Type 1 DM

Question 1

what is insulitis?

Answer 1

lymphocytic infiltration of islets in type 1 diabetes, eventually the cells are destroyed and inactivated (islet are pancreatic cells that secrete insulin)

Question 2

what condition do pure type 1 DM pts almost always start with?

Answer 2

insulitis

Question 3

definition of Type 1 DM

Answer 3

lack of insulin due to autoimmune destruction of pancreatic beta cells

Question 4

where is type 1 DM more common? what vitamin is linked to this type of DM?

Answer 4

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

Question 5

what do you also want to look for in a patient with type 1 DM?

Answer 5

another autoimmune disease (hadleys note says islet cell antibodies and glutamic acid decarboxylase are present in most patients with type 1 DM)

Question 6

describe the onset of type 1 DM

Answer 6

generally kids and young adults; acute

Question 7

what are type 1 DM pts (sometimes) low c peptide levels due to?

Answer 7

low insulin production (destroyed beta cells)

Question 8

what do you give a type 1 DM for tx? how do they monitor for dose adjustments?

Answer 8

exogenous insulin; they do finger stick blood sugars (FSBS) to monitor

Question 9

what diabetic markers are present in DM 1 patients but not type 2?

Answer 9

immunologic markers (islet cell antibodies and anti glutamic acid decarboxylase)

Question 10

what is latent autoimmune diabetes of adulthood? are these patients normal weight or obese? what is the end tx?

Answer 10

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

Question 11

what are the two main types of “Type 1.5” diabetes?

Answer 11

latent autoimmune diabetes of adulthood (LADA) and maturity onset diabetes of youth (MODY)

Question 12

what is maturity onset diabetes of youth? what age people usually get it? what are these pts sensitive to?

Answer 12

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

Question 13

what is the honeymoon effect?

Answer 13

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

Question 14

what is the usual strategy of treating a type 1 DM pt?

Answer 14

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

Question 15

what lab level is measured to indicate insulin synthesis?

Answer 15

peptide C

Question 16

what is “regular” insulin?

Answer 16

it mimics the body’s native form of insulin; short acting

Question 17

how do rapid acting insulins work?

Answer 17

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

Question 18

what is the intermediate acting insulin? what patient population is it typically used in?

Answer 18

NPH (regular insulin mixed with protamine); it is cheaper and may be used in older patients

Question 19

how are long/ultralong acting insulins created?

Answer 19

amino acid substitutions (like rapid acting) but different AA’s used

Question 20

what is the typical starting basal dose of insulin? what if replacing NPH? if replacing BID NPH?

Answer 20

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%

Question 21

what is the best time of day to check sugars when monitoring basal dosing?

Answer 21

in the morning because we want to know the fasting levels

Question 22

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

Answer 22

higher than 140- increase dose by 5%

less than 80- decrease by 5%

Question 23

what is the best insulin to use for bolus dosing?

Answer 23

rapid acting

Question 24

what is the rule of 1800? how do you calculate it?

Answer 24

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

Question 25

how to treat young children (under 2 yrs old) with type 1 DM?

Answer 25

you air on the side of caution; treat them less bc youd rather them be hyperglycemic than hypoglycemic

Question 26

what are insulin pumps filled with?

Answer 26

rapid acting insulin; pumps have a basal rate and you give a bolus for each meal

Question 27

(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?

Answer 27

no dietary restrictions, alcohol was allowed, 45 minute walks in town, restaurant dinners allowed; results= less hypoglycemia than open loop therapies

Question 28

what can a closed loop pump accommodate for?

Answer 28

can adjust insulin for low carb meals and exercise but still need to calculate bolus dosing for big meals/with carbs