NURS 5334 EXAM 3
1. What drugs are used to treat gestational diabetes?
Metformin and Insulin
2. What A1C value indicates diabetes mellitus? Pre-DM?
6.5% or greater is considered
diabetes 5.7-6.4% pre-diabetes
3. What fasting and random values indicate DM?
Fasting plasma glucose—126 or greater is diabetes
Random (casual) plasma glucose—anything greater than 200 is diabetes
4. What are complications of insulin therapy?
Hypoglycemia
Can develop lipohypertrophy
Accumulation of subcutaneous fat that occurs when it is injected too
frequently at the same site
Allergic reactions
Characterized by red and intensely itchy welts, breathing becomes
difficult
If severe allergy develops:
-Desensitization procedure (small doses to larger
doses) Hypokalemia
Promotes the uptake of potassium cells and insulin activates a
membrane-bound enzyme with sodium potassium and ATPase that
pumps potassium into the cells and sodium out
,5. Drug interactions?
Hypoglycemic agents
Can intensify the hypoglycemia included by insulin
Examples: sulfonylureas, glinides,
alcohol Use with caution with
hyperglycemic agents
Examples: thiazide and glucocorticoids and sympathomimetics
6. What effect do beta blockers have on insulin?
delay awareness of and response to hypoglycemia by masking the
signs that are associated with stimulation of sympathetic nervous
system
Impair glycogenolysis
Prevent the bodies counter-regulatory response
7. What are other therapeutic uses besides DM?
Hyperkalemia
Aids in diagnosis of GH deficiency
Diabetic ketoacidosis
8. Insulin dosage must be coordinated with what?
Carbohydrate intake
9. What is B/P goal in diabetic?
To be controlled, within normal 120/80
10. What medication can be given to decrease risk of diabetic nephropathy?
ACE inhibitor or ARB
,11. What role does exercise play in treatment of both type 1 and type 2 DM?
Exercise increases cellular responsiveness to insulin and increases
glucose tolerance
150 minute per week of moderate intensity exercise is recommended
12. What are the 4 steps in the 4-step approach?
Step 1—diagnosis
Lifestyle changes plus
metformin Step 2
Lifestyle changes plus metformin and a second drug (sulfonylurea,
TZD or a DPP4 inhibitor, a sodium glucose cotransporter or SGLT-2
inhibitor, a glucagon- like peptide 1, or a GLP-1 receptor agonist or
basal insulin
Second drug choice made considering efficacy, the hypoglycemia
risk of the patient, the patient tolerability, and weight-related
considerations (some help weight loss, some cause weight gain),
cost
Step 3
Three drug combination
Metformin
Plus 2 other drugs from step 2
Decided based on a drug and patient specific
considerations Step 4
If 3 drug combination that includes basal insulin fails after 3-6
months, more complex insulin regimen
Usually in combination with one or more non-insulin medications
13. When a patient is on insulin therapy what are the blood glucose goals
before meals? At bedtime?
Before meals—70-130
Bedtime—100-140
, 14. What is the A1C goal? When is goal below 7 not appropriate?
7% or below
Those with severe hypoglycemia risk, limited life expectancy,
advanced micro vascular or macro vascular complications—not
below 7
15. What are the short acting insulins? Intermediate? Long acting?
Short duration: Rapid acting
Insulin lispro [Humalog]
Insulin aspart [NovoLog]
Insulin glulisine
[Apidra] Short duration:
Slower acting
Regular insulin [Humulin R,
Novolin R] Intermediate duration
Neutral protamine Hagedorn (NPH) insulin
Insulin detemir
[Levemir] Long duration
Insulin glargine
16. When are short duration insulins used?
Administered in association with meals to control the post-prandial
rise in blood glucose between meals and at night
17. When are intermediate insulins needed?
Administer 2-3 times daily to provide glycemic control between meals
and during the night
18. How long is duration of glargine? Levemir? Degludec?
Glargine—up to 24 hours
1. What drugs are used to treat gestational diabetes?
Metformin and Insulin
2. What A1C value indicates diabetes mellitus? Pre-DM?
6.5% or greater is considered
diabetes 5.7-6.4% pre-diabetes
3. What fasting and random values indicate DM?
Fasting plasma glucose—126 or greater is diabetes
Random (casual) plasma glucose—anything greater than 200 is diabetes
4. What are complications of insulin therapy?
Hypoglycemia
Can develop lipohypertrophy
Accumulation of subcutaneous fat that occurs when it is injected too
frequently at the same site
Allergic reactions
Characterized by red and intensely itchy welts, breathing becomes
difficult
If severe allergy develops:
-Desensitization procedure (small doses to larger
doses) Hypokalemia
Promotes the uptake of potassium cells and insulin activates a
membrane-bound enzyme with sodium potassium and ATPase that
pumps potassium into the cells and sodium out
,5. Drug interactions?
Hypoglycemic agents
Can intensify the hypoglycemia included by insulin
Examples: sulfonylureas, glinides,
alcohol Use with caution with
hyperglycemic agents
Examples: thiazide and glucocorticoids and sympathomimetics
6. What effect do beta blockers have on insulin?
delay awareness of and response to hypoglycemia by masking the
signs that are associated with stimulation of sympathetic nervous
system
Impair glycogenolysis
Prevent the bodies counter-regulatory response
7. What are other therapeutic uses besides DM?
Hyperkalemia
Aids in diagnosis of GH deficiency
Diabetic ketoacidosis
8. Insulin dosage must be coordinated with what?
Carbohydrate intake
9. What is B/P goal in diabetic?
To be controlled, within normal 120/80
10. What medication can be given to decrease risk of diabetic nephropathy?
ACE inhibitor or ARB
,11. What role does exercise play in treatment of both type 1 and type 2 DM?
Exercise increases cellular responsiveness to insulin and increases
glucose tolerance
150 minute per week of moderate intensity exercise is recommended
12. What are the 4 steps in the 4-step approach?
Step 1—diagnosis
Lifestyle changes plus
metformin Step 2
Lifestyle changes plus metformin and a second drug (sulfonylurea,
TZD or a DPP4 inhibitor, a sodium glucose cotransporter or SGLT-2
inhibitor, a glucagon- like peptide 1, or a GLP-1 receptor agonist or
basal insulin
Second drug choice made considering efficacy, the hypoglycemia
risk of the patient, the patient tolerability, and weight-related
considerations (some help weight loss, some cause weight gain),
cost
Step 3
Three drug combination
Metformin
Plus 2 other drugs from step 2
Decided based on a drug and patient specific
considerations Step 4
If 3 drug combination that includes basal insulin fails after 3-6
months, more complex insulin regimen
Usually in combination with one or more non-insulin medications
13. When a patient is on insulin therapy what are the blood glucose goals
before meals? At bedtime?
Before meals—70-130
Bedtime—100-140
, 14. What is the A1C goal? When is goal below 7 not appropriate?
7% or below
Those with severe hypoglycemia risk, limited life expectancy,
advanced micro vascular or macro vascular complications—not
below 7
15. What are the short acting insulins? Intermediate? Long acting?
Short duration: Rapid acting
Insulin lispro [Humalog]
Insulin aspart [NovoLog]
Insulin glulisine
[Apidra] Short duration:
Slower acting
Regular insulin [Humulin R,
Novolin R] Intermediate duration
Neutral protamine Hagedorn (NPH) insulin
Insulin detemir
[Levemir] Long duration
Insulin glargine
16. When are short duration insulins used?
Administered in association with meals to control the post-prandial
rise in blood glucose between meals and at night
17. When are intermediate insulins needed?
Administer 2-3 times daily to provide glycemic control between meals
and during the night
18. How long is duration of glargine? Levemir? Degludec?
Glargine—up to 24 hours
