T1DM

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Questions and Answers

What is the half-life of Icodec, one of the new Once Weekly Insulins?

7-8 days (correct)

10-11 days

15-16 days

5-6 days

Which of the following statements about Teplizumab is correct?

It is used to treat all stages of Type 1 Diabetes.

It is the first FDA-approved medication for immediate T1D treatment.

It can delay the onset of T1D for approximately 2 years. (correct)

It is the only medication approved for diabetes management.

What additional supplies are necessary for managing Type 1 Diabetes?

A yearly health plan and a new insulin delivery device.

Alcohol preps and supplements for insulin degradation.

Only insulin syringes and testing strips.

Blood glucose monitoring devices and a medical alert ID. (correct)

Which medications are being studied for their potential use in Type 1 Diabetes management?

Metformin and GLP-1 Agonists Signup and view all the answers

What is a critical requirement for a patient to receive Teplizumab?

They need to be in Stage 2 with detectable antibodies without seroconversion. Signup and view all the answers

What is the primary cause of Type 1 Diabetes (T1D) as indicated in the overview?

Autoimmune destruction of beta cells Signup and view all the answers

Which combination of factors is acknowledged as contributing to the etiology of T1D?

Genetic predisposition and environmental trigger Signup and view all the answers

What percentage of diabetes cases does Type 1 Diabetes account for in the United States?

5-10% Signup and view all the answers

What diagnostic tests are employed for the laboratory diagnosis of T1D?

Fasting Plasma Glucose (FPG) and C-Peptide Signup and view all the answers

During which years was a 21% increase in the incidence of T1D observed?

2001-2009 Signup and view all the answers

Which viral agent has historical autopsy evidence linked to the onset of T1D?

Coxsackie virus Signup and view all the answers

What has been identified as a potential environmental trigger for T1D related to infant diet?

Early introduction of cow's milk Signup and view all the answers

What is considered the gold standard treatment for managing T1D?

Insulin via multiple daily injections or continuous infusion Signup and view all the answers

What is the fasting plasma glucose (FPG) threshold for diagnosing diabetes?

<blockquote> 126 mg/dL </blockquote> Signup and view all the answers

What does a C-Peptide level of < 0.2 nmol/L indicate?

Low endogenous insulin levels or activity Signup and view all the answers

What is the target range for self-monitoring blood glucose?

80-120 mg/dL Signup and view all the answers

Why is continuous glucose monitoring (CGM) advantageous compared to self-monitoring?

Offers more readings and trends Signup and view all the answers

What is the A1C target for reducing microvascular complications?

< 7% Signup and view all the answers

How often should blood glucose be checked when using self-monitoring methods?

3 to 4 times daily Signup and view all the answers

What is one of the main disadvantages of using continuous glucose monitors?

May delay real-time blood glucose readings Signup and view all the answers

What indicates a positive result for diabetes-related antibodies?

Positive for at least one type of antibody Signup and view all the answers

What is the primary mechanism by which diabetic ketoacidosis (DKA) develops?

Dehydration and increased blood glucose levels Signup and view all the answers

Which of the following is a common sign of diabetic ketoacidosis?

Fruity breath odor Signup and view all the answers

What is the typical starting dose of Symlin (Pramlintide) for an adult?

15 mcg Signup and view all the answers

What is the primary adverse effect associated with SGLT1/2 inhibitors?

Acute Kidney Injury Signup and view all the answers

In patients with DKA, which treatment is typically initiated first?

Intravenous fluids Signup and view all the answers

Why are SGLT1 inhibitors primarily used in Type 1 diabetes patients with caution?

They can lead to DKA Signup and view all the answers

What is the expected hourly fluid replacement for treating DKA?

1 L of 0.9% NS Signup and view all the answers

Which condition is likely to require higher doses of insulin treatment?

Insulin-resistant obese patients Signup and view all the answers

What is the general goal for fasting plasma glucose (FPG) during pregnancy to prevent complications?

FPG’s < 90 mg/dL Signup and view all the answers

Which of the following is NOT a recommended medication for improving sensation in patients with neuropathy?

Ibuprofen Signup and view all the answers

What annual assessments are recommended for patients to monitor kidney function during pregnancy?

Creatinine and urinary albumin excretion Signup and view all the answers

How often should patients be screened for distal symmetric polyneuropathy (DPN) after being diagnosed with type 2 diabetes?

At diagnosis and yearly thereafter Signup and view all the answers

What is a potential consequence of neuropathy combined with poor perfusion in diabetic patients?

Non-healing foot ulcers Signup and view all the answers

What is the primary reason for the increase in autoimmune destruction of beta cells in Type 1 Diabetes?

Genetic predisposition and environmental trigger Signup and view all the answers

What percentage of diabetes cases does Type 1 Diabetes account for in the United States?

5-10% Signup and view all the answers

Which environmental factor is linked to the onset of Type 1 Diabetes according to historical evidence?

Coxsackie virus Signup and view all the answers

What is a common diagnostic marker indicating autoimmune activity in Type 1 Diabetes?

Presence of autoantibodies Signup and view all the answers

What treatment modality is considered the gold standard for managing Type 1 Diabetes?

Insulin therapy Signup and view all the answers

What is one of the key anatomical changes observed in the pancreas during the progression of Type 1 Diabetes?

Decrease in size and weight Signup and view all the answers

Which laboratory diagnostic test is NOT commonly used for diagnosing Type 1 Diabetes?

Complete blood count (CBC) Signup and view all the answers

What is the relationship between the incidence of Type 1 Diabetes and the years between 2001 and 2009?

21% increase in incidence Signup and view all the answers

What is a key goal for fasting plasma glucose (FPG) levels during pregnancy to prevent complications?

FPG’s < 90 mg/dL Signup and view all the answers

Which medication is NOT considered helpful for improving sensation in diabetic neuropathy?

Ibuprofen Signup and view all the answers

What is the recommended frequency for screening patients for distal symmetric polyneuropathy (DPN) after being diagnosed with type 1 diabetes?

Yearly after diagnosis Signup and view all the answers

Which treatment is recommended if a patient's GFR is found to be less than 30?

Refer to nephrology Signup and view all the answers

What is the significance of Teplizumab in the treatment of Type 1 Diabetes?

It is FDA approved for delaying the onset of T1D. Signup and view all the answers

What annual measurements are suggested to monitor kidney function during pregnancy?

Urinary albumin excretion, serum creatinine, potassium Signup and view all the answers

Which of the following is NOT required for managing Type 1 Diabetes according to the content?

Monthly insulin infusions Signup and view all the answers

What is the duration of delay in onset achieved by Teplizumab?

Around 2 years Signup and view all the answers

Which two new insulins were highlighted for their potential benefits in Type 2 diabetes treatment?

Icodec and Efsitora Signup and view all the answers

Which of the following statements about the management of Type 1 Diabetes is accurate?

Annual assessments include funduscopic exams. Signup and view all the answers

What is the diagnostic threshold for fasting plasma glucose (FPG) for diagnosing diabetes?

<blockquote> 126 mg/dL </blockquote> Signup and view all the answers

Which of the following A1C results indicates a need for further evaluation of diabetes?

7.5% Signup and view all the answers

What is the minimum frequency recommended for self-monitoring blood glucose (SMBG) in patients with diabetes?

3 to 4 times daily Signup and view all the answers

What is one disadvantage of continuous glucose monitoring (CGM)?

Expensive Signup and view all the answers

Which of the following antibodies indicates a positive result for diabetes-related autoimmunity?

Insulin autoantibodies (IAA) Signup and view all the answers

What is the target range for blood glucose levels in diabetes management?

80-120 mg/dL Signup and view all the answers

What does a C-Peptide level of < 0.2 nmol/L indicate?

Low endogenous insulin levels Signup and view all the answers

What is the A1C target for reducing microvascular complications in diabetes?

< 7% Signup and view all the answers

What is the recommended frequency for patients with Type 1 Diabetes to be seen by a healthcare provider?

Every 3-6 months Signup and view all the answers

Which of the following is considered a 'quick' carbohydrate source for managing hypoglycemia?

4 oz. juice or regular soda Signup and view all the answers

What must be avoided when administering quick carbs for hypoglycemia?

Giving slow carbs before quick carbs Signup and view all the answers

What could be a possible reason for elevated blood glucose levels in a patient with Type 1 Diabetes?

Illness or stress Signup and view all the answers

If a patient's blood glucose level is 250 mg/dL with a target of 150 mg/dL, what formula should be applied to determine the correction dose?

Correction Factor = 1800/TDD Signup and view all the answers

What is a common symptom of hyperglycemia?

Polyuria Signup and view all the answers

What is a critical component of immediate treatment for a patient with hyperglycemia above 250 mg/dL?

Administer insulin after 1-2 hours Signup and view all the answers

What is a general goal for fasting plasma glucose (FPG) during pregnancy to prevent complications?

FPG’s < 90 mg/dL Signup and view all the answers

Which medication can help improve sensation in patients with neuropathy?

Pregabalin Signup and view all the answers

How often should patients be screened for distal symmetric polyneuropathy (DPN) after being diagnosed with type 2 diabetes?

Yearly Signup and view all the answers

What is a recommended action if a patient's GFR is found to be less than 30?

Refer to nephrology Signup and view all the answers

What is a potential complication of neuropathy combined with poor perfusion in diabetic patients?

Non-healing foot ulcers Signup and view all the answers

What is the primary benefit of the newly introduced Once Weekly Insulins in studies?

They demonstrate promise with less hypoglycemia and more time in range (TIR). Signup and view all the answers

For whom is Teplizumab approved for use in delaying type 1 diabetes onset?

Those in Stage 2 or antibody positive without seroconversion. Signup and view all the answers

Which of the following is a necessary requirement for every individual with type 1 diabetes?

A supply of Glucagon Injection and alcohol preps. Signup and view all the answers

What effect do Metformin and GLP-1 Agonists have in the study for managing Type 1 Diabetes?

They help in reducing insulin requirements and hepatic glucose production. Signup and view all the answers

Which statement best describes the financial aspect of Teplizumab treatment?

It is expensive for the full course of treatment. Signup and view all the answers

How often are patients with Type 1 Diabetes (T1D) typically seen for check-ups?

Every 3-6 months Signup and view all the answers

What is a common mistake when administering quick carbohydrates during hypoglycemia?

Administering too much too quickly Signup and view all the answers

What is the primary indicator that warrants checking blood glucose levels more frequently?

Blood glucose levels above 150 mg/dL Signup and view all the answers

What should be done before giving another dose of insulin when treating hyperglycemia?

Wait 1-2 hours Signup and view all the answers

What is the treatment option available for severe hypoglycemia in patients with T1D?

Glucagon injection Signup and view all the answers

If a patient's blood glucose is 250 mg/dL with a target of 150 mg/dL, how would you calculate the correction dose?

Use the formula (BG - target) / CF Signup and view all the answers

What symptom is commonly associated with hyperglycemia?

Blurry vision Signup and view all the answers

During an acute illness, what factor may contribute to higher blood glucose levels in T1D patients?

Non-compliance with treatment Signup and view all the answers

What is the primary mechanism by which autoimmune destruction occurs in Type 1 Diabetes?

Autoimmune destruction of beta cells Signup and view all the answers

Which factor is considered an environmental trigger for the development of Type 1 Diabetes?

Infection with Coxsackie virus Signup and view all the answers

What is a significant anatomical change observed in the pancreas during the progression of Type 1 Diabetes?

Decrease in size and weight Signup and view all the answers

What percentage of all diabetes cases does Type 1 Diabetes represent in the United States?

5-10% Signup and view all the answers

Which laboratory diagnostic test is commonly used to help diagnose Type 1 Diabetes?

C-Peptide Signup and view all the answers

What does the presence of autoantibodies indicate in the context of Type 1 Diabetes?

Autoimmune activity against beta cells Signup and view all the answers

What was the percentage increase in the incidence of Type 1 Diabetes observed between 2001 and 2009?

21% Signup and view all the answers

What is the gold standard treatment method for managing Type 1 Diabetes?

Insulin via MDI or CI Signup and view all the answers

What is the mechanism of action for Symlin (Pramlintide)?

Mimics the effects of endogenous amylin Signup and view all the answers

Which of the following signs is commonly associated with diabetic ketoacidosis (DKA)?

Fruity breath odor Signup and view all the answers

Which treatment is typically initiated first in managing DKA?

Fluid replacement therapy Signup and view all the answers

What is a common side effect associated with SGLT1 inhibitors?

Hypotension Signup and view all the answers

What is the initial insulin drip rate for treating DKA?

0.1 U/kg/hr Signup and view all the answers

Which factor is most likely to cause DKA?

Dehydration + high blood glucose Signup and view all the answers

What should be monitored closely in patients using Symlin (Pramlintide)?

Mealtime insulin dosage Signup and view all the answers

In what form is Symlin (Pramlintide) administered?

Subcutaneous injection Signup and view all the answers

What is identified as a primary contributor to the pathophysiology of Type 1 Diabetes?

Autoimmune destruction of beta cells Signup and view all the answers

The increase in incidence of Type 1 Diabetes between 2001 and 2009 was reported at what percentage?

21% Signup and view all the answers

Which environmental factor has been associated with an increased risk of developing Type 1 Diabetes according to historical evidence?

Early introduction of cow's milk Signup and view all the answers

What is the significance of autoantibodies in the context of Type 1 Diabetes diagnosis?

They indicate a positive autoimmune response. Signup and view all the answers

In Type 1 Diabetes, what anatomical change is often observed in the pancreas?

Decrease in size and weight of the pancreas Signup and view all the answers

What is a key factor that combines with genetic predisposition to contribute to the etiology of Type 1 Diabetes?

Viral infections Signup and view all the answers

Which laboratory diagnostic marker is relevant for the diagnosis of Type 1 Diabetes?

Hemoglobin A1C Signup and view all the answers

What primary treatment modality is considered the gold standard for individuals diagnosed with Type 1 Diabetes?

Insulin via MDI or CI Signup and view all the answers

What is a common mistake when consuming quick carbohydrates for managing low blood sugar?

Eating a large quantity at once Signup and view all the answers

When should patients with Type 1 Diabetes typically have their blood glucose monitored?

Every 3-6 months, depending on A1c and treatment changes Signup and view all the answers

What can commonly cause high blood glucose levels in a Type 1 Diabetes patient?

Mismanagement of insulin dosage Signup and view all the answers

In case of hyperglycemia, what is the most appropriate waiting period before administering another dose of insulin?

1-2 hours Signup and view all the answers

What should be monitored when blood glucose levels exceed 250 mg/dL?

Urine for ketones Signup and view all the answers

What type of carbohydrate should NOT be consumed before a quick carbohydrate to effectively raise blood sugar levels?

Chocolate milk Signup and view all the answers

What is the most critical symptom of hyperglycemia?

Fatigue Signup and view all the answers

What type of injection might a friend of a Type 1 Diabetes patient have received that provided rapid relief from symptoms?

Glucagon Signup and view all the answers

What is a common consequence of untreated diabetic ketoacidosis (DKA)?

Metabolic acidosis Signup and view all the answers

Which of the following treatments is initially recommended for managing DKA?

1L of 0.9% NS per hour Signup and view all the answers

What is a potential side effect of SGLT1/2 inhibitors in Type 1 diabetes patients?

Diabetic ketoacidosis Signup and view all the answers

What is the starting dose of Symlin (Pramlintide) when used as an adjunct therapy?

15 mcg Signup and view all the answers

Which breath odor is characteristic of diabetic ketoacidosis?

Fruity Signup and view all the answers

In patients requiring more than 200 units of insulin daily, which type of insulin should be considered?

Higher potency insulin Signup and view all the answers

What condition is indicated by a decreased bicarbonate level during DKA?

Metabolic acidosis Signup and view all the answers

What adverse effect may occur as a result of taking amylin drugs like Symlin?

Severe hypoglycemia Signup and view all the answers

What is the general goal for fasting plasma glucose (FPG) levels during pregnancy to prevent complications?

FPG < 90 mg/dL Signup and view all the answers

Which annual assessments are recommended to monitor kidney function during pregnancy?

Creatinine, K, and urinary albumin excretion Signup and view all the answers

What is a recommended action if a patient's GFR is found to be less than 30?

Refer to a nephrologist Signup and view all the answers

What tests are recommended to screen for distal symmetric polyneuropathy (DPN) at diagnosis?

Pinprick, vibration tuning fork, and 10-g monofilament tests Signup and view all the answers

Which medication may help with sensation in patients suffering from neuropathy?

Gabapentin Signup and view all the answers

What is the primary benefit of the new Once Weekly Insulins Icodec and Efsitora as indicated in the information shared?

They are associated with less hypoglycemia and more time in range (TIR) Signup and view all the answers

What is a requirement for a patient to be eligible for the treatment with Teplizumab?

Must be in Stage 2 or antibody positive without seroconversion to Type 1 Diabetes Signup and view all the answers

What is a distinctive feature of Teplizumab in the context of Type 1 Diabetes treatment?

It is the first medication approved for delaying T1D onset Signup and view all the answers

Which of the following best describes the role of Metformin and GLP-1 Agonists in Type 1 Diabetes management as stated?

They reduce the need for insulin and lower glucose production in the liver Signup and view all the answers

What necessary component is specifically mentioned as important for all individuals with Type 1 Diabetes?

T1D Medical Alert ID for emergency situations Signup and view all the answers

Study Notes

T1D Overview & Pathophysiology

Autoimmune Destruction: T1D is caused by the immune system attacking and destroying beta cells in the pancreas, which are responsible for producing insulin.
Genetic Predisposition: Individuals with T1D often have a genetic predisposition, with specific HLA genes (HLA-DQ and HLA-DR) being associated with increased risk.
Environmental Triggers: Environmental factors, such as exposure to viruses (like Coxsackie B4), autoimmune triggers, and early introduction of cow's milk, may play a role in triggering the autoimmune response.

T1D Epidemiology & Prevalence

Prevalence in the US: Approximately 1.25 million Americans have T1D, representing only 5-10% of all diabetes cases.
Increasing Incidence: The incidence of T1D has increased by 21% between 2001 and 2009.

T1D Diagnosis & Treatment

Diagnostic Tests: Diagnostic tests include:
- HbA1c: reflects average blood sugar levels over 2-3 months.
- Fasting Plasma Glucose (FPG): measures blood sugar after an overnight fast.
- Random Plasma Glucose (RPG): measures blood sugar at any time.
- Antibodies: tests for the presence of autoantibodies (IAA, GADA, IA-2A, ICA).
- C-Peptide: measures the amount of insulin produced by the pancreas.
Treatment Gold Standard: The gold standard treatment for T1D is insulin therapy, administered through multiple daily injections (MDI) or a continuous insulin pump (CI), along with self-monitoring of blood glucose (SMBG) or continuous glucose monitoring (CGM).

T1D Management & Monitoring

SMBG: Self-monitoring of blood glucose (SMBG) involves using a finger prick to test blood sugar levels several times a day. The target blood glucose range is typically 80-120 mg/dL.
CGM: Continuous glucose monitoring (CGM) uses a sensor under the skin to continuously measure blood sugar levels, providing more frequent data and alerts for high or low blood sugar.

T1D Complications

Diabetic Ketoacidosis (DKA): A life-threatening condition that occurs when the body produces ketones as an alternative energy source due to a lack of insulin. Symptoms include:
- Fruity breath
- Kussmaul respirations
- Nausea and vomiting
- Abdominal pain
- Dehydration
- Fatigue
Neuropathy: Damage to nerves, often affecting the feet and hands. Symptoms include:
- Numbness
- Tingling
- Pain
- Loss of sensation
Nephropathy: Kidney damage, often leading to kidney failure. Signs include:
- Increased creatinine levels
- Albuminuria (protein in the urine)
- Increased blood pressure
Retinopathy: Damage to blood vessels in the retina of the eye, leading to vision loss.
Cardiovascular Disease: T1D increases the risk of heart attacks, strokes, and other cardiovascular problems.

New Treatments & Research

Once Weekly Insulins: New insulin analogs with longer-acting formulations, like Icodec and Efsitora, are being investigated for improved blood sugar control and reduced hypoglycemia.
Teplizumab: An FDA-approved drug that can delay the onset of T1D for about two years in individuals with detectable autoantibodies and without seroconversion to T1D.
T2DM Medications for T1D: Research is exploring the use of medications originally developed for T2DM, such as metformin and GLP-1 agonists, in the treatment of T1D.

Essential Supplies & Management

T1D Medical Alert ID: People with T1D should wear an ID bracelet or necklace indicating their condition for emergency situations.
Insulin: A constant supply of insulin is essential, delivered through injections or an insulin pump.
Blood Glucose Monitoring Equipment: Frequent monitoring is necessary to manage blood sugar levels.
Glucagon: Glucagon is a life-saving hormone used to treat a severe low blood sugar episode (hypoglycemia).
Other Supplies: Additional supplies may include:
- Needles
- Skin adhesive patches
- Blood glucose testing strips
- Alcohol preps
- Extra insulin
- Supplies for low blood sugar
Regular Healthcare: People with T1D should have regular medical checkups with their healthcare provider, including A1C monitoring, neuro/podiatry assessments, yearly eye exams, and proactive management of complications.

T1D Overview

Type 1 Diabetes (T1D) is an autoimmune disease characterized by the destruction of beta cells in the pancreas, which are responsible for producing insulin.
T1D is characterized by a lack of insulin production, leading to hyperglycemia.
T1D affects roughly 1.25 million Americans, representing 5-10% of all diabetes cases.
The incidence of T1D has increased by 21% between 2001 and 2009.

T1D Pathophysiology

T1D develops due to a combination of genetic predisposition (especially HLA-DQ and HLA-DR genes) and environmental triggers.
Pancreatic tissue samples from individuals with T1D show signs of chronic inflammation in the endocrine regions, with evidence of inflammatory markers.
The progressive autoimmune process results in a decrease in pancreatic size and weight, as well as the presence of autoantibodies.

T1D Etiology

Potential triggers for T1D include:
- Coxsackie Virus: Historical evidence from the 1970s shows Coxsackie Virus B4 isolation from islet cells in children with diabetic ketoacidosis.
- Cow's Milk: Early introduction of cow's milk can induce a humoral response, potentially triggering an inflammatory autoimmune reaction due to diabetogenic antigens present in cow's milk.

T1D Presentation and Symptoms

T1D often presents with classic symptoms of hyperglycemia, including:
- Polyuria (increased urination)
- Polydipsia (increased thirst)
- Polyphagia (increased hunger)
- Blurred vision
- Fatigue

T1D Diagnosis

T1D diagnosis is based on a combination of clinical presentation and laboratory tests.
Diagnostic criteria include:
- HbA1c > 6.5%
- Fasting Plasma Glucose (FPG) > 126 mg/dL
- Random Plasma Glucose (RPG) > 200 mg/dL
- Presence of diabetes-specific antibodies (e.g., Insulin Autoantibodies (IAA), Glutamic Acid Decarboxylase Autoantibodies (GADA), Zinc Transporter-8 Autoantibodies (ZnT8A), Islet Cell Cytoplasmic Autoantibodies (ICA))
- C-Peptide < 0.2 nmol/L
- Hyperglycemia in the presence of antibodies

T1D Treatment

The gold standard treatment for T1D involves insulin therapy administered via different methods:
- Multiple Daily Injections (MDI)
- Continuous Insulin Infusion (CI)
Blood glucose monitoring is essential to manage T1D:
- Self-Monitoring of Blood Glucose (SMBG)
- Continuous Glucose Monitoring (CGM)
Target blood glucose levels are typically between 80-120 mg/dL.

Managing Hypoglycemia and Hyperglycemia

Hypoglycemia is defined as low blood glucose levels, typically below 70 mg/dL.
Signs and symptoms of hypoglycemia include:
- Shaking, sweating, feeling nervous, hunger, dizziness, and confusion.
Treatment for hypoglycemia includes consuming quick-acting carbohydrates like juice, glucose tablets, honey, or sugar.
In severe cases, glucagon injections are administered to increase blood glucose levels.
Hyperglycemia occurs when blood glucose levels are above 150 mg/dL.
Symptoms of hyperglycemia include:
- Polyuria (increased urination)
- Polydipsia (increased thirst)
- Polyphagia (increased hunger)
- Blurred vision
- Fatigue.
Treatment for hyperglycemia involves adjusting insulin dosing and monitoring blood glucose levels.
Inpatient management of hyperglycemia requires close monitoring and interventions to maintain blood glucose levels within safe ranges.
Correction factors (CF) can be calculated to determine the necessary insulin dosage for glucose correction.

T1D Complications

Long-term complications of T1D can impact various organ systems:
- Microvascular complications: Include retinopathy (eye damage), nephropathy (kidney damage), and neuropathy (nerve damage).
- Macrovascular complications: Include cardiovascular disease, peripheral vascular disease, and cerebrovascular disease.
Management of T1D complications involves:
- Regular monitoring and screening for early detection.
- Lifestyle modifications, including diet, exercise, and smoking cessation.
- Medications to manage underlying conditions such as high blood pressure and high cholesterol.
Neuropathy: Nerve damage, particularly the most common type, distal symmetric polyneuropathy (DPN) can lead to loss of sensation, pain, and balance issues.
- Early screening for DPN in individuals with T1D is recommended, and foot exams should be regularly conducted to identify potential complications.
- Treatment options for DPN include medications such as pregabalin, gabapentin, tricyclic antidepressants (TCAs), and topical treatments like lidocaine or capsaicin.
Diabetic nephropathy: Involves the progressive deterioration of kidney function.
- Early detection and management are crucial to slow down the progression of kidney disease.
- Treatment includes:
  - Annual creatinine, urinary albumin excretion, and potassium monitoring.
  - ACE inhibitors or angiotensin II receptor blockers (ARBs) to manage high blood pressure and protect the kidneys.
  - Insulin dose adjustments based on GFR.
  - Referral to nephrology if GFR falls below 30.

New Developments in T1D Management

New Insulin Therapies:
- Once-weekly insulin analogs like Icodec (Novo Nordisk) and Efsitora (Lilly) are being investigated for their potential to improve glycemic control and reduce hypoglycemia.
T1D Onset Delay:
- Teplizumab (ProventionBio & Sanofi) is FDA-approved to delay T1D onset.
- It is effective at delaying the onset of T1D for approximately 2 years in individuals with detectable antibodies and without seroconversion to T1D.
Investigational Medications:
- T2DM medications like metformin and GLP-1 agonists are being studied for their potential to reduce insulin requirements and improve blood glucose control in people with T1D.

Essential T1D Management Supplies

Individuals with T1D need a comprehensive set of supplies for effective management:
- T1D Medical Alert ID.
- Insulin (basal and bolus) delivered via various devices (e.g., insulin pens, insulin pumps).
- Needles or infusion sets for insulin delivery depending on the device.
- Skin adhesives for pump sites.
- Blood glucose monitoring equipment (SMBG or CGM) with related supplies (testing strips, lancets, skin adhesives for CGM).
- Glucagon injection (expires annually).
- Supplies for treating hypoglycemia.
- Alcohol preps for cleansing injection sites.

Importance of Regular Monitoring and Follow-Up

T1D requires a proactive approach to management, including:
- Quarterly visits with healthcare providers for HbA1c monitoring and neurological and podiatric assessments.
- Yearly fundoscopic exams to evaluate eye health.
- Adherence to health plans for managing T1D at school and in daily life.
- Extra supplies for emergencies such as pump site failures, insulin degradation, or unexpected changes in blood glucose levels.

Type 1 Diabetes Overview

Type 1 Diabetes (T1D) is an autoimmune disease in which the immune system destroys the insulin-producing beta cells in the pancreas.
Beta cell destruction is complex and is influenced by genetic predisposition and environmental factors.
Approximately 1.25 million Americans have T1D which represents only 5-10% of all diabetes cases.
The incidence of T1D has increased 21% between 2001 and 2009.

T1D Pathophysiology

Pancreatic tissue samples from individuals with T1D at the onset of symptoms show signs of chronic inflammation in the endocrine portions.
This inflammation is further evidenced by the presence of autoantibodies.
Over time, the pancreas undergoes anatomical changes, including a decrease in size and weight, contributing to the progressive autoimmune process.

T1D Etiology

Genetic Predisposition: Certain genes, particularly those associated with HLA-DQ and HLA-DR, increase susceptibility to T1D.
Environmental Factors:
- Coxsackie Virus: Historical evidence suggests a link between Coxsackie Virus B4 and the development of T1D.
- Cow's Milk: Early introduction of cow's milk has been associated with an increased risk of T1D due to the presence of diabetogenic antigens that trigger an immune response.

T1D Diagnosis & Treatment

Diagnosis relies on clinical presentation, laboratory testing, and assessment of autoantibodies.
Laboratory Tests: Fasting plasma glucose (FPG), random plasma glucose (RPG), glycosylated hemoglobin (A1c), C-peptide, and autoantibody testing.
Treatment Gold Standard: Insulin therapy through multiple daily injections (MDI) or continuous insulin pumps (CI), combined with self-monitoring of blood glucose (SMBG) or continuous glucose monitoring (CGM).

T1D Management

Patients with T1D require regular monitoring of blood glucose levels and adjustments to insulin doses based on individual needs.
Hyperglycemia:
- Symptoms include polyuria, polydipsia, polyphagia, blurry vision, and fatigue.
- Treatment involves insulin correction doses based on blood glucose readings, target blood sugar range, and individual insulin sensitivity.
- For blood glucose levels exceeding 250 mg/dL: check for ketones, adjust fluid intake, and monitor for signs of diabetic ketoacidosis (DKA).
Hypoglycemia:
- Symptoms include sweating, shakiness, confusion, and loss of consciousness.
- Treatment involves prompt administration of "quick" carbohydrates such as juice, glucose tablets, or honey.
- "Quick" carbs should be followed by a "slow" carb to prevent rebound hyperglycemia.

T1D Complications

Diabetic Ketoacidosis (DKA): A serious complication of uncontrolled T1D characterized by dehydration, high blood glucose, and accumulation of ketones, leading to metabolic acidosis.
Long-Term Complications:
- Retinopathy: Damage to the blood vessels in the retina, potentially leading to vision loss.
- Nephropathy: Damage to blood vessels in the kidneys, leading to kidney dysfunction and potentially kidney failure.
- Neuropathy: Damage to nerves, often affecting the feet and hands, causing numbness, pain, and weakness.

Insulin Therapy

Insulin Resistance: Individuals with insulin resistance may require higher insulin doses and might benefit from higher potency insulin formulations.
Pregnancy: Tight blood glucose control is crucial during pregnancy to prevent complications for both mother and fetus.

Future Developments

New Insulin Formulations: Research is ongoing to develop longer-acting insulin analogs aimed at improving blood glucose control and reducing hypoglycemia.
Prevention: Research is investigating the use of teplizumab, an antibody that can delay the onset of T1D in individuals with detectable autoantibodies.

Importance of Comprehensive Care

Patients with T1D require regular checkups, including A1C monitoring, neurologic and podiatric assessments, and annual funduscopic exams.
Proper management of T1D involves close collaboration between patients, healthcare providers, and family members.

T1D Overview

T1D is an autoimmune disease that causes the body to destroy beta cells in the pancreas, resulting in an inability to produce insulin.
T1D is a chronic condition that requires lifelong management with insulin therapy.
Prevalence of T1D is 1.25 million Americans, representing only 5-10% of all diabetes cases.
Incidence of T1D has increased by 21% between 2001-2009.

T1D Pathophysiology & Etiology

T1D develops due to genetic predisposition and environmental triggers.
Genetic factors include HLA-DQ and HLA-DR genes.
Environmental triggers may include Coxsackie virus, cow’s milk, and other factors.
Pancreatic tissue specimens taken at the onset of symptoms show signs of chronic inflammation.

T1D Diagnostic Tests

T1D diagnosis relies on clinical presentation, fasting plasma glucose (FPG), random plasma glucose (RPG), A1C levels, C-peptide levels, and antibody testing.

T1D Treatment & Management

Treatment involves insulin therapy delivered via multiple daily injections (MDI) or continuous insulin pump (CIP) with self-monitoring of blood glucose (SMBG) or continuous glucose monitoring (CGM).
Glucagon injection is used to treat severe hypoglycemia.
Dietary management plays a crucial role in managing blood glucose levels.
Correction factor (CF) is used to calculate insulin doses for correcting hyperglycemia.

T1D Complications

Complications include hyperglycemia, hypoglycemia, diabetic ketoacidosis (DKA), neuropathy, nephropathy, retinopathy, and cardiovascular disease.
Hyperglycemia occurs when blood glucose > 150 mg/dL.
Hypoglycemia occurs when blood glucose < 70 mg/dL.
DKA is a serious condition resulting from high blood glucose and dehydration.
Neuropathy can cause numbness, tingling, and pain in the extremities.
Nephropathy is damage to the kidneys.
Retinopathy is damage to the eyes.
Cardiovascular disease is a leading cause of death in people with T1D.

T1D Medications

Amylin (Pramlintide): a synthetic amylin analog used as adjunctive therapy for post-prandial glucose control.
SGLT1/2 inhibitors: (Dapagliflozin, Empagliflozin) inhibit glucose reabsorption in the kidneys and are used as adjunctive therapy for reducing A1C and FPG/RPG levels.

Insulin Therapy for Special Populations

Insulin-resistant patients may require higher potency or concentration insulin.
Pregnant women with T1D require tighter glucose control to prevent complications.

New Treatments & Research

Novel once-weekly insulins (Icodec and Efsitora) with longer half-lives are being investigated to improve glycemic control with fewer hypoglycemic episodes.
Teplizumab is a monoclonal antibody approved for delaying T1D onset in individuals with detectable antibodies.

T1D Management Resources

T1D medical alert ID is essential for patients with T1D.
Regular monitoring of blood glucose, A1C levels, and neuro/podiatry checks are vital for managing T1D.
Appropriate supplies for insulin delivery, blood glucose monitoring, and treatment of hypoglycemia are crucial for managing T1D.

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Description

This quiz covers the fundamentals of Type 1 Diabetes (T1D), focusing on its pathophysiology, epidemiology, and diagnosis. Learn about autoimmune destruction, genetic factors, and environmental triggers contributing to T1D, along with its prevalence and suggested diagnostic tests. Test your knowledge on how T1D is diagnosed and treated.