NR 601 Final exam review
Weeks 5-8 content Week Topics
,5 Glucose metabolism disorders
Dunphy: Types of diabetes (prediabetes, type 1 and type 2)
Chapter 58: Diabetes
Mellitus p. 909-938 * PreDmM = glucose intolerance, Islet cell–specific antibodies, Screening for
prediabetes and DM should be considered in all individuals who are
Kennedy: overweight or obese, regardless of age, and for all adults aged 45 years
➢ Chapter 14:
Endocrine,
and older.
Metabolic, and * Type I - severe insulin deficiency resulting from beta cell destruction,
Nutritional which produces hyperglycemia due to the altered metabolism of lipids,
Disorders (p.369- carbohydrates, and proteins
376)
➢ Obesity (p. 392-396)
* Type II - abnormal secretion of insulin, resistance to the action of insulin in
the target tissues, and/or an inadequate response at the level of the insulin
receptor.
Types of diabetes- Two types: Type 1 and Type 2- Improper function of the hormone insulin,
secreted by the pancreas. Hyperglycemia is a hallmark sign of diabetes.
Prediabetes: Impaired glucose tolerance (IGT) describes a prediabetic state of hyperglycemia
where a 2-hour post-glucose load glycemic level is 140 to 199 mg/dL.
* Type 1 (insulin deficiency)- Presents mostly during childhood. Genetic predisposition
plus some sort of environmental trigger. Results in an auto-immune disorder in
which the immune system attacks the beta cells of the pancreas to prevent them
from producing insulin (decreases production). Inhibits this first step in the insulin
pathway.
* Type 2- Presents mostly during adulthood. Strongly associated with a genetic
predisposition. Accompanied with other predisposing conditions, such as obesity or
hypertension. Inability of these cells throughout the body to respond to insulin. The
pancreas continues to secrete insulin. The cells throughout the body that are
unable to adequately respond to it.
* Miscellaneous
* Drug-induced diabetes- caused by medications Most commonly occurs with a
group of medications that are known as glucocorticoids (steroids) such as in asthma
or chrons.
* Gestational diabetes
Presentation: acute, subacute, and asymptomatic
* Acute: most severe presenting situation and can be life threatening for both type
I and type II diabetes. very sick over a relatively short period of time, usually only
a couple of days.
S/S: nausea, vomiting, and abdominal pain leads to severe dehydration. Confusion or
unconscious as a result. In type I diabetes, this is known as diabetic ketoacidosis. 30% of
individuals with type I diabetes will initially present before diagnosis. DKA- acidotic due
to the production of ketoacids
Type 2 diabetes: 2% of individuals hyperosmolar nonketotic state- ketones are not
produced. Can occur with either type I or type II diabetes.
, * Subacute: mild to moderate presentation that occurs over a period of weeks
to months.
S/S: Generally, just not feeling as well. Fatigue, increased thirst, frequent urination, or
even weight loss. Most common form of presentation in Type 1 diabetes (70%).
* Asymptomatic screening tests: Type II diabetes affects nearly 10% of the population.
Those with the risk factors of type II diabetes should be routinely screened. Most
common means by which type II diabetes is diagnosed.
* Diagnostic criteria - ADA criteria for diagnosing DM-
* Random BG >200 (week 5 quiz question)
* 3 Ps of DM: polyphagia, polydipsia, polyuria (week 5 quiz question)
* FPG ≥126 mg/dL (7.0 mmol/L). Fasting is defined as no caloric intake for
at least 8 hrs
* 2-h PG ≥200 mg/dL (11.1 mmol/L) during OGTT. The test should be
performed as described by the WHO, using a glucose load containing
the equivalent of 75-g anhydrous glucose load dissolved in water.
* A1C ≥6.5% (48 mmol/mol). The test should be performed in a laboratory
using a method that is NGSP certified and standardized to the DCCT
assay.
* In a patient with classic s/s of hyperglycemia or hyperglycemic crisis
(polyuria, poly dipsia, weight loss), a random plasma glucose ≥200 mg/dL
(11.1 mmol/L)
Current guidelines for the diagnosis of DM include any one of the following:
• Glycosylated hemoglobin (A1C) of 6.5% or higher
• Symptoms of diabetes (e.g., polyuria, polydipsia, weight loss) plus a random
plasma glucose level of 200 mg/dL or higher
• Fasting plasma glucose level of 126 mg/dL or higher (following 8 hours of no caloric intake)
• Two-hour plasma glucose level of 200 mg/dL or higher during an oral glucose
tolerance test (OGTT) with a 75-g glucose load
Diagnostic testing: laboratory tests. The hyperglycemia and the hemoglobin A1C are tested
for in the blood to aid in the diagnosis of diabetes mellitus.
Hemoglobin A1C: greater than or equal to 6.5%
Blood glucose levels: greater than or equal to 200 mg/dL.
* Random- cannot be used to diagnose pre-diabetes.
* Fasting- slightly lower, then the level is 126 mg/dL.
* Two-hour glucose tolerance test
* Initial treatment recommendations
* If FPG is above 126, next action: order A1C (week 5 quiz question)
* Treatment goals for older adults (Kennedy table 14-2)
, * Hbg A1C goals based on complications (Dunphy p.925)
* An A1C value of less than 7% indicates strong control; however, a value of
less than 6.5% has been shown to significantly decrease the occurrence of
complications, provided this can be achieved without hypoglycemia or other
adverse effect.
* Weight loss recommendations (Kennedy)
* modest weight loss of 5% can improve glycemic control
Risk factors (Dunphy p.922)
* Family history (first-degree relative)
* Body mass index >25 kg/m2 (lower for Asian Americans)
* Age >45 years
* Impaired fasting glucose or A1C >5.7%
* History of gestational diabetes
* Hypertension (> 140/90 mm Hg or on antihypertensive therapy)
* Hyperlipidemia (high-density lipoprotein <35 mg/dL, triglycerides
>250 mg/dL)
* Women with polycystic ovarian syndrome
* Race/Ethnicity
• African American
• Latino
• Native American
• Asian American
• Pacific Islander
Complications (Dunphy p.919)
* Type 1 DM, the risk of development or progression of
retinopathy, nephropathy, hyperlipidemia, and neuropathy
* Most common s/e of DM: Yeast infections (week 5 quiz question)
: page 932 Dunphy
• Retinopathy - Optimizing blood pressure and lipid levels can reduce the risk or
slow the progression of retinopathy.
• Hyperlipidemia - an annual fasting lipid profile, including serum cholesterol,
triglyceride, HDL, and calculated LDL cholesterol measurements. Lifestyle
management (i.e., modifications to diet and physical activity),
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