Type 1 Diabetes Flashcards
Type 1 Diabetes Mellitus
Destruction of insulin-producing pancreatic beta cells (most commonly autoimmune)
Usually presents in childhood <19 yo (1/4 cases diagnosed in adults)
There is commonly an affected family member
Symptoms are commonly polyuria, polydipsia and weight loss.
Diagnosis is based on increased fasting glucose (>126mg/dL), random glucose (>200mg/dL) or high Hemoglobin A1C (>6.5%) in combination with high antibodies (glutamic acid decarboxylase, tyrosine phosphatase, insulin, zinc transporter 8), and low fasting insulin and c-peptide.
T1DM – General Treatment (Children)
(In patient care-> Side effect->Hyperglycemia)
- *Family education important**
- They will need to monitor for hyperglycemia and hypoglycemia through regular blood glucose readings, as well as blood and urinary ketones.
*Aim for a target A1C of <7.5 % (blood glucose = 90 – 130mg/dL before meals and 90 – 150mg/dL at bedtime and overnight)
T1DM – General Treatment (Adult)
Goal is to have strict management of blood glucose (reduce side effects of hyperglycemia)
Aim for a HbA1c < 7% (Lower->CV complications-Metabolic need lower)
They will need to monitor for hyperglycemia and hypoglycemia through regular blood glucose readings, as well as blood and urinary ketones.
Types of Insulin Administration:
- Rapid Acting/Short Acting
- Intermediate Acting
- Long-Acting
- (prandial) – administered as premeal bolus depending on carbohydrate intake
Insulin Lispro – 5-15 minutes before meal
Insulin Aspart – 5-15 minutes before meal
Insulin Glulisine – 5-15 minutes before meal
Regular Insulin – 30 - 60 minutes before meals - Intermediate Acting – usually given with long-acting insulins, can cover multiple meals
Neutral Protamine Hagedorn (NPH) – 2-3x per day - Long-Acting (basal) – usually administered in the evening if single dose – provides 50% of total daily insulin needs.
Insulin Glargine – 1-2x per day
Insulin Detemir – 1-2x per day
Multiple Daily Injections vs Pump
- Multiple Daily Injections (MDI)
- Insulin Pumps – continuous subcutaneous insulin infusion–> Used for patients with recurrent severe hypoglycemia, wide fluctuations of blood glucose, recalcitrant high HbA1c, difficulty with compliance.
Dosage and Monitoring
- Dosage is based on weight, age and pubertal stage of child.
- Follow up visits – should be every 3 months to adjust the insulin dose in growing children.
- There is often a honeymoon phase where the dose of insulin needs to be reduced – close monitoring of blood glucose is important here – you don’t want hypoglycemic attacks; this usually lasts several months to years.
Insulin Regular (Humulin)
Treatment Indication – Diabetes Mellitus – Short Acting
- Dosing Adult/child: dose dependent on weight and carbohydrate intake (initial dose: 0.5 – 1 units/kg/day divided– MDI)
- Monitoring: plasma glucose (daily), electrolytes, HbA1c (x3 mo)
- Main SE: Hypoglycemia, hypokalemia, edema, erythema.
- Avoid combination with the following supplements/foods: Berberine, EDTA
Insulin Lispro (Humalog)
Treatment Indication – Diabetes Mellitus – Rapid Acting
- Dosing Adult/child: dose dependent on weight and carbohydrate intake (initial dose: 0.2 – 0.6 units/kg/day divided – MDI)
- Monitoring: plasma glucose (daily), electrolytes, HbA1c (x3 mo)
- Main SE: Hypoglycemia, hypokalemia, edema, erythema, diarrhea, headache
- Avoid combination with the following supplements/foods: Berberine, EDTA
Insulin Aspart (Novolog)
Treatment Indication – Diabetes Mellitus – Rapid Acting
- Dosing Adult/child: dose dependent on weight and carbohydrate intake (initial dose: 0.2 – 0.6 units/kg/day divided – MDI)
- Monitoring: plasma glucose (daily), electrolytes, HbA1c (x3 mo)
- Main SE: Hypoglycemia, hypokalemia, edema, erythema, diarrhea, headache
- Avoid combination with the following supplements/foods: Berberine, EDTA
Insulin Glargine (Lantus)
Treatment Indication – Diabetes Mellitus – Long Acting
- Dosing Adult/child: dose dependent on (maintenance dose: 0.5 – 1 units/kg/day divided – MDI)
- Monitoring: plasma glucose (daily), electrolytes, HbA1c (x3 mo)
- Main SE: Hypoglycemia, hypokalemia, edema, diarrhea,
- Avoid combination with the following supplements/foods: Berberine, EDTA
Insulin Detemir (Levemir)
Treatment Indication – Diabetes Mellitus – Long Acting
- Dosing Adult/child: dose dependent on (maintenance dose: 0.5 – 1 units/kg/day divided – MDI)
- Monitoring: plasma glucose (daily), electrolytes, HbA1c (x3 mo)
- Main SE: Hypoglycemia, hypokalemia, edema, diarrhea,
- Avoid combination with the following supplements/foods: Berberine, EDTA
