Type 1 Dm throughout the Lifespan Flashcards
What are preprandial glucose goals, A1c, and time in range goals for pt’s with DM1 ages 0-17?
80-130 mg/dL, A1c 7.0-7.5%, and TIR > 70% of the time
At the time of dx of DM1, what percentage of beta cells have been destroyed?
80-90%
What tests of test may be used to help differentiate dx of DM1 and DM2 in children/adolescents?
islet autoantibodies and C Peptide levels; between 85-95% of pt’s with DM1 have circulating antibodies directed against 1 or more islet cell components
What are the initial survival skills that should be taught to a child/family with newly dx’d DM1?
- Testing BG and urine/blood ketones
- Measurement and administration of insulin
- Understanding insulin action and peaks
- Meal planning
- Preventing, recognizing, and treating hypoglycemia
How often should a person with DM1 be monitoring their blood glucose?
6-8 times per day or use of CGM
How often will a person with DM be taking insulin?
4-6 times per day or insulin infusion therapy
According to the ADA, when should blood glucose be checked for those with DM1 when using MDI or insulin pump therapy?
Prior to meals/snack, occasionally post prandially, at bed time, prior to exercise, when lows are suspected, after treating a low, and prior to critical tasks (driving)
When should ketone testing be done?
When blood glucose levels exceed 250 mg/dL and during illness
What is the dawn phenomenon?
Fasting hyperglycemia r/t normal risk in growth hormone, cortisol, and other hormones that can raise blood glucose in the absence of insulin
The presence of persistent and moderate or large amounts of ketones in the urine in concentrations is greater of ____ in the blood suggest the possibility of DKA and should prompt pt’s to adjust their insulin or seek assistance from healthcare provider
0.6 mmol/L
Additional fluids and/or insulin are often needed to clear ketosis
What is the initial TDD of insulin for children with newly dx’d DM1?
0.5-1.0 units per kg
Younger and prepubertal children usually require lower does, while presence of ketoacidosis, use of steroids, and onset of puberty all dictate need for higher doses
By how much may insulin requirements decrease during the honeymoon period?
insulin requirements may decrease to 0.2-0.6 units per kg of body weight per day
How long does the honeymoon period last in DM1?
3-12 months
What is the honeymoon period in DM1?
A phase that some people with type 1 diabetes experience shortly after being diagnosed. During this time, a person with diabetes seems to get better and may only need minimal amounts of insulin.
Some people even experience normal or near-normal blood sugar levels without taking insulin. This happens because the pancreas is still making some insulin to help control the blood sugar.
By how much may insulin requirements increase with puberty?
May increase to as much as 1.5 units per kg per day due to hormonal influences and sex hormone secretion
Once the person with DM1 recovers from the acute onset of DM and their appetite decreases, what should be done to avoid hypoglycemia?
Insulin dose must decrease; the pt and family of the person with DM should be forewarned this may occur and watch for this
What is the difference in insulin regimens between those using insulin to CHO ratios vs those on fixed insulin regimens?
Insulin to CHO ratios allow for more flexibility in food intake, whereas fixed insulin regimens will need to. be more consistent
For an adult with DM what are the average daily insulin requirements?
0.4-1.0 units of insulin per kg
Which disorder is the most common autoimmune disorder associated with DM1?
thyroid disorders (hypothyroid most common)
Pt’s with DM1 should be screened for Celiac disease by measuring what?
Tissue transglutaminase or antiendomysial antibodies
A small intestinal biopsy is the gold standard for dxf celiac disease
How often should pt’s with DM1 see their healthcare providers?
Every 3 months
In the adult dx’d with DM, how should the provider differentiate between DM1 and DM2?
look for the presence or absence of islet auto antibodies. Markers of immune destruction of beta cell include islet cell autoantibodies, autoantibodies to glutamic acid decarboxylase (GAD), tyrosine phosphatase related islet antigen 2, and insulin autoantibodies.
What does low or undetectable levels of plasma C peptide indicate?
Little to no insulin secretion
