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Source: Triplitt CL, Repas T, Alvarez C. Diabetes mellitus. In: DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM, eds. Pharmacotherapy: A Pathophysiologic Approach. 10th ed. New York, NY: McGraw-Hill; 2017. http://accesspharmacy.mhmedical.com/content.aspx?bookid=1861§ionid=146065891. Accessed March 9, 2017.
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CONDITION/DISORDER SYNONYMS
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Autoimmune disorder usually developing in childhood or early adulthood probably initiated by exposure of genetically susceptible individual to unknown environmental agent.
Idiopathic type 1 DM is nonimmune form often seen in minorities, especially Africans and Asians, with intermittent insulin requirements.
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Immune-mediated destruction of pancreatic β-cells usually resulting in absolute deficiency of insulin.
A genetically susceptible individual must be exposed to a trigger that initiates the autoimmune process and destruction of pancreatic β-cells.
β-Cell destruction thought to occur during long preclinical period (9–13 years) associated with presence of immune markers.
Hyperglycemia occurs when 80–90% of β-cells are destroyed.
A transient remission (“honeymoon phase”) may precede established disease with associated risks for complications and death.
Factors initiating the autoimmune process unknown, but process mediated by macrophages and T lymphocytes with autoantibodies to β-cell antigens (eg, islet cell antibody, insulin antibodies)
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PREVENTION AND SCREENING
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Parent or sibling with type 1 DM
Mother who had preeclampsia during pregnancy.
Respiratory infection shortly after birth.
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CLINICAL PRESENTATION
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Onset: usually abrupt, <30 years old.
Patients often thin and prone to develop diabetic ketoacidosis (DKA) if insulin withheld or under conditions of stress.
20–40% of patients present with DKA several days of.
Polyuria.
Polydipsia.
Polyphagia.
Weight loss.
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Criteria for diagnosis of DM include any one of the following:
A1C ≥6.5%
Fasting plasma glucose ≥126 mg/dL (7.0 mmol/L)
2-hour plasma glucose ≥200 mg/dL (111.1 mmol/L) during oral glucose tolerance test (OGTT) using 75 g anhydrous glucose in water.
Random plasma glucose concentration ≥200 mg/dL (111.1 mmol/L) with symptoms of hyperglycemia.
In absence of unequivocal hyperglycemia, confirm criteria 1 through 3 by repeat testing.
Normal fasting plasma glucose (FPG) <100 mg/dL (5.6 mmol/L)
Impaired fasting glucose defined as FPG of 100–125 mg/dL (5.6–6.9 mmol/L)
Impaired glucose tolerance diagnosed when 2-hour postload sample of OGTT ...