions (like rapid acting) but different AA’s used
what is the typical starting basal dose of insulin? what if replacing NPH? if replacing BID NPH?
10u every night at bedtime of glargine (lantus) for both type 1 and 2 diabetics (usually people can tolerate this without becoming hypoglycemic); if replacing NPH dosed once daily then use same dose for basal; if replacing BID NPH, reduce total dose by 20%
what is the best time of day to check sugars when monitoring basal dosing?
in the morning because we want to know the fasting levels
how do we adjust the basal insulin dosing if FSBS are greater than 140 for more than 2 days? how about if its less than 80 for more than 2 days
higher than 140- increase dose by 5%
less than 80- decrease by 5%
what is the best insulin to use for bolus dosing?
rapid acting
what is the rule of 1800? how do you calculate it?
it predicts how much glucose will be reduced by one unit of rapid acting insulin: (the rule of 1500 is used for regular insulin); 1800/total daily insulin dose
how to treat young children (under 2 yrs old) with type 1 DM?
you air on the side of caution; treat them less bc youd rather them be hyperglycemic than hypoglycemic
what are insulin pumps filled with?
rapid acting insulin; pumps have a basal rate and you give a bolus for each meal
(research study) for patients with a closed loop artificial pancreas (vs open loop insulin pump therapy), what activities were allowed during the study ? what were the results?
no dietary restrictions, alcohol was allowed, 45 minute walks in town, restaurant dinners allowed; results= less hypoglycemia than open loop therapies
what can a closed loop pump accommodate for?
can adjust insulin for low carb meals and exercise but still need to calculate bolus dosing for big meals/with carbs
