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AGACNP- Endocrine
Type I DM pathology - ANS-strongly associated with the presence of human leukocyte
antigens (HLA), islet cell antibodies found in 90% of pts, Ketone development usually
occurs, believed to be the result of environmental/infectious insult to pancreatic B cells
in a genetically predisposed person
Type II DM oathology - ANS-circulating insulin exists enough to prevent ketoacidosis,
caused either by tissue insensitivity to insulin or an insulin secretory defect, assoc w/
met syndorme & obesity
Metabolic syndrome - ANS-Any 3 of the following: waist circumference >40" M, >35" W,
BP >130/85, triglycerides >150, FBG >100, HDL <40 M, <50 W
Type I DM sx - ANS-polyuria, polydipsia, polyphagia, wt loss, nocturnal enuresis,
weakness, fatigue
Type II DM sx - ANS-insidious onset of >BG, asymptomatic at first, polyuria, polydipsia,
recurrent vaginitis, peripheral neuropathies, blurred vision, chronic skin infections,
pruritis
Type I DM labs/dx - ANS-random BG >200 with polyuria, polydipsia and wt loss
serum fasting (8 hr) BG >126 x 2
ketonemia, ketonuria, or both
BUN/Cr elevated (dehydration)
OGTT >200 2 hrs post prandial
Hgb A1C >5.7%
Hgb A1C - ANS-gives indication of BG over last 2-3 mo, normal 5-5.7%
Impaired glucose tolerance - ANS-FBG >100 and<125
Type I DM mgmt - ANS-if presening w/ ketones, start insulin, begin w/ 0.5u/kg/day, give
2/3 in am, 1/3 pm, or 2/3 NPH, 1/3 regular am, 1/2 NPH 1/2 reg pm
baseline studies for new DM dx - ANS-obesity, cardiac risk factors, cholesterol, EKG,
renal studies, baseline exam doc pulses, neuro function, eye exam, foot exam
Dietary teaching w/ DM - ANS-carbs 55-60%
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fats 20-30%
protein 10-20%
fiber 25g/1000 calories
Type II DM mgmt - ANS-begin with weight control, diet, exercise, oral meds, then insulin
Sulfonyureas - ANS-Glipizide, Glyburide, Glimepiride, most widely used, stimulate the
pancreas to release more insulin
Classes of oral diabetic medication - ANS-sulfonyureas, biguanides, alpha-glucosidase
inhibitors, thiazolidinediones, non-sulfonyurea insulin release stimulators
which DM medication stimulates the pancreas to release more insulin? -
ANS-sulfonyureas (Gs)
Biguanides - ANS-increase insulin sensitivity
Metformin- adjunct to sulfonyureas or alone, esp for obese pts, lactic acidosis potential
side effect, muscle pain
Alpha-glucosidase inhibitors - ANS-Bins to disaccharidases more readily than sucrose,
less glucose absorbed by gut
Acarbose, Miglitol
Thiazolidinediones - ANS-"glitazones", decrease gluconeogenesis
Non-sulfonyurea insulin release stimulators - ANS-rapidly absorbed from intestine,
mimics the effect of rapidly acting insulin
Repaglinide
Nateglinide
Exentide - ANS-injectable that mimics effects of incretins (signals pancreas to increase
insulin secretion and liver to stop producing glucagon), may cause n/v/d
Sitagliptan - ANS-Januvia
DD-4 inhibito, DD-r breaks down incretins
Pramlintide - ANS-Symlin- injectible, resembles human amylin, slows absorption of
glucose and inhibits the action of glucagons; promotes wt loss white <BG
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AGACNP- Endocrine.pdf!@@@@@@@@@@@@@@@@@@@@@@@@@@@@############################################################
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AGACNP- Endocrine.pdf!@@@@@@@@@@@@@@@@@@@@@@@@@@@@############################################################
AGACNP- Endocrine
Type I DM pathology - ANS-strongly associated with the presence of human leukocyte
antigens (HLA), islet cell antibodies found in 90% of pts, Ketone development usually
occurs, believed to be the result of environmental/infectious insult to pancreatic B cells
in a genetically predisposed person
Type II DM oathology - ANS-circulating insulin exists enough to prevent ketoacidosis,
caused either by tissue insensitivity to insulin or an insulin secretory defect, assoc w/
met syndorme & obesity
Metabolic syndrome - ANS-Any 3 of the following: waist circumference >40" M, >35" W,
BP >130/85, triglycerides >150, FBG >100, HDL <40 M, <50 W
Type I DM sx - ANS-polyuria, polydipsia, polyphagia, wt loss, nocturnal enuresis,
weakness, fatigue
Type II DM sx - ANS-insidious onset of >BG, asymptomatic at first, polyuria, polydipsia,
recurrent vaginitis, peripheral neuropathies, blurred vision, chronic skin infections,
pruritis
Type I DM labs/dx - ANS-random BG >200 with polyuria, polydipsia and wt loss
serum fasting (8 hr) BG >126 x 2
ketonemia, ketonuria, or both
BUN/Cr elevated (dehydration)
OGTT >200 2 hrs post prandial
Hgb A1C >5.7%
Hgb A1C - ANS-gives indication of BG over last 2-3 mo, normal 5-5.7%
Impaired glucose tolerance - ANS-FBG >100 and<125
Type I DM mgmt - ANS-if presening w/ ketones, start insulin, begin w/ 0.5u/kg/day, give
2/3 in am, 1/3 pm, or 2/3 NPH, 1/3 regular am, 1/2 NPH 1/2 reg pm
baseline studies for new DM dx - ANS-obesity, cardiac risk factors, cholesterol, EKG,
renal studies, baseline exam doc pulses, neuro function, eye exam, foot exam
Dietary teaching w/ DM - ANS-carbs 55-60%
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AGACNP- Endocrine.pdf!@@@@@@@@@@@@@@@@@@@@@@@@@@@@############################################################
,@@@@@@@@@@@@@@@################################################################################!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
df!@@@@@@@@@@@@@@@@@@@@@@@@@@@@################################################################################!!!!!!!!!!!
AGACNP- Endocrine.pdf!@@@@@@@@@@@@@@@@@@@@@@@@@@@@############################################################
fats 20-30%
protein 10-20%
fiber 25g/1000 calories
Type II DM mgmt - ANS-begin with weight control, diet, exercise, oral meds, then insulin
Sulfonyureas - ANS-Glipizide, Glyburide, Glimepiride, most widely used, stimulate the
pancreas to release more insulin
Classes of oral diabetic medication - ANS-sulfonyureas, biguanides, alpha-glucosidase
inhibitors, thiazolidinediones, non-sulfonyurea insulin release stimulators
which DM medication stimulates the pancreas to release more insulin? -
ANS-sulfonyureas (Gs)
Biguanides - ANS-increase insulin sensitivity
Metformin- adjunct to sulfonyureas or alone, esp for obese pts, lactic acidosis potential
side effect, muscle pain
Alpha-glucosidase inhibitors - ANS-Bins to disaccharidases more readily than sucrose,
less glucose absorbed by gut
Acarbose, Miglitol
Thiazolidinediones - ANS-"glitazones", decrease gluconeogenesis
Non-sulfonyurea insulin release stimulators - ANS-rapidly absorbed from intestine,
mimics the effect of rapidly acting insulin
Repaglinide
Nateglinide
Exentide - ANS-injectable that mimics effects of incretins (signals pancreas to increase
insulin secretion and liver to stop producing glucagon), may cause n/v/d
Sitagliptan - ANS-Januvia
DD-4 inhibito, DD-r breaks down incretins
Pramlintide - ANS-Symlin- injectible, resembles human amylin, slows absorption of
glucose and inhibits the action of glucagons; promotes wt loss white <BG
@@@@@@@@@@@@@@@################################################################################!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
df!@@@@@@@@@@@@@@@@@@@@@@@@@@@@################################################################################!!!!!!!!!!!
AGACNP- Endocrine.pdf!@@@@@@@@@@@@@@@@@@@@@@@@@@@@############################################################
