DM Diagnostics and LTC Diagnostics
▪ Oral glucose tolerance test
o Often used to dx gestational DM
o Not generally used for routine
... [Show More] testing
o Fasting glucose level drawn at the start, pt consumes glucose then glucose levels are obtained q30min for 2 hours
o Pt must be assessed for hypoglycemia throughout the procedure
▪ Fasting should be <110, <180 at 1 hour and <140 at 2 hours
o Consume balanced diet 3 days prior to test
o Fast for 10-12 hours prior to test
o Only water can be consumed until after test
▪ Glycosylated hemoglobin (HbA1c)
o Expected range is 4-6% for pts w/out DM
o Expected range is 6.5-8% for pts with DM, and a target goal of <7%
o Best indicator of the average blood glucose level for the past 120 days
o Assists in evaluating treatment and compliance
▪ Test recommended quarterly or twice a year
▪ Urine Ketones
o Accumulate in blood due to breakdown of fatty acids when insulin is not available
o High ketones in urine associated w/hyperglycemia (>300mg/dL) med ER
▪ Lipid profile
o Obtain baseline at dx then every 1-2 years
▪ Other
o C-peptide, autoantibodies for insulin, islet cells and glutamic acid decarboxylase, and self-
monitored blood glucose (SMBG) normal range 70-110
Long Term Care/Medications
▪ Insulin
o Rapid acting (MOST DEADLY)
▪ Lispro, aspart, glulisine, inhaled human insulin
▪ Admin before meals to control postprandial rise in BS
▪ Onset is 10-30 min, peak 30 min-2.5 hour, duration 3-6 hr
▪ Admin in conjunction with intermediate or long acting to provide BS control between meals and at night
o Short-acting
▪ Regular insulin IVP/IV only
▪ Admin 30-60 min before meals to control postprandial hyperglycemia
▪ Available in two concentrations
• U-500 for insulin resistance pts (never admin IV)
• U-100 for most pts and can be admin IV
▪ Onset 30-60 min, peak 1-5 hr, duration 6-10 hr
o Intermediate (NEVER GIVE IV)
▪ NPH insulin
▪ For BS between meals and at night
▪ Not given before meals to control BS
▪ Contains a protein that delays insulin absorp [Show Less]