NR601 FINAL EXAM STUDY GUIDE
Week 5: Glucose metabolism disorders
Types of DM
1. Type 1- severe insulin deficiency resulting in reduction or absence of
... [Show More] functioning beta cells in
the pancreatic islets of Langerhans. This leads to hyperglycemia due to altered metabolism of
lipids, carbs, and proteins. Initial s/s of hyperglycemia. Subjective findings- polyuria, polydipsia,
nocturnal enuresis and polyphagia with paradoxical weight loss, visual changes and fatigue.
Objective-dehydration(poor skin turgor and dry mucous), wt loss despite normal/increase
appetite, reduction in muscle mass. DKA-fatigue, cramping, abnormal breathing
2. Type 2- Type 2 DM is 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.
3. Prediabetic- fasting glucose consistently elevated above the normal range but less than 100-125.
Impaired glucose tolerance (IGT) state of hyperglycemia where 2 hr post glucose load glycemic
level is 140-199
Diagnostic criteria- there are 4 lab-based criteria to confirm DM: A1C, random plasma glucose, fasting
plasma glucose, and 2-hr post load plasma glucose
AIC of 6.5 or higher=diabetes
Random plasma glucose level of 200 WITH classic symptoms of hyperglycemia or a
hyperglycemic crisis
Fasting plasma glucose level of 126 or higher on TWO occasions(fasting is defined as no caloric
intake for at least 8 hrs
2-hour post load plasma glucose level of 200 or higher during an OGTT, following consumption of
a glucose load containing the equivalent of 75g of anhydrous glucose dissolved in water (OGTT is
also used to screen for diabetes during pregnancy)
*** In the absence of unequivocal hyperglycemia results should be confirmed by repeat testing on a
new blood sample without delay, preferably using the same type of test.***
*All above-but confirmation of type 2 diabetes mellitus requires: two fasting blood glucoses
≥126 mg/dL or two random blood glucoses ≥200 mg/dL.
You do not screen for type 1 diabetes but you do screen for type 2 if 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
Initial TreatmentType 1- FIRST LINE: INSULIN. The initial goal of treatment for type 1 DM is to normalize the
elevated blood glucose level. This is best accomplished by intensive insulin regimens to achieve
the following goals: plasma glucose levels of 80 to 130 mg/dL before meals, peak postprandial
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