NP Exam: Endocrine Study Guide.
Diabetes Mellitus Type I pathology - CORRECT ANSWER -May occur from childhood to early adulthood
-pancreas makes no insulin
-Strongly associated with human leukocyte antigens HLA-DR3 and HLA-DR4
-Islet cell antibodies found in approx 90% of patients within 1st year of diagnosis
-Ketone development usually occurs from breakdown of protein for energy
-Believed to be the result of an infectious or toxic environmental insult to pancreatic B cells of
genetically predisposed persons
DM 1 signs and symptoms - CORRECT ANSWER -Polyuria
-Polydipsia
-polyphagia
-Nocturnal enuresis
-weight loss
-weakness/fatigue
DM 1 labs/diagnostics - CORRECT ANSWER -Random plasma glucose >200mg/dl with symptoms
-Serum fasting blood sugar >126 mg/dl X 2
-Ketonemia, ketonuria, or both
-BUN/CR elevated from dehydration
-Hgb A1C elevated - greater than 7% (gives indication of glycemic control over last 2-3 months)
Many type 1 DM patients present for first time with DKA
(Same for DM 2 except no ketones in blood/urine)
DM 1 management - CORRECT ANSWER -highly individualized
, -baseline studies for obesity, cardiac risk factors, presence of ketones, diagnostic markers, lipid panel,
ECG, renal studies, peripheral pulses, neurologic function, eye and foot exams
-Dietary teaching - total carbs 55-60%m fats 20-30%, protein 10-20%
Insulin therapy:
-0.5 u/kg/day with 2/3 given in morning and 1/3 in evening
-intensive therapy: reduce or omit PM dose and add a portion at bedtime
-Insulin analogs: aspart (novolog); Glargine (lantus) prolonged duration; Lispro (Humalog) rapid onset
Somogyi Effect in DM 1 - CORRECT ANSWER -Nocturnal hypoclycemia stimulates hormones which raise
blood sugar.
-Patient will be HYPOGLYCEMIC at 3 am and rebound with hyperglycemia at 7 am
Treatment: REDUCE or OMIT the bedtime insulin dose
sOmOgyi - Omit bedtime dose
Dawn Phenomenon in DM 1 - CORRECT ANSWER Tissues become desensitized to insulin at night.
Blood glucose progressively rises through the night, resulting in elevated glucose at 0700.
Treatment: Add or increase the bedtime dose of insulin
Dawn is rising
Type 2 DM pathology - CORRECT ANSWER -Most common type of diabetes. >90% of DM is type 2
-Circulating insulin exists to prevent DKA, but is inadequate
-Either tissue is insensitive to insulin or insulin secretory defect results in insulin resistance or impaired
production
-Not linked to HLA or islet cell antibodies
-Associated with obesity and metabolic syndrome (low HDLs and high triglycerides)
-Slow onset of hyperglycemia, pt may be asymptomatic
-Polyuria, polydipsia
Diabetes Mellitus Type I pathology - CORRECT ANSWER -May occur from childhood to early adulthood
-pancreas makes no insulin
-Strongly associated with human leukocyte antigens HLA-DR3 and HLA-DR4
-Islet cell antibodies found in approx 90% of patients within 1st year of diagnosis
-Ketone development usually occurs from breakdown of protein for energy
-Believed to be the result of an infectious or toxic environmental insult to pancreatic B cells of
genetically predisposed persons
DM 1 signs and symptoms - CORRECT ANSWER -Polyuria
-Polydipsia
-polyphagia
-Nocturnal enuresis
-weight loss
-weakness/fatigue
DM 1 labs/diagnostics - CORRECT ANSWER -Random plasma glucose >200mg/dl with symptoms
-Serum fasting blood sugar >126 mg/dl X 2
-Ketonemia, ketonuria, or both
-BUN/CR elevated from dehydration
-Hgb A1C elevated - greater than 7% (gives indication of glycemic control over last 2-3 months)
Many type 1 DM patients present for first time with DKA
(Same for DM 2 except no ketones in blood/urine)
DM 1 management - CORRECT ANSWER -highly individualized
, -baseline studies for obesity, cardiac risk factors, presence of ketones, diagnostic markers, lipid panel,
ECG, renal studies, peripheral pulses, neurologic function, eye and foot exams
-Dietary teaching - total carbs 55-60%m fats 20-30%, protein 10-20%
Insulin therapy:
-0.5 u/kg/day with 2/3 given in morning and 1/3 in evening
-intensive therapy: reduce or omit PM dose and add a portion at bedtime
-Insulin analogs: aspart (novolog); Glargine (lantus) prolonged duration; Lispro (Humalog) rapid onset
Somogyi Effect in DM 1 - CORRECT ANSWER -Nocturnal hypoclycemia stimulates hormones which raise
blood sugar.
-Patient will be HYPOGLYCEMIC at 3 am and rebound with hyperglycemia at 7 am
Treatment: REDUCE or OMIT the bedtime insulin dose
sOmOgyi - Omit bedtime dose
Dawn Phenomenon in DM 1 - CORRECT ANSWER Tissues become desensitized to insulin at night.
Blood glucose progressively rises through the night, resulting in elevated glucose at 0700.
Treatment: Add or increase the bedtime dose of insulin
Dawn is rising
Type 2 DM pathology - CORRECT ANSWER -Most common type of diabetes. >90% of DM is type 2
-Circulating insulin exists to prevent DKA, but is inadequate
-Either tissue is insensitive to insulin or insulin secretory defect results in insulin resistance or impaired
production
-Not linked to HLA or islet cell antibodies
-Associated with obesity and metabolic syndrome (low HDLs and high triglycerides)
-Slow onset of hyperglycemia, pt may be asymptomatic
-Polyuria, polydipsia
