Type 1 Diabetes

Front 1

Type 1 diabetes: Natural History, Epidemiology, DCCT/EDIC, Treatment, Glycemic Targets, Adaptation, Complications, Associated Conditions

Back 1

1. Natural History: genetic predisposition->beta cell injury/insulitis->"pre"-diabetes->diabetes
2. Epidemiology: rates are increasing in children and are highest in developed countries that are further from the equator
3. DCCT/EDIC: clinical trials that guide treatment philosphy
4. Treatment: basal insulin (glargine>detemir>NPH), bolus insulin (aspart,lispro,glulisine)
5. Glycemic Targets: <5yr old-AIC<8.5/PPG 6-12, 5-12yr old-AIC<8/PPG 4-10, 13-18yr old-AIC<7or6/PPG 4-7or6
6. Adaptation: takes 6-9 months, adolescence depends on inter and intrapersonal factors
7. Complications: acute (hypoglycemia, ketoacidosis),microvascular (nephropathy, neuropathy, retinopathy), macrovascular (Cardio, cerebro and peripheral vascular disease)
8. Associated Conditions: thyroiditis, celiac disease, addison's

Front 2

Diabetic Ketoacidosis: Pathogenesis, Treatment, Complications, Danemen's Failure Hypothesis, Implications of Prevention, Mortality Trends

Back 2

1. Pathogenesis: absolute loss of insulin-> FFA breakdown in liver->ketone bodies->acidosis
2. Treatment: low dose insulin, slow infusion of fluids (no hypotonic solutions), replace K+ early, dextrose once glucose at 15-17, avoid bicarbonates
3. Complications: cerebral edema and death
4. Daneman's Failure Hypothesis: DKA is a failure to recognize signs and symptoms of diabetes
5. Implications of Prevention: reduce morbidity and mortality, protect youngest children, prolong honeymoon period, cost-benefit
6. Mortality Trends: countries with lower incidence of diabetes have higher percentage of DKA at presentation