0 ophthalmology exam no retinopathy tsh ft4 normal

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Unformatted text preview: crobiosis Prayer Sign Prayer Limited joint Limited mobility mobility Associated with: Associated poor control, increased risk of retinopathy, nephropathy nephropathy Monitoring Monitoring • • • Hemoglobin A1c – every 3 months Celiac screen – at diagnosis and if ssx Annually – – – – TSH Ophthalmology exam - after 10 and 3-5 yrs disease Ophthalmology Urine microalbumin - after 10 and 5 yrs disease Lipid panel - puberty, unless fam hx, q5 years if Lipid normal normal – Influenza vaccine Influenza Case 1 Case • • • • • Hemoglobin A1c - 6.0% Ophthalmology exam – no retinopathy TSH, FT4 – normal Lipids – cholesterol 143 Urine microalbumin - negative Hemoglobin A1c Hemoglobin A1C • Reflects blood Reflects glucose over the past 3 months months • Goal <7 for adults <7.5% for teens <7.5% <8% for 6-12 y/o <8% 7.5-8.5% for <6 y/o 7.5-8.5% BG 6 135 7 170 8 205 9 240 10 275 11 310 12 345 Case 1 Case • 1 year after diagnosis, remains diligent year about sending blood sugars about • Insulin requirements 0.5 units/kg/day • A1c 5.9% • Interested in the insulin pump )))) ))))) )))) Insulin Pump Candidates Insulin • Highly motivated • Willing to perform frequent blood Willing glucose monitoring glucose • Good control on basal/bolus regimen • Proficient at carbohydrate counting • Proficient at adjusting insulin doses with Proficient I:CHO and correction factor I:CHO Insulin Pump Insulin • • Only NovoLog or Humalog insulin Hourly basal rate: Hourly 1. 1. 2. 3. • 80% of total daily insulin dose Divided by 2 Divide by 24 Same I:CHO and correction factor Insulin Pump Insulin • Advantages – Mimics physiologic pancreatic secretion – Lifestyle – Accurate dosing – Less hypoglycemia • Disadvantages – No depot to protect from DKA – Labor intensive – Expensive Jason Johnson Jason Detroit Tigers Detroit Pitcher Pitcher Type 1 diabetes Type diagnosed age 11 diagnosed Wears insulin pump Wears on field on Case 2 Case • 9 y/o male with type 1 diabetes for 4 y/o years years • NPH and Regular insulin 2 shots per day • Total insulin dose = 0.8 units/kg/day • Relatively high AM numbers Case 2 Case B L D HS 200 110 106 120 220 97 102 115 198 105 132 110 241 99 96 122 Case 2 Case • What is going on? • What additional information...
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