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Etiology * Autoimmune destruction of pancreatic -cells * Genetic predisposition (HLA-DR3, HLA-DR4) * Environmental triggers (e.g., viral infections) Risk Factors * Family history of T1DM * Other autoimmune diseases * Genetic susceptibility * Younger age (peak onset: 47 years and 1014 years) Pathophysiology * Autoimmune -cell destruction * Progressive loss of insulin secretion * Increased hepatic glucose production * Reduced peripheral glucose uptake * Increased lipolysis and ketogenesis * Risk of Diabetic ketoacidosis (DKA) Clinical Features * Polyuria * Polydipsia * Polyphagia * Weight loss * Fatigue * Blurred vision * Nocturia * Recurrent infections * DKA may be the initial presentation Diagnosis Diagnosis is made by any one of the following: * Fasting plasma glucose 126 mg/dL (7.0 mmol/L) * Random plasma glucose 200 mg/dL (11.1 mmol/L) with classic symptoms * 2-hour plasma glucose 200 mg/dL (11.1 mmol/L) during a 75-g oral glucose tolerance test * HbA1c 6.5% (48 mmol/mol) Investigations * Blood glucose * HbA1c * Urinalysis (glucose and ketones) * Serum ketones * Electrolytes and renal function * Arterial or venous blood gas if DKA is suspected * Lipid profile * Thyroid function tests * Screening for Celiac disease and autoimmune thyroid disease Management Insulin Therapy * Lifelong insulin replacement * Basal-bolus regimen (preferred) * Continuous subcutaneous insulin infusion (insulin pump) in selected patients Monitoring * Self-monitoring of blood glucose or continuous glucose monitoring (CGM) * HbA1c every 3 months until stable, then every 36 months Lifestyle * Medical nutrition therapy * Regular physical activity * Carbohydrate counting * Diabetes education * Foot care Hypoglycemia Management * Conscious patient: 1520 g fast-acting carbohydrate * Unconscious patient: IV dextrose or IM glucagon Acute Complications * Diabetic ketoacidosis * Hypoglycemia Chronic Complications Microvascular * Diabetic retinopathy * Diabetic nephropathy * Diabetic neuropathy Macrovascular * Coronary artery disease * Stroke * Peripheral arterial disease Prognosis * Good glycemic control significantly reduces the risk of microvascular complications

Gluten-Free

No, Mounjaro should not interact with nicotine patches, such as NicoDerm CQ or Habitrol

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