NR 601 Final Exam

prediabetes - correct answer impaired fasting glucose: fasting glucose is consistently elevated above normal range but below 100 and 125 mg/dL impaired glucose tolerance: state of hyperglycemia where a 2-hour post glucose load glycemic level is 140-199 mg/dl type 1 diabetes - correct answer characterized by severe insulin deficiency resulting from beta cell destruction producing hyperglycemia due to altered metabolism of lipids, carbs, and proteins immune mediated DM (type 1A)- 90% of cases; autoimmune destruction of insulin producing pancreatic beta islet cells; triggering factor: infection (rubella, Coxsackie before virus, cytomegalovirus, adenovirus, mumps virus) or toxic insult with genetic predisposition idiopathic DM (type 1B)- inherited; more common in people of Asian, African, or Hispanic origin type 1 diabetes - risk factors - correct answer * 60% of patients are 18 years old Caucasian of European descent 1.5-2X more common *High birth weight 4,000 g; higher than expected weight gain in first year of life * protein components of cow's milk * intro of gluten and rice containing cereals before 3 months or after 7 months type 1 diabetes - presentation - correct answer polyuria, polyphagia with paradoxical weight loss, polydipsia, visual changes, fatigue, weakness signs of dehydration such as poor skin turger, and dry mucous membranes signs of severe ketosis (DKA): extreme fatigue, abnormal cramping, alterations and breathing pattern, and telltale sign of halitosis Hg A1C gives insight into glycemic control over what time period? - correct answer 2 to 3 months initial goal of treatment for type 1 diabetes - correct answer plasma glucose level 80-130 mg/dl before meals, postprandial (1-2hrs after beginning of a meal) glucose level 180 mg/dl, and a1c 7% for adults lab values for DKA - correct answer hyperglycemia - BG 359 mg/dl ketonemia - plasma ketone 5 mmol/L acidosis - bicarbonate 9 mEq/L goals of glucose management in type 1 diabetes - correct answer before meals: 80-120 mg/dL postprandial: less than 180 mg/dL bedtime: 100-140 mg/dL management of hypoglycemia - correct answer 1/2 cup of fruit juice 6 oz of regular soda when cup milk glucose tabs recheck blood sugar after 15 minutes and give additional carbs if BG less than 70 number of kilocalories needed to maintain current weight - correct answer men col on 66 + 13.7(WT in kg) +5(by in cm) -6.8(age) women: 65 + 9.6(at in kg) + 1.7(ht in cm) -4.7 (age) guidelines regarding exercise to regulate glycemic response - correct answer check BG before, q30-60 min, and after exercise avoid exercise if fasting BG greater than 250 and ketosis; or if BG greater than 300 consume additional carbs if BG less than 100 and PRN type 2 diabetes - correct answer characterized by abnormal secretion of insulin, resistance to action of insulin in target tissues, and/or inadequate response to level of insulin receptor diabetes- risk factors - correct answer 95% of people diagnose with DM stronger genetic predisposition than T1DM first degree relatives with T2DM have 5-10 fold higher risk BMI greater than 25 age greater than 45 PCOS hyperlipidemia HYN HX of GDM AA, Latino, NA, Asian Am, Pacific islander type 1 diabetes-diagnostic criteria - correct answer * glycosylated hemoglobin A1C of 6.5% or higher * symptoms of diabetes plus random plasma glucose level of 200 mg/dl or higher * fasting plasma glucose of 126 mg/dl or higher (following 8 hours NPO) * 2-hour plasma glucose of 200 mg/dl or higher during OGTT with 75 g glucose load type 2 diabetes - diagnostic criteria - correct answer capillary BG level A result of $200 or greater should be followed up with whole blood sample for lab-based criteria to confirm DM: 1. A1C level greater than or equal to 6.5% 2. random glucose of 200 and presence of classic symptoms 3. 8-hr fasting glucose of 126 or higher on two occasions 4. 2-hour post load glucose level of 200 or higher during OGTT (75 g) type 2 DM-presentation - correct answer pruritus fatigue neuropathic complaints: numbness or tingling, blurred vision obese HX of dyslipidemia, HTM, CAD abnormal healing, increase occurrence of infection prediabetes - initial treatment recommendations - correct answer type one diabetes - first line treatment - correct answer insulin therapy type 2 diabetes - first line treatment - correct answer lifestyle Management, nutritional therapy, physical activity, medication if weight loss indicated: caloric restriction of 500-700 calories less than average daily intake exercise: 150 minutes per week of moderate-intensive physical effort, 3x per week; flexibility and balance training 2-3X per week for older adults metformin- first line of pharmacological treatment; 500 mg daily with breakfast or dinner for one week, then bid with breakfast and dinner insulin diabetes - HB A1C goals based on complications - correct answer healthy older adult: fasting of 90-130 and HB A1C target of less than 7.5% intermediate complex: fasting of 90 to 150 and HB A1C less than 8% very complex older adult: fasting of 100-180 and HB A1C Target of less than 8.5% diabetes - goals of treatment - correct answer weight loss recommendations to decrease risks related to diabetes - correct answer weight loss of 5% can improve glycemic control diabetes- common medication side effects with risk factors - correct answer metformin -diarrhea, nausea, anorexia, abdominal discomfort CONTRAINDICATED: renal disease