Kim Ackerman Lecture

Question 1

LADA: Latent Autoimmune Diabetes:

Commonly diagnosed when?

Describe the onset?

What is our aim for treatment?

Answer 1

Called Type 1.5 Diabetes

Typically over age 30 (often misdiagnosed as dmt2);

Later onset and slow progression to fully needing insulin

Still have some insulin production therefore aim for protecting beta cell function and mass

Question 2

LADA is what kind of disease?

What is present for diagnosis?

Answer 2

Autoimmune

Antibodies present at diagnosis (GAD)

Question 3

Diagnosis Labs
for DMT1
8

Answer 3

1. Proinsulin: precursor of insulin
2. GAD(gluctamic acid decarboxylase)autoantibody
3. C-peptide: level below 0.6 ng/mL suggest DMT1 (because theres no insulin), level above 1 ng/dL suggest DMT2 (residual beta cell function)
4. GAD antibody
5. Islet-cell (IA2), antiGAD 65, and anti-insulin autoantibodies (IgG and IgM antibodies against insulin)
6. Urine glucose
7. HgbA1C
8. Random blood sugar

Question 4

Diabetes Mellitus Type I
clinical findings?
4

Answer 4

1. Weight loss
2. Polyuria
3. Polydipsia
4. Bedwetting (child) or nocturia

Question 5

Screening for DMT1?

Answer 5

New standards in screening for DMT1, screen relatives at a clinical research center

Question 6

DPP4 Inhibitor(Dipeptidyl peptidase-4 Inhibitor)
MOA?

Increase weight?

Answer 6

Reduce glucagon and blood glucose levels , DPP4-I increase incretin levels (GLP 1), which inhibit insulin secretion, decrease gastric emptying, and decrease blood glucose

weight neutral

Question 7

GLP 1 (Glucagon Like Peptide)
MOA?

Answer 7

Incretin mimetics: slow gastric emptying, reduce glucagon from liver,
Weight loss
(In a pen)

Question 8

Symlin (Pramlintide)
is used with what?

MOA?

Answer 8

Used with insulin

Synthetic analog of human amylin,
Amylin naturally occurs in body to control hormonal function of beta cell of pancreas that contributes to glucose control in the postprandial period
(in a pen)

Question 9

DMT1
Total Daily Insulin
Daily Calculations?
Basal/Bolus?

Rule of 500 for carb count?

Rule of 1800 for Correction?

Answer 9

0.55 X Weight in Kg=TDD
TDD divided by 2= 50 %basal/50%bolus

500 divided by TDD=Carb ratio (potential)

1800 divided by TDD=Correction (potential)

Question 10

WHy do we have young kids A1C run low?

Answer 10

Because they are growing and bottoming out would be worse than being high

Question 11

What kind of insulin are pts with a pump taking?

Answer 11

fast acting. novalog/humlog

dont take the basal usually with it