lOMoAR cPSD| 55112919
NUR 170 Exam 3 Study Guide
DIABETES
Insulin: a key that allows glucose into cells
Glucose: the brain needs a constant supply of glucose because it cannot store it (stroke-
like symptoms if no glucose) Glucagon – raises BS.
Diabetes
Type 1: absolute absence of insulin. Always needs insulin. Occurs in younger than 30.
Cause: autoimmune destruction of beta cells in the pancreas.
Type 2: adult onset
Indications for testing/Risk factors:
• Obese, Native American, African American, Hispanic, Pacific Islander.
• Female pt with gestational diabetes or had birth to +9ibs baby.
• Bp > 140/90
• HDL < 35 mg/dL and/or triglyceride >250 mg/dL
• A1C > 5.7% or fasting BS > 100
• Hx of vascular disease
• Veterans exposed to agent orange.
Patho: deficit in insulin secretion or action
Management:
• Appropriate diet and exercise and lifestyle changes in combo w/ meds. Initial Tx:
Metformin
S/S of hyperglycemia: Polyuria, Polydipsia, Polyphagia, and weight loss.
• Blurred vision
• Paresthesia
• Yeast infections (balanitis in men)
Severe hyperglycemia:
• Elevated serum ketones:
• Hypovolemia
• Acidosis
• Kussmaul Respirations: deep, labored, rapid breathing (tachypnea) Fruity breath
• Electrolyte imbalances: dilutional hyponatremia and hyperkalemia
, lOMoAR cPSD| 55112919
Assessment:
Weight and weight changes
Family hx – strongest r/f for type 1
• Frequent infections (fungal, UTI, pneumonia)
• Delayed healing (poor LE blood flow) – fat sticks in blood vessels
• Peripheral neuropathy, gastropathy
• 3 Ps
• Age/Race: type 2 is higher in non-whites and ages> 40
Physical Exam:
• Acanthosis Nigricans: darkening of skin folds in the back of the neck, armpits, and
groin.
• Yeast infection (breasts, groin, skin flaps)
• Type 1: may present w/ DKA. – no insulin to (-) ketones
• Type 2: obesity and hypertension, may present w/ HHS (rare): extremely high BS w/ no
ketones and dehydration.
Diagnosing:
• Blood tests:
o Fasting BG >126 o Random BG > 200 o A1C > = 6.5% o 75
gm, 2-hour glucose tolerance test w/ plasma glucose >200
Glucometer: steps for BG monitoring (at home)
Wash hands (no alcohol wipes)
• Don’t have to wipe the first drop.
Drug Tx:
Metformin: Type 2 monotherapy
• Decreases glucose in the liver. Does not cause hypoglycemia.
• SE: weight loss, GI distress/diarrhea – SE decrease over time
• CONTRAINDICATION: Can cause lactic acidosis in pt with kidney impairment and not be
used in pt with kidney disease.
o Creatinine > 1.5 men, >1.4 women o
GFR < 46
• HIGH creatinine and LOW GFR – AVOID
, lOMoAR cPSD| 55112919
• Contrast study (CTs, Cardiac cath): stop 24 hours before OR time of, hold for 48 hours
after, and restart when renal functions show normal.
Sulfonylureas: stimulate insulin release from Beta cells
Glipizide, Glyburide, Glimepiride
Give with or just before meals.
• Pt may not be adherent because of weight gain.
• SE: weight gain/HYPOGLYCEMIA
Thiazolidinediones (TZDs): decrease glucose production and increase the sensitivity of insulin.
• Contraindications: Metformin, HF (increase fluid retention), liver disturbances (LFTs
check every 3mos)
GLP-1 Agonist (injectable):
Incretin mimetics – augments insulin secretion post-prandial (after meals). Beta cell level
• Exenatide
• Liraglutide: cause weight loss but are injectable (teach pt) and expensive.
o Pt should STOP if shows s/s of pancreatitis.
S/S: upper epigastric pain radiates to back, N/V, fever.
DPP-4 inhibitors (oral): break down GLP-1 (increases insulin secretion) and decrease blood
glucose.
• Sitagliptin
• Linagliptin (BEST FOR NEEDLE PHOBIC PT): SE – N/V (WARN PT), pancreatitis, oral med,
weight neutral.
• Raise insulin levels to take care of sugar spikes when eating. Not known to cause
hyperglycemia.
Newly Dx Type 2? Diet and exercise plus oral meds
A1C < 7.5% - monotherapy
<7.5-9.0 Dual therapy. – Metformin plus another drug
Insulin – Who gets it?
• Type 1 – ALWAYS
• Type 2 – may or may not – if A1C > 9.0% + neuropathy, blurry vision, frequent
infections
NUR 170 Exam 3 Study Guide
DIABETES
Insulin: a key that allows glucose into cells
Glucose: the brain needs a constant supply of glucose because it cannot store it (stroke-
like symptoms if no glucose) Glucagon – raises BS.
Diabetes
Type 1: absolute absence of insulin. Always needs insulin. Occurs in younger than 30.
Cause: autoimmune destruction of beta cells in the pancreas.
Type 2: adult onset
Indications for testing/Risk factors:
• Obese, Native American, African American, Hispanic, Pacific Islander.
• Female pt with gestational diabetes or had birth to +9ibs baby.
• Bp > 140/90
• HDL < 35 mg/dL and/or triglyceride >250 mg/dL
• A1C > 5.7% or fasting BS > 100
• Hx of vascular disease
• Veterans exposed to agent orange.
Patho: deficit in insulin secretion or action
Management:
• Appropriate diet and exercise and lifestyle changes in combo w/ meds. Initial Tx:
Metformin
S/S of hyperglycemia: Polyuria, Polydipsia, Polyphagia, and weight loss.
• Blurred vision
• Paresthesia
• Yeast infections (balanitis in men)
Severe hyperglycemia:
• Elevated serum ketones:
• Hypovolemia
• Acidosis
• Kussmaul Respirations: deep, labored, rapid breathing (tachypnea) Fruity breath
• Electrolyte imbalances: dilutional hyponatremia and hyperkalemia
, lOMoAR cPSD| 55112919
Assessment:
Weight and weight changes
Family hx – strongest r/f for type 1
• Frequent infections (fungal, UTI, pneumonia)
• Delayed healing (poor LE blood flow) – fat sticks in blood vessels
• Peripheral neuropathy, gastropathy
• 3 Ps
• Age/Race: type 2 is higher in non-whites and ages> 40
Physical Exam:
• Acanthosis Nigricans: darkening of skin folds in the back of the neck, armpits, and
groin.
• Yeast infection (breasts, groin, skin flaps)
• Type 1: may present w/ DKA. – no insulin to (-) ketones
• Type 2: obesity and hypertension, may present w/ HHS (rare): extremely high BS w/ no
ketones and dehydration.
Diagnosing:
• Blood tests:
o Fasting BG >126 o Random BG > 200 o A1C > = 6.5% o 75
gm, 2-hour glucose tolerance test w/ plasma glucose >200
Glucometer: steps for BG monitoring (at home)
Wash hands (no alcohol wipes)
• Don’t have to wipe the first drop.
Drug Tx:
Metformin: Type 2 monotherapy
• Decreases glucose in the liver. Does not cause hypoglycemia.
• SE: weight loss, GI distress/diarrhea – SE decrease over time
• CONTRAINDICATION: Can cause lactic acidosis in pt with kidney impairment and not be
used in pt with kidney disease.
o Creatinine > 1.5 men, >1.4 women o
GFR < 46
• HIGH creatinine and LOW GFR – AVOID
, lOMoAR cPSD| 55112919
• Contrast study (CTs, Cardiac cath): stop 24 hours before OR time of, hold for 48 hours
after, and restart when renal functions show normal.
Sulfonylureas: stimulate insulin release from Beta cells
Glipizide, Glyburide, Glimepiride
Give with or just before meals.
• Pt may not be adherent because of weight gain.
• SE: weight gain/HYPOGLYCEMIA
Thiazolidinediones (TZDs): decrease glucose production and increase the sensitivity of insulin.
• Contraindications: Metformin, HF (increase fluid retention), liver disturbances (LFTs
check every 3mos)
GLP-1 Agonist (injectable):
Incretin mimetics – augments insulin secretion post-prandial (after meals). Beta cell level
• Exenatide
• Liraglutide: cause weight loss but are injectable (teach pt) and expensive.
o Pt should STOP if shows s/s of pancreatitis.
S/S: upper epigastric pain radiates to back, N/V, fever.
DPP-4 inhibitors (oral): break down GLP-1 (increases insulin secretion) and decrease blood
glucose.
• Sitagliptin
• Linagliptin (BEST FOR NEEDLE PHOBIC PT): SE – N/V (WARN PT), pancreatitis, oral med,
weight neutral.
• Raise insulin levels to take care of sugar spikes when eating. Not known to cause
hyperglycemia.
Newly Dx Type 2? Diet and exercise plus oral meds
A1C < 7.5% - monotherapy
<7.5-9.0 Dual therapy. – Metformin plus another drug
Insulin – Who gets it?
• Type 1 – ALWAYS
• Type 2 – may or may not – if A1C > 9.0% + neuropathy, blurry vision, frequent
infections
