Flashcards in EXAM #2: TYPE I DM Deck (25)
What drugs can induce DM?
2) Atypical antipsychotics (Clozapine)
What causes DM-I?
Destruction of pancreatic beta cells resulting in ABSOLUTE insulin deficiency
What is the difference between DM-Ia and Ib?
Ib= no underlying autoimmune disease
What HLA antigens are associated with DM-I?
HLA- DR3, DR4, and DQB
What chromosome are the HLA antigens located on that lead to DM-I susceptibility? What does this region code for?
*Codes for MHC-II on macrophages
What mediates the autoimmune etiology of DM-Ia?
- Inappropriate adaptive immune response directed against pancreatic B-cells
- Specifically, T-cell mediated
In DM-Ia, what antibody is positive in the majority of patients?
Glutamic acid decarboxylase (GAD65)
*Also, insulin, islet cell, tryosine phosphatase
If a patient has a sibling with DM-Ia, what can you do to determine their likelihood of developing DM-I?
Measure antibodies= more positive antibodies-->increased likelihood
When does the disease process that leads to DM-Ia start?
Months to years prior to diagnosis
At what age are the majority of DM-I cases diagnosed?
Under 19 y/o
How is DM diagnosed?
1) Oral glucose tolerance test-- give glucose and then check serial blood sugars
2) Classical presentation of DKA
4) C-peptide (low)
What are the necessary components for the diagnosis of DKA?
2) Low bicarbonate
3) Low serum pH
3) Serum ketones
How is DKA treated?
1) Fluid replacement
2) Insulin to correct hyperglycemia
3) Replace electrolytes
*Search for underlying cause
What are the treatment goals in treating DM-I?
2) Normal HbA1c
3) Normal growth in children
4) Treatment of cardiac risk factors
What are the basal/long-acting insulins?
*These are used to meet basal insulin needs
What are the rapid/short-acting insulins?
*These are used to treat meal or stress needs
What is the total insulin requirement in DM-I?
0.6 units/kg bodyweight
How much of the daily total insulin requirement should be "basal" insulin?
0.2-0.3 units/kg bodyweight
*The remaining bolus insulin is divided amongst the number of meals per day and dosed prior to oral intake
What is the best way to mimic both basal and bolus insulin requirements?
What type of insulin is used in an insulin pump?
Short/rapid acting only
What is the MOA of Pramlitide?
Amylin mimic that:
1) Slows GI transit
2) Decreases glucagon
3) Decreases appetite
*Provides better postprandial control of blood sugar
What does CGMS stand for?
Continuous Glucose Monitoring System
What is the goal HbA1c?
What is the BP goal?
Less than 130/80