ENDO-DM Type1

Question 1

What is the gold standard for diabetes diagnosis?

Answer 1

HgbA1c for assessing glucose control over previous 6-8 weeks.

glycated hemoglobin A1c. - RBC independent of insulin
glucose molecule bonds with a protein or fat molecule without the help of an enzyme.

Question 2

Why HgbA1ct test is for 3 months?

Answer 2

RBC 120 days.
Blood RBC exposed to sugar molecules
HbA1c formed, not altered until RBC death

Question 3

What is the new diagnostic test?

Answer 3

Timed test

Question 4

How would you describe Pathophysiology of Type 1 Diabetes to a Patient?

Answer 4

1] an autoimmune destruction of the beta cells- insulin deficiency. slowly or rapidly.

2] associated with Hashimoto’s thyroiditis and Celiac disease

Question 5

What AUTOABS markers for type I are seen?

Answer 5

islet cell autoantibodies

glutamic acid decarboxylase 65 (GAD 65).

Question 6

Who gets Type 1 Diabetes?

Answer 6

5-15%
MC metabolic disease of childhood.

children age 4 years and older.
Peak age 11-13 years.

adulthood -less aggressive with hyperglycemia without DKA)

Question 7

Pt c/o the following:
polyuria, polydipsia and polyphagia,
What other findings?

Answer 7

1] weight loss, 
fatigue,
 nausea, 
muscle cramping 
blurred vision. 

2] MC diabetic ketoacidosis or on the verge. Missed in kid until too late

Question 8

How do HCP Diagnosis type I?

Answer 8

This population

symptoms + random BG >200mg/dl is diagnostic.

Question 9

What insulin is used for meals?

Answer 9

1] Rapid-acting: lispro, aspart, glulisine,
“Theres a LAG in DX of DM 1”

2] Short-acting: Regular

Question 10

What insulin is used for basal?

Answer 10

1]Intermediate-acting: NPH, Lente,
“Basal Night Light.”

2] Long-acting: Ultralente, glargine, detemir
“UGD- u got LONG diabetes”

Question 11

What are pre-mixed insulin?

Answer 11

1] NPH/Regular Based 70/30, 50/50,
2] Lispro/NPL Based 75/25, 50/50,
3] Aspart/NPL Based 70/30

Question 12

What are the new insulins?

Answer 12

1] degludec (Tresiba) ultra longacting insulin half life of 24 hours U100 or U200,

2] Glargine U 300 (Toujeo),

3] Humalog U200

Question 13

What are the adjunct therapy to insulin for type I

Answer 13

Pramlintide (Symlin)

analogue Amylin.
affects post prandial glucose values by:
slowing gastric emptying-appetite suppression.
inhibiting glucagon
less post meal hyperglycemia
potential for weight loss.

Question 14

Describe Amylin

Answer 14

secreted from the beta cells with insulin

MOA-hypoglycemia, nausea, headache and dizziness.

Question 15

What is the honeymoon period for new DX patients with DM1”?

Answer 15

patients continue to make insulin and so their needs are less than they will eventually be.

Question 16

How to initiate insulin in Type 1 DM

Answer 16

1] 0.3-0.5 x KG= total daily dose (TDD)

2] ½ (TDD) as basal insulin so 8u long acting insulin,

3] other ½ is the rapid acting/ #meals OR

come up with ratios, For meals 2-3u rapid acting AC

Question 17

How much rapid acting insulin is needed/gm of carbohydrate ?

Answer 17

Rule of 500

Divide 500 by TDD = 1 unit per #

Question 18

How to calculate the correction use Rule of 1800

Answer 18

Divide 1800 by TDD,

1u drops blood sugar

Question 19

What is the insulin dosage correction?

Answer 19

1] BG: <210 -> 2u (for food),

2] BG: 211-320 -> 3u,

3] 321-430 -> 4u,

4] >431 -> 5u

Question 20

What is the goal for all patients with type I DM

Answer 20

intensive insulin therapy (IIT)- long acting and rapid acting insulin (basal/bolus therapy)

continuous subcutaneous insulin infusion (CSII) an insulin pump.

Question 21

what is the standard insulin sensitivity

Answer 21

0.5-0.8 x BW kg = TDD

Not newly diagnosed, learning new techniques of intensive insulin therapy

Question 22

Your PT who has DM 2 needs to initiate insulin. What are the steps and WHy

Answer 22

covers hepatic glucose production in a fasting state
meal insulin to cover food ingested.

basal 0.3-0.5u/kg
replacement 0.6-1.0u/kg

Question 23

Are premeal insulin based on CHO? how?

Answer 23

YES
I:CHO ratio
Also given a correction amount if the premeal BG is elevated -1u:50>150

Question 24

What are pumps used for?

Answer 24

only rapid acting insulin.

continuous infusion rate (basal rate) is programmed to cover daily hepatic glucose production

insulin boluses are given for meals and to correct for an elevated glucose

programmable calculators- enter in their current BG and CHO, the pump will calculate the bolus needed.

Question 25

What are the off-label medications use for type I

Answer 25

1] GLP-1 agonists,
2] SGLT2 Inhibitors,
3] Metformin

Question 26

Pt feels hot, irritable, thirsty, drowsy, lots of urination early morning hours (2-8am). What is this effect?

Answer 26

insulin resistance-BG rise due to hepatic glucose production, nocturnal growth hormone release that

The Dawn Phenomenon

Question 27

Pt c/o blurred vision, confusion, and dizziness upon waking? Why? What are steps to prevent?

Answer 27

BG drops too low at night due to excess dinner time or bedtime insulin w/ release of counter regulatory hormones such as glucagon and epinephrine.

liver converts glycogen to glucose= high BG following a hypoglycemic episode.

The Somogyi Effect
Pt should dec. Insulin amount post meal

Question 28

Goal for long term success of type I

Answer 28

self monitor blood glucose (SMBG)
diet that is individualized for each patient.
A dietician
psychosocial stressors.

Question 29

What considerations are suggestive of Type I DM

Answer 29

1] elevated FBG and a C-peptide level <0.6ng/mL,

2] high positive titer of GAD 65 or islet ABS

Question 30

PT 6yo M in ED c/o n/v, ABD pain. Parents say he has been the following: polyuria, polydipsia, Weakness, malaise and headache.
P/E- Kussmal- Deep, rapid RR-

Work up
Hyperkalcemia- 5.3
LOW Na 134
CO2 6
BUN- 15
SCr 0.3 LOW
GLU- 543
Describe the acute complications of hyperglycemia in type I DM
]

Answer 30

Diabetic Ketoacidosis (DKA)

that causes respiratory alkalosis in an attempt to correct the metabolic acidosis, ketonemia

Usually occurs in Type 1 diabetics due to profound insulin deficiency. hormone release which causes hydrolysis of TGs, releasing free fatty acids (FFA) and glycerol (lipolysis).

glycerol l/t increased hepatic glucose production, which worsens hyperglycemia.

Excessive amounts of ketone bodies are formed in the liver from FFA

Question 31

How do we treatment of DKA?

Answer 31

1] Hospitalization
2] Correct fluid and electrolyte disturbances.
3] Provide insulin SLOWLY D/T effects of Na/K+ pumps t
4] Watch for complications of treatment- HYPORKalemia

Question 32

Describe the use of Continuous Glucose Monitors

Answer 32

standard of care for Type 1 DM: transcutaneous sensors that transmit a continuous glucose reading to a receiver Q 5 minutes,

calculate predicted blood glucose
expensive

Question 33

Describe long term management for type I

Answer 33

1] ACE I or ARB prevent or delay proteinuria.

2] Aspirin therapy for all patients >40 y/o.,

3] Statin therapy if history of MI or LDL >100. CV risk

Question 34

When should ACE I, ARBs, and Statins be avoided in?

Answer 34

DO NOT USE IN WOMEN OF CHILD BEARING AGE,

risk of fetal renal damage