type 1 diabetes

what are 2 main structural units in the pancreas?

islet cells

acinar cells

what is the function of acinar cells?

secretes digestive enzymes

what hormones are secreted by the islet cells?

insulin

glucagon

somatostatin

which genetic condition can make the pancreas specifically vulnerable through attack of the acinar cells?

cystic fibrosis

what are 2 types of cells within the islet cells?

alpha and beta

what do alpha cells secrete?

glucagon

what do beta cells secrete?

insulin

what is a polypeptide hormone secreted by the alpha cells in response to hypoglycemia?

glucagon

what does glucagon stimulate?

glycogenolysis in the liver

what other hormone stimulates glycogenolysis?

epinephrine

what is glycogenolysis?

conversion of glycogen to glucose

what is gluconeogenesis?

metabolic pathway that generates glucose from non carbs such as lactate, glycerol, and glucogenic amino acids

what is the function of gluconeogenesis?

keeps glucose from dropping too low besides glycogenolysis

what is a hormone secreted by the beta cells in response to hyperglycemia?

insulin

what is the function of insulin?

enables glucose to be transported into the cell

reduces serum glucose

which glucose transporters are insulin independent?

GLUT1-3

which glucose transporter has high affinity?

GLUT3

what is the main type of glucose transport found in the liver and pancreas?

GLUT2

what are the 3 types of diabetes?

type 1

type 2

GDM

which type of diabetes is the result of genetic, environmental, and immunologic factors that ultimately lead to destruction of the pancreatic beta cells and complete insulin deficiency?

type 1 DM

which type of diabetes results from chronic obesity and lifestyle factors that lead to increased inflammation, progressive decreased sensitivity of insulin receptor sites, and increased serum glucose levels?

type 2 DM

which type of diabetes is marked by insulin resistance due to placental hormones such as prolactin and cortisol?

GDM

which cell is destroyed in type 1 DM?

beta cells

which cells are still working in type 1 DM? which hormone is normal then?

alpha cells; glucagon

which process continues despite autoimmune destruction of beta cells?

gluconeogenesis in the liver

which antibodies and markers are present in type 1 DM?

islet cell Ab

GAD-65 Ab

anti insulin Ab

none or low c-peptide levels

when is type 1 DM usually diagnosed?

any age but usually in childhood

what are causes of type 1 DM?

genetically predisposed (isolated HLA-DR3/4)

infectious disease damage

if type 1 diabetic does not get insulin treatment within days, what is the result?

death from starvation despite severe hyperglycemia

what is c peptide?

precursor of production of insulin

what are signs and symptoms of type 1 DM?

polyuria

polydipsia

fatigue

muscle cramps

enuresis

blurred vision

nausea

fruity breath odor

what are the main results of insulin deficiency in type 1 DM?

hyperglycemia

dehydration

acidosis

what are physical exam findings for type 1 DM?

dehydration

hypotension

kussmaul breathing

neuropathy

what are labs for type 1 DM?

anyone - random glucose > 200

any child - random glucose > 170

CBC (hyperglycemia, no lipid abnormality)

low c-peptide

islet cell Ab

GAD 65 Ab

anti insulin Ab

what is the treatment for type 1 DM?

exogenous insulin

diet moderation

frequent blood sugar monitoring

if blood glucose remains > 300 or is experiencing nausea and vomiting - what should you do next?

UA - eval for ketones

if ketones are positive in the urine, what do you do next?

go to ER for further eval and management to avoid DKA

what regimen is important for a type 1 diabetic in order to prevent DKA and ketonuria?

stay hydrated and have access to rapid acting insulin

what is the first line treatment for type 1 DM?

basal insulin (long acting)

start at 10 units, use body weight and blood sugar to titrate

which diabetic is more insulin sensitive - type 1 or 2?

type 1

when should type 1 diabetics take their insulin?

15 mins before a meal

if glucose is > 150 for type 1 diabetic, what do they need to do for management?

meal dose of insulin PLUS correction dose

what is the carb goal for type 1 DM diet?

40-60g per meal

plus 15-20g per snack

stay consistent!!

how do you calculate total daily insulin dose?

weight in lbs x 0.23

how do you calculate carb to insulin ratio?

500/total daily insulin dose

how much meal time insulin do you need for 15g of carbs?

1 unit

what are 2 emergencies in the context of type 1 DM?

profound hyperglycemia

profound hypoglycemia

what can cause profound hyperglycemia in type 1 diabetic?

non compliance

acute and significant variation in diet

acute illness

what is the treatment for profound hyperglycemia?

insulin

what can cause profound hypoglycemia in type 1 diabetic?

insulin overdose

excessive exercise

what is the treatment for profound hypoglycemia?

oral fast acting carbs

IV dextrose

what parts of type 1 DM regimen need to stay consistent in order to prevent complications?

meal times

exercise

what is a measurement of elevated plasma glucose caused from an increase in nonenzymatic glycation of hemoglobin?

HbA1c

what does HbA1c reglect?

glycemic hx over the past 2-3 months

how often should A1c be monitored?

every 3 months

basal insulin shouldn't need much dose correction, but if you do need to change the dose then how should you do that?

change by 2 units initially

NEVER change by > 10-20% at one time

what does regular monitoring for type 1 DM consist of?

continuous glucose monitoring (daily by pt)

A1c

ophthalmology evaluation

diabetic foot screening

what are requirements in order to give a type 1 diabetic an insulin pump?

must be responsible

must be compliant

must be willing to test glucose 6 times daily

what is the patient's responsibility with an insulin pump?

has to tell the pump what to do based on carb intake and blood sugar testing throughout the day

what is the basal rate of insulin pumps?

boluses of novolog, humalog, or apidra is pumped at a certain rate 24 hrs a day determined by endocrinologist

what is the function of a glucose sensor?

monitors and reports glucose levels 24 hrs a day

can set alarms for highs and lows

what is a disadvantage of a glucose sensor for type 1 DM?

not accurate enough to use for insulin dosing calculations

what is the ultimate goal of insulin therapy?

to mimic normal insulin levels

natural insulin from the pancreas keeps your blood sugar in a ___________ range.

very narrow

3 multiple choice options

what is the state of insulin in a "normal" functioning body during sleep of fasting times?

low, background level is being released

what is the benefit of basal insulin for type 1 DM?

provides a low, continuous level of insulin to control glucose overnight and between meals

what are 3 types of long acting insulins?

lantus

levemir

tresiba

how much of the body's total daily insulin is basal insulin?

50%

what are 2 kinds of bolus replacement?

mealtime bolus

high blood sugar correction bolus

what are 3 types of bolus insulin?

novolog

humalog

apidra

how do you calculate basal insulin dose based on total daily insulin dose?

total daily insulin dose / 2

how do you calculate mealtime insulin dose based on basal insulin dose?

basal insulin dose / 3

how do you calculate the correction ratio of insulin?

1700 / total daily insulin dose

how do you interpret the correction ratio?

for every 1 unit of insulin, the glucose should decrease by 37 points

what is an acute, major, life threatening complication of diabetes?

DKA

who is more likely to get DKA - type 1 or 2?

type 1

what does DKA result from?

absolute insulin deficiency

counter regulatory hormone excess

dehydration

acid base abnormality

what does ketosis result from?

increase in free fatty acid release from adipocytes

shift to ketone body synthesis in the liver

what are ketone bodies initially neutralized by?

bicarb

as bicarb stores are depleted from neutralizing ketones, what happens?

metabolic acidosis

what are signs and symptoms of DKA?

polydipsia

polyuria

malaise, N/V

decreased perspiration, chills

AMS

SOB, acute chest pain

abdominal tenderness

hx missed insulin injections

what are physical exam findings for DKA?

ill appearing

dehydration

kussmaul's breathy

fruity breath

decreases reflexes

tachycardia

hypotension

AMS

what are lab findings for DKA?

glucose > 300

pH < 7.30

ketonuria

what is treatment for DKA?

correct fluid loss

correct high BG w insulin

correct electrolytes

correct acid base abnormality

treat infection if needed

monitor:

BG q1-2 hrs

serum electrolytes q1-2 hrs

BUN

ABG

what is the overall management plan for addressing DKA?

confirm diagnosis (labs)

admit to ICU

assess critical levels (labs)

replace fluids 2-3L of 0.9% saline

add dextrose

administer IV insulin 0.1 u/kg IV bolus

replace potassium

assess pt

measure finger stick q1-2 hrs

monitor vitals