Milk progression to type 1 dm progression autoimmune

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Unformatted text preview: Environmental triggers – Viruses: congenital rubella, coxsackievirus, Viruses: enterovirus, mumps enterovirus, – Early exposure to cow’s milk Progression to Type 1 DM Progression Autoimmune markers (ICA, IAA, GAD) Autoimmune destruction Islet Cell Mass Honeymoon “Diabetes threshold” 100% Islet loss Associated Autoimmune Disorders Disorders • • • Thyroid (Hashimoto’s, Graves’): 5-10% Celiac Disease: 6% Addison’s disease: <1% Nicole Johnson Nicole Miss America 1999 Type 1 diabetes Management Management • • • • • Diabetes team Insulin Diet Exercise Psychological support Banting and Best Banting 1923 Nobel Prize for 1923 discovery and use of insulin in the treatment of IDDM treatment The Miracle of Insulin Patient J.L., December 15, 1922 February 15, 1923 c. 1923 c. Insulin Preparations - US Insulin • Novo Nordisk – – – – – NovoLog (aspart) NovoLog Mix 70/30 Novolin® R Novolin® N Novolin® 70/30 • Sanofi-Aventis – Lantus® (glargine) • Lilly – – – – – – Humalog (lispro) Humalog Mix 75/25 Humulin® R Humulin® N Humulin® 70/30 Humulin® 50/50 • Lente, Ultralente Lente, have been discontinued discontinued Treatment with Insulin Treatment • Total daily requirement: – 0.5-1 unit/kg/day – 1.5 units/kg/day during puberty • Typical Regimens – NPH and Regular – Basal/Bolus: glargine and Novolog/Humalog Insulin Delivery Insulin • • • Vials and syringes Pens Insulin pump Physiological Serum Insulin Physiological Secretion Profile Secretion Plasma insulin ( µU/ml) 75 Breakfast Lunch Dinner 50 Dawn Dawn phenomenon phenomenon 25 4:00 4:00 8:00 12:00 16:00 Time Time 20:00 20:00 24:00 24:00 4:00 8:00 NPH and Regular Plasma insulin ( µU/ml) 75 Breakfast 50 Lunch R R N N 25 4:00 4:00 Dinner 8:00 12:00 16:00 Time Time 20:00 20:00 24:00 24:00 4:00 8:00 NPH and Regular AM 2/3 AM PM 1/3 2/3 NPH 1/3 Regular ½ NPH (2/3) ½ Regular (1/3) NPH and Regular NPH • Regular insulin given 30 min prior to a Regular meal meal • NPH dose often given at bedtime • Prescribed amount of carbs at Prescribed meals/snacks meals/snacks NPH and Regular NPH • • • • AM blood glucoses → Evening NPH AM Evening Lunch → AM Regular Dinner → AM NPH Bedtime → PM Regular Basal/Bolus Breakfast Lunch Plasma insulin Aspart or Lispro Dinner Aspart or Lispro Aspart or Lispro Glargine 4:00 8:00 12:00 16:00 Time 20:00 24:00 4:00 8:00 Basal/Bolus Basal/Bolus • Basal: glargine, 50% total daily dose...
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