A General Overview of Type 1 Diabetes
Savranthi Madala, MD, PhD. Endocrinology Specialist at AristaMD
Just a general overview of type 1 diabetes. Only five to 10% of all of diabetes is type one. And like I said, there’s an absolute deficiency of insulin because of the beta cell destruction in the pancreas. And there are autoimmune markers present in 80% of these individuals. So when considering testing someone for type two, type one diabetes, we consider testing the anti GAD 65 antibody, the islet cell antibody, and an insulin antibody as long as the patient’s not already on insulin. And in type one diabetes, about 5% of patients have a first degree relative with diabetes. So the genetic components are there, but they’re not as strong as type two diabetes and the treatment for type one diabetes. Because there is no insulin, it is insulin. Typically these patients, they always require basal and based on when they present in childhood versus adulthood childhood.
In type one diabetes, al always typically requires both basal and bolus insulin in adulthood. If it is latent autoimmune diabetes of adulthood and has a slow onset of, um, destruction, it is still type one, but they may not need short acting insulin right from the get go. There’s a typically a honeymoon period when these patients do not need high levels of insulin. So patients require long-acting insulin, such as glargine. It’s typically given one to two times a day. Over 50 units a day should be split into two times a day just because the absorption is better and less leakage is there on the injection site. That’s a general rule of thumb for any type of insulin. And then they also require rapid acting insulin with meals aspart, a k, a NovoLog, or lispro, AKA Humalog, and there are other, um, short acting insulins out there. Now, Admiral Analog FIAs their ultra fast acting, typically NovoLog and Humalog need to be given 15 minutes prior to a meal. Whereas Admiral Log or, or FIAs, or they need to be given five minutes before the meal or with the first bite. So if a patient has trouble remembering to take it 15 minutes before the meal in order to allow the IT to build up a steady state, then consider putting them on ultra fast acting such as FIAs or luge.
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Five Ways eConsults Support Value-Based Care
Combine your referral management platform with an eConsult solution to reduce patient wait times and the cost of care. Learn five ways our eConsults support value-based care by allowing primary care physicians, nurse practitioners or PAs to submit electronic requests for patient advice to our team of specialists to manage low-acuity patients.
#1 Help Patients Avoid Unnecessary Face-to-Face Specialty Visits
About 70% of eConsults can address what physicians typically send for a face-to-face specialty visit. As a web-based physician-to-physician consultation, there is no need for any particular technology or integration — the PCP orders the referral the same way they would traditionally order one. Or suppose the patient was to go face-to-face for a specialty consult with the provider using our referral nurse coordination, RNN service, and nurse navigators. In that case, our nurse will curate the eConsults by grabbing all of the data needed for the patient from the chart. Private health information is then sent to our specialist, who reviews the data and provides an evidence-based response on that patient’s best practice and management. Within four to six hours, the primary care provider receives a notification and can view the eConsult specialist’s recommendations.
The bottom line — for every specialty visit where we serve the patient using an eConsult and address issues through the primary care provider, we can fend off the need for three face-to-face visits. Also, once you gain specific knowledge from a specialist on a particular condition, you have the answer to the same question when it comes up again.
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Savranthi Madala, MD, PhD
Endocrinology Specialist at AristaMD
Savranthi Madala, MD, PhD, is Board Certified in Internal Medicine and fellowship-trained in endocrinology. She attended medical school at the Medical College of Virginia followed by residency at the University of Connecticut Medical Center. Dr. Madala completed her fellowship in endocrinology at the Warren Alpert Medical School of Brown University.