NR 601 Final Exam Study Guide (Version-2) / NR601 Final Exam Study Guide (NEW, 2020)
NR 601 FINAL EXAM STUDY GUIDE
Week 5: Glucose metabolism
... [Show More] disorders
Types of DM
Type 1 - severe insulin deficiency resulting in reduction
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. by the abnormal secretion of insulin, resistance to the actionof 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.
1. or absence of functioning beta cells in
Type 2 - Type 2 DM is characterized
3. 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 Treatment-
Type 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 (1– 2 hours after the beginning of a meal) glucose levels of less than 180 mg/dL, and an A1C below 7% for adults with type 1 DM. A comprehensive treatment plan requires exogenous insulin, frequent self-monitoring of blood glucose (SMBG), medical nutrition therapy, regular exercise, continuing education in prevention and treatment of diabetic complications, and the periodic reassessment of treatment goals. (Type 1A: insulin dependent, Type 1B: variably insulin dependent). The ADA Standards of medical care in diabetes states that the majority of patients with type 1 DM, should be treated with multiple daily injections of prandial insulin and daily
basal insulin or with a continuous subcutaneous insulin infusion pump. INITIATION OF INSULIN THERAPY IN NEWLY DIAGNOSED TYPE 1 DM, SHOULD BE MANAGED BY OR IN CLOSE COLLABORATION WITH AN ENDOCRINOLOGIST. [Show Less]