NR 601 FINAL EXAM - Correct solutions 2024/2025
Diabetes Diagnostic criteria - ANS -- 2 fasting BS > 126
-Random BS >200 if sx of DM present
- A1C > 6.5 x2
- 2 hour plasma glucose (OGTT) >200
- Prediabetes 5.7-6.4 A1C
Initial Tx of DM - ANS -- Type 1: usually need hospitalization d/t being in crisis,
endocrinology, daily basal & prandial insulin
-Type 2: A1C <7.5: Nutritional therapy, physical activity, weight loss, monotherapy
(usually metformin).
>7.5 @ diagnosis or after 3 months: add a 2nd agent
>9.0 insulin (AACE)
>10 insulin (ADA)
DM medication side effects - ANS -- Metformin: decr B12 absorption, diarrhea,
nausea, anorexia, abd discomfort, *lactic acidosis* (rare), metallic taste
- Sulfonylureas (glyburide, glipizide): hypoglycemia, weight gain, GI upset, skin rashes,
severe anemia, headache
- Acarbose & Miglitol (alpha- glucosidase inhibitors): flatulence & diarrhea
-Actos & Avandia (thiazolidinones): weight gain, URI, edema, anemia, hypoglycemia,
*CHF*, possible liver damage, bladder tumors
, - Januvia, onglyza, nesina: stevens-johnson syndrome, pancreatitis, renal failure, abd
pain
- Trulicity, Tanzeum, Victoza (glucagon-like peptide-1..): pancreatitis, arthralgia
- Invokana, Farxiga, jardiance (NA-glucose transport..): renal failure, ketoacidosis,
hypotension, genital fungal infections
- Glufast, Starlix, Prandin (Meglitinides): wt gain, hypoglycemia
DM Tx goals - ANS -- Healthy pt, long life exp.: A1C <7.5, Fasting: 90-130, Bedtime:
90-150, BP: <140/90,
- Complex/intermediate pt, interm. life exp., A1C <8.0, Fasting: 90-150, Bedtime: 100-
180, BP <140/90
- Very complex/poor health, limited life exp, A1C < 8.5, Fasting: 100-180, Bedtime: 110-
200, BP <150/90
*A1C < 6.5 reduces complications*
DM weight loss recommendations - ANS -- Wt loss not recommended in frail elderly
d/t risk of sarcopenia, but even modest exercise is good.
-5% weight loss recommended
DM Risk factors - ANS --Type 1: Caucasians, environmental, autoimmune, and viral
toxins, young age, congenital rubella, CMV, Adenovirus, Coxsackie B4, and mumps,
high birth weight