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Type I Diabetes Mellitus

Type I Diabetes Mellitus. MR 8/14/09 J.Chen. Management. Insulin Monitoring Nutrition Exercise Education. Insulin. Insulin Requirements. Preadolescent-0.5-1 unit/kg/day Adolescents-0.8-1.2 units/kg/day During honeymoon period-<0.5 units/kg/day. Starting an Insulin Regimen.

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Type I Diabetes Mellitus

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  1. Type I Diabetes Mellitus MR 8/14/09 J.Chen

  2. Management • Insulin • Monitoring • Nutrition • Exercise • Education

  3. Insulin

  4. Insulin Requirements • Preadolescent-0.5-1 unit/kg/day • Adolescents-0.8-1.2 units/kg/day • During honeymoon period-<0.5 units/kg/day

  5. Starting an Insulin Regimen • Split mixed Regimen vs. Basal/Bolus Regimen

  6. Split/Mixed Regimen • 2-3 injections based on NPH • 2/3 in AM, 1/3 in PM • 2/3 NPH, 1/3 Regular/Rapid • More rapid/regular may be required in AM because of dawn phenomenon (nocturnal release of counter regulatory hormones-less insulin sensitivity in AM) • May require less during Honeymoon period

  7. Split/Mixed Regimen

  8. Monitoring • Traditionally before meals, at bedtime, overnight • More often when ill or active • Acceptable range • Fasting/preprandial: • preschool: 100-180mg/dL • School age: 90-180mg/dL • Teenagers: 90-130mg/dL • Bedtime/overnight • Preschool: 110-200mg/dL • School age:100-180mg/dL • Teenagers: 90-150mg/dL

  9. Basal Bolus Regimen • Aims to achieve more physiologic insulin concentrations • Basal provides baseline or fasting insulin • Bolus provides coverage for food and correct for hyperglycemia • Basal rate given either through injection or via insulin pump

  10. Basal/Bolus Regimen • Basal requirement ~50% daily insulin need • Either long acting insulin or • Rapid acting insulin via pump • Bolus dose has 2 parts: • 1. coverage for carbohydrates in meal • 2. correction for blood glucose concentration outside of target range.

  11. Monitoring • HbA1c • <6yr: 7.5-8.5% • 6-12yr:<8% • 13-19yr: <7.5% • Urine or blood ketones should be monitored: • Blood glucose elevated • Nausea • Vomiting • Feeling ill

  12. Nutritional Management • Balanced Diet with adequate calories and nutrients for normal growth • 50-55% carbohydrate calories, 20% protein calories, 30% fat calories • Most carb calories should be complex carbohydrates • Fat portion should be low in cholesterol and saturated fats

  13. Nutritional Management • Split/Mixed- • timing important • Snacks • Treats should be allowed • Basal/Bolus • Flexibility in timing, amount, and content • Accurate carb counting and insulin dose calculation

  14. Next TIME: DKA

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