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NR 565 FINAL EXAM STUDY GUIDE FROM WEEK 5-8
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NR 565 FINAL EXAM STUDY GUIDE FROM WEEK 5-8
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, lOMoARcPSD| 47481126Diabetes Mellitus
Leading cause of kidney failure, nontraumatic limb amputation, new
cases of adult blindness, heart disease and stroke.
Acute symptoms of diabetes plus casual plasma glucose concentration
greater than or equal to 200 mg/dL.
Casual is defined as any time of day without regard to time since last
meal. The classic symptoms of diabetes are polyuria, polydipsia, and
unexplained weight loss.
2 hour post-load plasma glucose in an oral glucose tolerance test
greater than or equal to 200 mg/dL. The test uses a glucose load
containing the equivalent of 75 g anhydrous glucose dissolved in
water.
HgbA1C greater than or equal to 6.5%
Fasting plasma glucose greater than or equal to 126 mg/dL.
Fasting is defined as no caloric intake for at least 8 hours
Pre Diabetes
Fasting plasma glucose 100 to 125 mg/dL (IFG) or
HgbA1c 5.7% to 6.4%
Plasma glucose 140 to 199 mg/dL (IGT) 2 hours post-ingestion of
standard glucose load (75 g)
Criteria for diagnosis
FPG > or = to 126
Oral glucose tolerance test (OGTT) 2hr plasma glucose > or =
t0 200
Random Plasma glucose > or = to 200mg/dL plus DM
symptoms
HgbA1C 6.5% or higher Treatment
Step 1Lifestyle change and metformin
Step 2 Continue step 1 and add second drug
Step 3 continue step one and progress to 3 drug combination
If step 3 includes basal insulin falls, combine injectable
regimen with possibly a GLP-1 receptor agonist Insulin
, lOMoARcPSD| 47481126
MOA: Anabolic, energy conservation, promotes cellular growth
and division
Baseline data: random plasma glucose, urinate glucose and
ketones, A1c, serum electrolyte
Monitor glucose lever and A1c every 2-4 times per year (every 3
month max)
CI: medication that impact blood glucose (sulfanuria and
steroids)
SE: educate s/s of hypo and hyperglycemia
Insulin lisipro Regular insulin Humulin N and Lantus Insulin
Rapid: Humalog Humulin R, Novolin N (insulin degludec Novolin
R: short (NPH): glargine) (Tresiba)
acting intermediate Ultralon acting
g
onset 15-30min 30-60min 60-120min 70min 30-
90min
duratio 3-6hrs 6-10hrs 12-24hrs 18-24hrs >24hrs
n
Biguanides: Metformin (max 2000mg/day)
MOA: inhibits glucose production in liver, reduces glucose absorption
in the gut, synthesizes insulin receptor to increase glucose uptake
Therapeutic use
Glycemic control, DM2 prevention, gestational DM, PCOS
Side effect: decrease appetite, nausea, diarrhea, absorption of vitamin
B12 and folate
(can cause spinal bafida and neural tubal defect if taken while
pregnant)
Black box: lactic acidosis (hemodialysis might be needed)
Monitor renal function Sulfonylureas
MOA: stimulate insulin release from pancreatic islets
Basic data: random plasma glucose, fasting plasma glucose, A1c,
serum electrolyte, urine ketone and glucose
Monitoring: glucose level and A1c 2-4times/year
CI: pregnancy, Brest feeding, renal dysfunction and hepatic
dysfunction
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