©FYNDLAY.
NUR 543 Exam 3 Study Guide.
Type 1 DM definition/patho - Answers✔Absolute deficiency of insulin --> severe hyperglycemia
and serum ketone production when untreated
Autoimmune beta cell destruction - genetic/environmental combo
Type 1 DM incidence - Answers✔10% of cases of diabetes
most commonly occurs in children (onset 10-14 years)
Northern, Western European, and Scandinavian descent
10% are idiopathic with no HLA antigen - more common in Asian/African descent
Other autoimmune disorders increase risk (Addison's, hypothyroid, etc)
What antigens are strongly associated with type 1 DM - Answers✔HLA-DR3
HLA-DR4
HLA-DQ
Human leukocyte antigens
What are some triggers for DM 1 in genetically predisposed individuals?
Other causes in non-genetically predisposed individuals? - Answers✔viruses, toxic chemical
agents, cytotoxins
Pancreatitis, surgical, toxic, or cystic fibrosis
DM1 s/s - Answers✔polyuria, polydipsia, polyphagia
nocturnal enuresis
blurred vision
weight loss/loss of fat/muscle wasting
fatigue
weakness
paresthesia
change in LOC
1
, ©FYNDLAY.
vomiting d/t acidosis
Fruity breath
orthostatic hypotension
dysfunction of peripheral sensory nerves
skin/vaginal infections
eye exam - microaneurysms in advanced disease
peripheral vascular insufficiency in advanced disease
diminished deep tendon reflexes in advanced disease
Drugs that can cause hyperglycemia - Answers✔glucocorticoids, anticonvulsants, beta
adrenergic agonists, thiazide diuretics
DM 1 diagnostics - acute - Answers✔Fasting serum glucose <126 on two separate occasions]
Ketonuria
CBC - increased WBC due to stress
K+ level normal despite total body potassium being depleted
OGTT
glucosuria
ketonemia
elevated BUN/CR - dehydration
Islet cell antibodies
GAD antibodies
C peptide decreases as DM1 progresses
Evaluate family members (3-5% risk of also developing DM1)
Baseline cholesterol panel
Baseline PE - pulses, nuero exam, and foot exam
Baseline EKG
DM1 diagnostics - monitoring - Answers✔HgAlc target below 6% (indicates glycemic control
over 8-12 weeks, the life of a RBC)
Each percent elevation from 6% is about 30mg/dL FBS elevation
DM1 management goals - Answers✔Fasting 90 - 130 mg/dL
2
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1 hour post prandial < 180 mg/dL
2 hours post prandial <150 mg/dL
A1C<6%
Insulin therapy options - Answers✔Option 1: A common approach includes 3 daily doses of
short or ultra-short-acting insulin prior to meals based on CHO counting- 1 unit of insulin per 10-
15 gms of CHO content and a dose of long-acting insulin prebreakfast and predinner- dose equal
to 0.5 x weight in kg/2, split evenly between prebreakfast and predinner
Option 2: Another option includes 3 daily doses of short or ultra-short-acting insulin prior to
meals based in carbohydrate counting 1 unit of insulin per 10-15 gms CHO content and a single
dose of insulin glargine (Lantus) at hs = to 0.5X wt in kg/2
Option 3: combine short/ultrashort and intermediate-acting (NPH) as follows
Not used as often
Premeal short or ultra short-acting based upon carbohydrate counting as previously described
NPH total daily dose=0.5x weight in kilograms/2
One-half of NPH at HS
The remaining NPH divided evenly among the three meals and administered premeal with short
or ultrashort preparations
Rapid acting insulin - types, onset, peak, duration - Answers✔Aspart (Novolog), Lispro
(Humalog)
Onset: <15min
Peak 0.5-1.5hrs
Duration: 3-4hrs
Short acting insulin - types, onset, peak, duration - Answers✔Regular insulin (Humulin R,
Novolin R)
Onset: 30-60min
Peak: 2-3hrs
Duration: 5-8hrs
Intermediate acting insulin - types, onset, peak, duration - Answers✔NPH insulin (Humulin N,
Novolin N)
Onset - 2-4 hrs
peak 4-10hrs
3
NUR 543 Exam 3 Study Guide.
Type 1 DM definition/patho - Answers✔Absolute deficiency of insulin --> severe hyperglycemia
and serum ketone production when untreated
Autoimmune beta cell destruction - genetic/environmental combo
Type 1 DM incidence - Answers✔10% of cases of diabetes
most commonly occurs in children (onset 10-14 years)
Northern, Western European, and Scandinavian descent
10% are idiopathic with no HLA antigen - more common in Asian/African descent
Other autoimmune disorders increase risk (Addison's, hypothyroid, etc)
What antigens are strongly associated with type 1 DM - Answers✔HLA-DR3
HLA-DR4
HLA-DQ
Human leukocyte antigens
What are some triggers for DM 1 in genetically predisposed individuals?
Other causes in non-genetically predisposed individuals? - Answers✔viruses, toxic chemical
agents, cytotoxins
Pancreatitis, surgical, toxic, or cystic fibrosis
DM1 s/s - Answers✔polyuria, polydipsia, polyphagia
nocturnal enuresis
blurred vision
weight loss/loss of fat/muscle wasting
fatigue
weakness
paresthesia
change in LOC
1
, ©FYNDLAY.
vomiting d/t acidosis
Fruity breath
orthostatic hypotension
dysfunction of peripheral sensory nerves
skin/vaginal infections
eye exam - microaneurysms in advanced disease
peripheral vascular insufficiency in advanced disease
diminished deep tendon reflexes in advanced disease
Drugs that can cause hyperglycemia - Answers✔glucocorticoids, anticonvulsants, beta
adrenergic agonists, thiazide diuretics
DM 1 diagnostics - acute - Answers✔Fasting serum glucose <126 on two separate occasions]
Ketonuria
CBC - increased WBC due to stress
K+ level normal despite total body potassium being depleted
OGTT
glucosuria
ketonemia
elevated BUN/CR - dehydration
Islet cell antibodies
GAD antibodies
C peptide decreases as DM1 progresses
Evaluate family members (3-5% risk of also developing DM1)
Baseline cholesterol panel
Baseline PE - pulses, nuero exam, and foot exam
Baseline EKG
DM1 diagnostics - monitoring - Answers✔HgAlc target below 6% (indicates glycemic control
over 8-12 weeks, the life of a RBC)
Each percent elevation from 6% is about 30mg/dL FBS elevation
DM1 management goals - Answers✔Fasting 90 - 130 mg/dL
2
, ©FYNDLAY.
1 hour post prandial < 180 mg/dL
2 hours post prandial <150 mg/dL
A1C<6%
Insulin therapy options - Answers✔Option 1: A common approach includes 3 daily doses of
short or ultra-short-acting insulin prior to meals based on CHO counting- 1 unit of insulin per 10-
15 gms of CHO content and a dose of long-acting insulin prebreakfast and predinner- dose equal
to 0.5 x weight in kg/2, split evenly between prebreakfast and predinner
Option 2: Another option includes 3 daily doses of short or ultra-short-acting insulin prior to
meals based in carbohydrate counting 1 unit of insulin per 10-15 gms CHO content and a single
dose of insulin glargine (Lantus) at hs = to 0.5X wt in kg/2
Option 3: combine short/ultrashort and intermediate-acting (NPH) as follows
Not used as often
Premeal short or ultra short-acting based upon carbohydrate counting as previously described
NPH total daily dose=0.5x weight in kilograms/2
One-half of NPH at HS
The remaining NPH divided evenly among the three meals and administered premeal with short
or ultrashort preparations
Rapid acting insulin - types, onset, peak, duration - Answers✔Aspart (Novolog), Lispro
(Humalog)
Onset: <15min
Peak 0.5-1.5hrs
Duration: 3-4hrs
Short acting insulin - types, onset, peak, duration - Answers✔Regular insulin (Humulin R,
Novolin R)
Onset: 30-60min
Peak: 2-3hrs
Duration: 5-8hrs
Intermediate acting insulin - types, onset, peak, duration - Answers✔NPH insulin (Humulin N,
Novolin N)
Onset - 2-4 hrs
peak 4-10hrs
3
