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NR 601 Final Exam 2 Verified Solutions .
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NR 601 Final Exam 2 Verified Solutions .
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NR 601 Final Exam 2 Verified SolutionsPrediabetes - ANS-a condition in which the blood sugar level is higher than
normal, but not high enough to be classified as type 2 diabetes; fasting glucose
consistently elevated above the normal range but less than 100-125;
impaired glucose tolerance - ANS-state of hyperglycemia where 2 hr post glucose load
glycemic level is 140-199
Type 1 diabetes - ANS-severe insulin deficiency resulting in reduction or absence of
functioning beta cells in the pancreatic islets of Langerhans. This leads to
hyperglycemia due to altered metabolism of lipids, carbs, and proteins
Type 1 diabetes: subjective - ANS-polyuria, polydipsia, nocturnal enuresis and
polyphagia with paradoxical weight loss, visual changes and fatigue
Type 1 diabetes: Objective - ANS-dehydration (poor skin turgor and dry mucous), wt
loss despite normal/increase appetite, reduction in muscle mass. DKA (fatigue,
cramping, abnormal breathing, halitosis (rotten fruit + nail polish smell)
Retinopathy; Complication of long standing T1D - ANS-1. dilation of retinal venules and
retinal capillary microaneurysms. 2. Increased vascular permeability. 3. Retinal ischemia
due to vascular occlusion. 4. Angiogenesis - proliferation of new retinal surface blood
vessels. 5. Retinal hemorrhage with fibrovascular proliferation and contraction, which
may lead to retinal detachment
Skin complications; Complication of long standing T1D - ANS-chronic pyogenic
infections or necrobiosis lipoidica diabeticorum (plaques with shiny yellow surface on
anterior surfaces of legs or dorsal aspects of ankles)
Paresthesia; Complication of long standing T1D - ANS-distal extremities -> leads to
(foot ulcers, burns on hands from cooking)
Cranial nerve palsies; Complication of long standing T1D - ANS-Gaze deviations in
affected eyes
Type 2 DM - ANS-characterized by the 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. A patient may, however, present with pruritus, fatigue, neuropathic
complaints such as numbness and tingling, or blurred vision
Ethnicity - ANS-Diabetes most common risk factor
Most common ethnicities at risk for DM - ANS-African American; Latino; Native
American; Asian American; Pacific Islander
Diabetes Diagnostic Criteria - ANS-- hba1c > 6.5 OR
- fasting (no caloric intake for at least 8 hours) plasma glucose >126 OR - 2 hour
plasma glucose >200 during an oral glucose tolerance test following a glucose load of
75 g glucose OR
- patent with symptoms of hyperglycemia, a random plasma glucose >200
results should be confirmed by repeat testing on a new blood sample without delay,
preferably using the same type of test - ANS-absence of unequivocal hyperglycemia
Type 2 DM Diagnosis - ANS-two fasting blood glucoses ≥126 mg/dL or two random
blood glucoses ≥200 mg/dL.
Type 1 DM diagnosis - ANS-You do not screen
Type 2 DM screen - ANS-· an individual is overweight or obese, regardless of age, and
for all adults aged 45 years and older. Tests should be repeated at a minimum of 3 year
intervals
Insulin - ANS-Type 1 DM first line treatment
Type 1 DM 2017 ADA standards - ANS-treated with multiple daily injections of prandial
insulin and daily basal insulin or with a continuous SQ insulin infusion pump
Typ 1 DM - ANS-- Goal is to normalize the elevated blood glucose level;
- achieve plasma glucose levels:
o Before meals: 80-130 o Peak postprandial (1-2 hours after the beginning of a meal): <
180 o Hgb A1C < 7%
80-130 - ANS-Goal Type 1 diabetes: before meal goal
<180 - ANS-Goal Type 1 diabetes: Peak postprandial (1-2 hours after the beginning of a
meal)
,<7% - ANS-Goal type 1 diabetes: HgbA1C:
Single-dose therapy Type 1 diabetes - ANS-Intermediate or long-acting insulin with or
without regular insulin in the morning
Or Intermediate or long acting insulin at bedtime
Recommended at a minimum self monitoring blood glucose in the morning and at
bedtime
Conventional Split Dose Therapy Type 1 diabetes - ANS-· Mixture of NPH and regular
insulin in the morning and evening
· Recommended at a minimum SMBG before each dosing and at bedtime
Intensive insulin therapy 3 injections Type 1 diabetes - ANS-· NPH + regular insulin in
the morning; regular insulin at dinner; NPH insulin at bedtime
· Monitor for increased risk of hypoglycemic episodes
Intensive insulin therapy 4 injections Type 1 diabetes - ANS-Regular or lispro insulin
before meals and long-acting insulin to maintain basal insulin levels
Insulin Glulisine - ANS-Onset: <5 min; Peak 1-2 hours; duration 2-3 hours. Example:
Apidra
Insulin Aspart - ANS-Onset: <10 min; Peak 1-3 hours; duration 3-5 hours.
Example: Novolog
Insulin Lispro - ANS-Onset: <15 min; Peak 1-2 hours; duration 3-4 hours; Example
Humalog
Regular insulin - ANS-Onset: <30-60 min; Peak 2-6 hours; duration 6-8 hours;
examples: Humulin R; Iletin II Regular; Novolin R; Purified ; Pork Regular; Velosulin
Insulin (NPH) - ANS-Onset: <1-1.5hr ; Peak 4-12 hours; duration 18-24 hours ;
Examples: Humulin N; Iletin II NPH; Novolin N; Purified Pork NPH
NPH/Regular insulin - ANS-Onset: <30-60min ; Peak 70/30= 2-12hr, 50/50 3-5hr hours;
duration: 24hr Examples: Humulin 70/30; Humulin 50/50; Novolin 70/30
insulin glargine - ANS-Gradual onset, peakless, duration up to 24 hours; Lantus
, Insulin Detemir - ANS-Gradual onset, peak 6-10 hours; duration 24 hours; Levemir
Life style management - ANS-First line treatment for type 2 DM
Lifestyle management for Type 2 DM - ANS-- Nutrition therapy; Activity prescriptions for
exercise; Decreased prolonged sitting; Older adults: training in balance and flexibility;
Mental health; Proper sleep; Smoking cessation; Obesity management; Diabetes
self-management education and diabetes self-management support at the time of
diagnosis; Treatment directed at both risk reduction and glycemic control
Metformin - ANS-First line pharmacological treatment for Type 2 DM if lifestyle
management doesn't work
Contradictions for metformin - ANS-renal disease or abnormal creatinine clearance,
acute MI, or septicemia; Not for patients with an eGFR < 45
Add second agent - ANS-what to do if Hgb A1C is > 7.5% at the time of diagnosis or
after 3 months of monotherapy
A1C<7% - ANS-indicates strong blood sugar control
A1C <6.5% - ANS-decreases occurrence of complications achieved w/o hypoglycemia
or other adverse effects
A1C - ANS-monitors blood sugar over 2-3 months and is helpful in documenting control
and continuing care
at dx of Type 2 DM - ANS-begin lifestyle therapy with medically assisted obesity
treatment
type 2 diabetes - ANS-- After 3 months, if glycemic goals are not met, begin a
single-agent or dual therapy with antidiabetic agents, depending on whether A1C is < or
> 7.5%
Triple therapy - ANS-Type 2 DM; glycemic controls are not met in 3 months, initiate this
Type 2 DM - ANS-If after 3 additional months (or at the time of diagnosis) A1C is 9.0%
or higher and the patient is symptomatic, add
Metformin - ANS-- Monotherapy
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