NURS 5334 EXAM 3 STUDY GUIDE & EXAM REVIEW~ QUESTIONS & ANSWERS

Exam 3 Study Questions
 What drugs are used to treat gestational diabetes?
o Metformin and Insulin
 What A1C value indicates diabetes mellitus? Pre-DM?
o 6.5% or greater is considered diabetes
o 5.7-6.4% pre-diabetes
 What fasting and random values indicate DM?
o Fasting plasma glucose—126 or greater is diabetes
o Random (casual) plasma glucose—anything greater than 200 is diabetes
 What are complications of insulin therapy?
o Hypoglycemia
o Can develop lipohypertrophy
 Accumulation of subcutaneous fat that occurs when it is injected too frequently
at the same site
o Allergic reactions
 Characterized by red and intensely itchy welts, breathing becomes difficult
 If severe allergy develops:
 Desensitization procedure (small doses to larger doses)
o 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
 Drug interactions?
o Hypoglycemic agents
 Can intensify the hypoglycemia included by insulin
 Examples: sulfonylureas, glinides, alcohol
o Use with caution with hyperglycemic agents
 Examples: thiazide and glucocorticoids and sympathomimetics
 What effect do beta blockers have on insulin?
o delay awareness of and response to hypoglycemia by masking the signs that are
associated with stimulation of sympathetic nervous system
o Impair glycogenolysis
o Prevent the bodies counter-regulatory response
 What are other therapeutic uses besides DM?
o Hyperkalemia
o Aids in diagnosis of GH deficiency
o Diabetic ketoacidosis
 Insulin dosage must be coordinated with what?
o Carbohydrate intake
 What is B/P goal in diabetic?
o To be controlled, within normal 120/80
 What medication can be given to decrease risk of diabetic nephropathy?
o ACE inhibitor or ARB

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, What role does exercise play in treatment of both type 1 and type 2 DM?
o Exercise increases cellular responsiveness to insulin and increases glucose tolerance
o 150 minute per week of moderate intensity exercise is recommended
 What are the 4 steps in the 4-step approach?
o Step 1—diagnosis
 Lifestyle changes plus metformin
o 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
o Step 3
 Three drug combination
 Metformin
 Plus 2 other drugs from step 2
o Decided based on a drug and patient specific considerations
o 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
 When a patient is on insulin therapy what are the blood glucose goals before meals? At
bedtime?
o Before meals—70-130
o Bedtime—100-140
 What is the A1C goal? When is goal below 7 not appropriate?
o 7% or below
o Those with severe hypoglycemia risk, limited life expectancy, advanced microvascular or
macrovascular complications—not below 7
 What are the short acting insulins? Intermediate? Long acting?
o Short duration: Rapid acting
 Insulin lispro [Humalog]
 Insulin aspart [NovoLog]
 Insulin glulisine [Apidra]
o Short duration: Slower acting
 Regular insulin [Humulin R, Novolin R]
o Intermediate duration
 Neutral protamine Hagedorn (NPH) insulin
 Insulin detemir [Levemir]
o Long duration
 Insulin glargine
 When are short duration insulins used?


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, o Administered in association with meals to control the post-prandial rise in blood glucose
between meals and at night
 When are intermediate insulins needed?
o Administer 2-3 times daily to provide glycemic control between meals and during the
night
 How long is duration of glargine? Levemir? Degludec?
o Glargine—up to 24 hours
o Levemir
 Low dose (0.2 units/kg)—12 hours
 High doses (0.4 units/kg)—20-24 hours
o Degludec—up to 42 hours
 What are routes of administration? Which can be inhaled?
o SQ injection
o IV infusion
o Inhalation—Afrezza, mealtime insulin
 What is typical dosing for type 1? Type 2?
o Total doses may range from 0.1 unit/kg body weight to more than 2.5 units/kg
o Type 1
 Initial doses typically range from 0.5-0.6 units/kg per day
o Type 2
 Initial doses range from 0.2-0.6 units/kg per day
 Dosage increased or decreased according to carb intake, activity
 What are the 3 dosing schedules?
o Twice daily dosing
o Intensive basal/bolus strategy
o Continued subcutaneous insulin
 How does metformin work?
o Inhibits glucose production in the liver
o Reduces glucose absorption in the gut
o Sensitizes insulin receptors in target tissues (fat and skeletal muscle) thus increase
glucose uptake and response to whatever insulin is available
 What are side effects? BB warning?
o GI effects—diarrhea
o Lactic acidosis
 How does alcohol effect?
o Inhibits the breakdown of lactic acid
 What are the therapeutic uses other than DM?
o Gestational diabetes
o PCOS
 Sulfonylureas
o First generation
 Chlorpropamide [Diabinese]
 Tolazamide [Tolinase]


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,  Tolbutamine [Orinase]
o Second Generation:
 Glyburide [Diabeta, Glynase, Micronase] with metformin [Glucovance]
 Glypizide (Glucotrol, Glucotrol XL); with metformin [metaglip])
 Glimepiride (Amaryl; with metformin [Amaryl M], with pioglitazone [Duetact]
with rosiglitazone [Avandaryl]
o MOA?
 Promote insulin release
o Main side effect?
 Hypoglycemia
 Weight gain
o How does cimetidine effect? Beta blocker?
 Cimetidine—intensifies the response
 Beta blockers—diminish the benefits by suppressing the insulin release
 Meglitinides (Repaglinide and Nateglinide)
o MOA—stimulate pancreatic insulin release
o Drug/Drug interaction—gemfibrozil
 Thiazolidinediones (glitazones)
o Reduce glucose levels primarily by decreasing insulin resistance
o Only indication is type 2 diabetes, mainly as an add-on to metformin
o Rosiglitazone [Avandia]: Restricted use
o Pioglitazone [Actos]
o Can they be used in patient with CHF?
 No
 Alpha-glucosidase inhibitors (Acarbose or Precose; Miglitol (glyset))
o What races are these more effective in?
 Latinos and African Americans
 DPP-4 inhibitors (gliptins)
o MOA—promote glycemic control by enhancing the actions of the incretin hormones and
they stimulate glucose dependent release of insulin
 Suppress your post-prandial release of glucagon
o What is the % of A1C reduction?
 0.5%
 Sodium-glucose cotransporter 2 (SGLT-2) inhibitors (Canagliflozin, Dapagliflozin)
 How does colesevelam work in treatment of DM? Bromocriptine?
o Colesevelam—bile acid sequestrant used to lower cholesterol and helps lower blood
glucose
 Many with diabetes also have high cholesterol so 2 birds-1 stone
o Bromocriptine—adjunct to diet and exercise (0.5% reduction)
 Injectables
o Amylin memetics?
 Pramlintide
 Side effects—hypoglycemia when used with insulin
 Drug/Drug—insulin

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