NR 601 Answers to final exam study guide.docx
1. Types of diabetes
3 Types
• Type 1 diabetes can develop at any age, but occurs most frequently
... [Show More] in children and adolescents. When you have type 1 diabetes, your body produces very little or no insulin, which means that you need daily insulin injections to maintain blood
glucose levels under control.
• Type 2 diabetes is more common in adults and accounts for around 90% of all diabetes cases. When you have type 2 diabetes, your body does not make good
use of the insulin that it produces. The cornerstone of type 2 diabetes treatment is healthy lifestyle, including increased physical activity and healthy diet.
However, over time most people with type 2 diabetes will require oral drugs and/or insulin to keep their blood glucose levels under control.
• Gestational diabetes (GDM) is a type of diabetes that consists of high blood glucose during pregnancy and is associated with complications to both mother
and child. GDM usually disappears after pregnancy but women affected and their children are at increased risk of developing type 2 diabetes later in life.
Diagnostic criteria
• A fasting plasma glucose (FPG) level of 126 mg/dL (7.0 mmol/L) or higher, or
• A 2-hour plasma glucose level of 200 mg/dL (11.1 mmol/L) or higher during a 75g oral glucose tolerance test (OGTT), or
• A random plasma glucose of 200 mg/dL (11.1 mmol/L) or higher in a patient with classic symptoms of hyperglycemia or hyperglycemic crisis
Whether a hemoglobin A1c (HbA1c) level of 6.5% or higher should be a primary diagnostic
Initial treatment
The American Diabetes Association recommends routine screening for type 2 diabetes beginning at age 45, If the results are normal, repeat the test every three years. Screening is also recommended for people who are under 45 and overweight if there are other heart disease or diabetes risk factors present, such as a sedentary lifestyle, a family history of type 2 diabetes, a personal history of gestational diabetes or blood pressure above 140/90 millimeters of mercury
For patients with type 2 diabetes with overweight (BMI ≥25 to 29.9 kg/m2) or obesity (BMI ≥30 kg/m2)
Examples of possible treatments for type 2 diabetes include:
Biguanides
Metformin (Glucophage, Glumetza, others). Generally, metformin is the first medication prescribed for type 2 diabetes. It works by lowering glucose production in
the liver and improving your body's sensitivity to insulin so that your body uses insulin more effectively.
Nausea and diarrhea are possible side effects of metformin. These side effects may go away as your body gets used to the medicine or if you take the medicine with a meal. If metformin and lifestyles changes aren't enough to control your blood sugar level, other oral or injected medications can be added.
Medications
• Metformin (Fortamet, Glucophage, others Action
• Inhibit the release of glucose from the liver
• Improve sensitivity to insulin
Advantages
• Very effective
• May promote modest weight loss
• Low cost
Possible side effects
• Nausea
• Diarrhea
• Very rarely, the harmful buildup of lactic acid (lactic acidosis) when used in patients with kidney or liver failure
Alpha-glucosidase inhibitors
Medications
• Acarbose (Precose)
• Miglitol (Glyset)
Action
• Slow the breakdown of starches and some sugars
Advantages
• Don't cause weight gain
• Don't cause hypoglycemia (unless combined with insulin or a sulfonylurea)
Possible side effects
• Stomach pain
• Gas
• Diarrhea
Bile acid sequestrants
Medications
• Colesevelam (Welchol) Action
• Lower cholesterol and have a very modest effect in lowering blood glucose when used in combination with other diabetes medications
Advantages
• Likely safe for people with liver problems Possible side effects
• Flatulence
• Constipation
• Indigestion
Sulfonylureas.
These medications help your body secrete more insulin
Medications
• Glipizide (Glucotrol)
• Glimepiride (Amaryl)
• Glyburide (DiaBeta, Glynase)
Action: Stimulate the release of insulin Advantages
• Low cost
• Effective in lowering blood sugar Possible side effects
• Hypoglycemia
• Weight gain
• Skin rash
Meglitinides
These medications —work like sulfonylureas by stimulating the pancreas to secrete more insulin, but they're faster acting, and the duration of their effect in the body is shorter. They also have a risk of causing low blood sugar and weight gain.
Medications
• Repaglinide (Prandin)
• Nateglinide (Starlix)
Action- Stimulate the release of insulin
Advantages- Work quickly
Possible side effects
• Low blood sugar (hypoglycemia)
• Weight gain
• Nausea or vomiting, when interacting with alcohol
Thiazolidinediones
Like metformin, these medication ,make the body's tissues more sensitive to insulin. These drugs have been linked to weight gain and other more-serious side effects, such as an increased risk of heart failure and anemia. Because of these risks, these medications generally aren't first-choice treatments. These medications shouldn't be used in people with kidney disease or heart problems.
Medications
• Rosiglitazone (Avandia)
• Pioglitazone (Actos)
Action
• Improve sensitivity to insulin
• Inhibit the release of glucose from the liver
Advantages
• May slightly increase high-density lipoprotein (HDL), or "good," cholesterol
Possible side effects
• Weight gain
• Heart failure
• Heart attack
• Fractures
• Possible increased risk of bladder cancer with pioglitazone
Dipeptidyl-peptidase 4 (DPP-4) inhibitors
These medications —help reduce blood sugar levels, but tend to have a very modest effect. They don't cause weight gain, but may cause joint pain and increase your risk of pancreatitis.
Medications
• Saxagliptin (Onglyza)
• Sitagliptin (Januvia)
• Linagliptin (Tradjenta)
• Alogliptin Action
• Stimulate the release of insulin when blood glucose is rising
• Inhibit the release of glucose from the liver
•
Advantages
• Don't cause weight gain
• Don't cause hypoglycemia (unless combined with insulin or a sulfonylurea)
Possible side effects
• Upper respiratory tract infection
• Sore throat
• Headache
Sodium-glucose transporter 2 (SGLT2) inhibitors (SGLT2 inhibitors)
These drugs prevent the kidneys from reabsorbing sugar into the blood. Instead, the sugar is excreted in the urine.
Medications in this drug class may reduce the risk of heart attack and stroke in people with a high risk of those conditions. Side effects may include vaginal yeast infections, urinary tract infections, low blood pressure, and a higher risk of diabetic ketoacidosis. Canagliflozin, but not the other drugs in the class, has been associated with increased risk of lower limb amputation.
Medications
• Canagliflozin (Invokana)
• Dapagliflozin (Farxiga)
• Empagliflozin (Jardiance)
Action
• Block glucose from being reabsorbed by the kidneys Advantages
• May promote weight loss
• May lower blood pressure
Possible side effects
• Urinary tract infections
• Yeast infections
• Rare, serious genital infection
Insulin. Some people who have type 2 diabetes need insulin therapy.
Diabetes treatment: Lowering blood sugar
Several classes of type 2 diabetes medicines exist. Each class of medicine works in different ways to lower blood sugar. A drug may work by:
• Stimulating the pancreas to produce and release more insulin
• Inhibiting the production and release of glucose from the liver
• Blocking the action of stomach enzymes that break down carbohydrates
• Improving the sensitivity of cells to insulin
• Inhibiting the reabsorption of glucose in the kidneys
• Slowing how quickly food moves through the stomach
Each class of medicine has one or more drugs. Some of these drugs are taken orally,
while others must be injected.
Compare diabetes medications
Here's an at-a-glance comparison of common diabetes medications. More medications are available depending on your needs and situation. Ask your doctor about your options and the pros and cons of each.
Injectable medications Amylin mimetics Medications
• Pramlintide (Symlin) Action
• Help regulate glucose
• Slow food moving through the stomach
• Used with insulin injections Advantages
• May suppress hunger
• May promote modest weight loss Possible side effects
• Hypoglycemia
• Nausea or vomiting
Incretin mimetics (GLP-1 analogs)
Medications
• Albiglutide (Tanzeum)
• Dulaglutide (Trulicity)
• Exenatide (Byetta)
• Exenatide extended release (Bydureon)
• Liraglutide (Saxenda, Victoza)
• Lixisenatide (Adlyxin)
Action
• Stimulate the release of insulin
• Used with metformin, basal insulin or a sulfonylurea
Advantages
• May suppress hunger
• May promote modest weight loss
Possible side effects
• Nausea or vomiting
• Increased risk of inflamed pancreas (pancreatitis) and some thyroid tumors
Treatment goals for older adults (Kennedy table 14-2) Risk factors
Complications
Treatments for complications Obesity Comorbidities related to obesity
6 Urology and aging
UTI risk factors, differences based on gender
o UTI diagnostic criteria and when to treat Sexuality and aging
o STIs
o Age related changes GSM
o Signs and symptoms
o When to treat, common treatments Menopause Erectile Dysfunction
o Diagnosis o Treatment
7 Elder Abuse
o Types of abuse o Provider responsibilities in suspected abuse Alzheimer's
o Distinguishing features Delirium
o Distinguishing features Dementia
o Distinguishing features
8 Ethical Issues and End of life care
o Barriers to end of life care
o Differences between palliative care and hospice Advanced directives/Advanced care planning (ACP)
o Barriers to ACP
o Durable power of attorney for healthcare POLST Palliative care
o eligibility criteria o Services offered
o Length of eligibility
o Symptom management (Kennedy table 19-4) Hospice
o eligibility criteria
o Services offered
o Length of eligibility
o Symptom management (Kennedy table 19-4)
Pain management options in palliative and hospice care
• Indications- most appropriate medications for each type of pain
• Onset of action
• Side effects [Show Less]