NR 293: pharm final study guide | 2026 Update

DM dx

- fasting plasma glucose > 126 mg/dL
- random plasma glucose > 200 + s/s (polyuria, polydipsia, unexplained
weight loss)
- oral glucose tolerance test (OGTT): 2h plasma glucose > 200 mg/dL
- A1c > 6.5%

Type 1 diabetes education

- Polyuria, polydipsia, polyphagia, weight loss  ~ thin & malnourished at dx
o Ketosis common
- lifelong insulin therapy, diet adjustments, and regular blood glucose
o strict dietary control
- glycemic control & ↓ CVD risk factors
o diet & exercise
o self-monitoring of glucose (SMBG) several time a day
o insulin replacement
 basal/bolus strategy
 coordinate doses w carb intake, activity, stress, infection, growth
 tight glycemic control benefits young w T1D > T2D
 targets for adults
 A1C < 7%
 Premeal glucose: 80-130 mg/dL
 Peak post meal glucose: <180 mg/dL (1-2 hrs after)
o management or HTN, nephropathy, HLD (ADA)
- education on
o mixing insulin & storage
o calculating dosages
o s/s & tx of hypoglycemia & DKA, have ID card
o ppx lipohypertrophy by site rotation

Prediabetes

- Impaired FPG (100-125 mg/dL)
- Impaired OGTT (140 – 199 mg/dL)
- ↑ risk for T2D (no microvascular risk)  Diet, exercise & weight loss
meds
- ↑ risk for CVD Diet, exercise, meds if indicated (ACEi/ARB & statins)




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,ADA 2023 guidelines

- ADA guidelines
o Step 1: lifestyle changes + metformin
o 2: + 2nd drug (GLP1 RA)
 Consider basal insulin if not at goal
o 3: + 3rd drug r/t
 Risk CVD/renal = SGLT2
 Social determinants (affordability/insurance)
 Pt preference r/t adverse effects
o START at step 2 if A1c >9% at dx
o START on combo injectable tx if:
 A1c >10%, FPG >300 or Markedly s/s
o management or HTN, nephropathy, HLD (ADA)
 ↓ risk nephropathy & HTN
 ACEi/ARBs
 Goal = <130/80 BP
 ↓ risk HLD  Statins
- Determine appropriate glycemic goals
o r/t lifestyle & risk factors
 duration of DM, age/life expectancy
 comorbid, CVD, comps, hypoglycemia unawareness
o targets for adults
 A1C < 7%
 Premeal glucose: 80-130 mg/dL
 Peak post meal glucose: <180 mg/dL (1-2 hrs after)

Insulin adjustments

- Insulin dosage = closely matched w needs
o Integrated program of activity, nutrition, insulin & SBGM
o Typical daily dosage = 0.1 u/kg – 2.5 u/kg
 T1D initial dosage
 0.5u/kg – 0.6u/kg
 T2D initial dosage (r/t degree of resistance & /b cell
function)
 0.2 u/kg – 0.6 u/kg
o Divide TDIR between basal & bolus doses



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,  Basal = 40-50% of TDIR = once day
 Bolus = remaining 50-60% = divided w meals
o ↑ insulin dosage
 Infection, stress
 Obesity
 ↑ carbs (carb: insulin ratio)
 Adolescent growth spurt
 Pregnancy after 1st trimester
o ↓ insulin dosage
 Activity
 skipped meals, ↓ carbs
 after 1st trimester of pregnancy
- dosing schedules (can use as needed to meet needs & goals)
o BID premixed regimen
 Basal & prandial coverage  Only need 2 injections/day
 If given AM & PM meals, no coverage at lunch
 Dose not allow for adjustments of long/short acting
 If dose change = both altered
o Intensive basal/bolus strategy
 Most often used for T1D
 Long acting + short acting
 Allows for good basal coverage & dose short acting prn

Insulin detemir

- U-100, subQ, once or BID, AM or PM, same time each day, RX
needed
- Blood levels rise to peak & fall to trough
- Dose dependent duration:
o Up to 12 hr = 0.2 u/hg
o 20-24 hr = 0.4 u/kg
- For basal control of glucose

Insulin glargine administration

- Once/BID dosing for 24 hr basal control in adults/children T1D & adults
T2D
- Rx needed
- Subq, AM, noon, PM, same time each day
- U-100 (Lantus) = long duration
- U-300 (toujeo) = ultra long duration



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