Nurs 659 Endocrine Test With
Complete Solution
Describe what a hemoglobin A1C test is looking at. Is this a reliable test? -
ANSWER Essentially how many red blood cells were saturated with glucose
over 3 months/120 days (lifespan of an RBC), estimate of glucose control
over this time
Relatively reliable but because it is an average, outliers can mess it up (very
high or very low) so it is not a substitute for checking your blood sugar day
to day
Biggest overarching goal of diabetes management? - ANSWER decrease end
organ damage and long-term effects by controlling glucose
Brief patho of T1DM - ANSWER Destruction of pancreatic beta cells --> NO
insulin
Body turns to fat and protein as energy sources in the absence of insulin -->
catabolic state
Autoimmune process?
Can be genetic, or familial
Typically diagnosed in childhood or young adulthood
Symptoms of type 1 dm - ANSWER Classic: 3 Ps
Polyuria, polydipsia, polyphagia along with anorexia, weight loss
Other: nocturnal enuresis, visual changes, weakness, fatigue, abdominal pain,
,repeated infections, decreased wound healing, uncommon infections
Are type 1 DM symptoms typically rapid or slow to show for the first time? -
ANSWER Often rapid onset
These patients may not be diagnosed until they wind up in the hospital with
DKA
Why would a type 1 diabetic present with poor skin turgor and dry mucous
membranes? - ANSWER dehydration common 2/2 polyuria
Ketones in the urine signifies what? - ANSWER Sign of fat and protein
breakdown, cachexia. Concerning for impending DKA
Describe the labs and/or symptoms required for a diabetes diagnosis. -
ANSWER Symptoms + RANDOM glucose (so not fasting) of 200+
A1C 6.5%+
2 hour glucose of 199+ during an OGTT (not common, more pregnancy)
Fasting glucose 125+
How many abnormal labs are typically required for a definitive diabetes
diagnosis? - ANSWER If they have an abnormal one (whether it is
symptoms+random glu, A1C, fasting glu, or glucose during OGTT), typically
it is preferred to repeat the test. If they have two abnormals, that is typically
sufficient.
I.E. an abnormal fasting + an abnormal A1C = diagnosis
OR abnormal fasting on two occasions = diagnosis
What are some labs that may help you distinguish between type 1 and type 2
diabetes if you are unable to tell on presentation alone? - ANSWER Peptide
,level, insulin level (remember type 2 still produce insulin just don't respond),
1A autoantibodies (autoimmune component of type 1)
likely, refer to endo and let them figure it out
What is required in the medical management of type 1 diabetes regardless? -
ANSWER Insulin, no matter what
How often should a type 1 diabetic be checking their blood sugars? -
ANSWER Around 4-6x a day
Type 1 diabetics are usually on an insulin regimen that mimics the body's
release. How is this accomplished? - ANSWER require a once a day long
acting and then short acting usually based off their blood sugar or their carb
intake
What is the A1C goal for type 1 diabetics? - ANSWER <7% (usually more
stringent than a type 2)
You need to calculate the total daily dose for a patient who weights 60 kg.
What is the calculation you will use and what is the amount? How will you
divide this total up between basal (long acting) and prandial (rapid or short
acting)? - ANSWER The equation: 0.5 mg/kg/day.
Half of that should be basal, half should be prandial.
For this 60kg patient: 30mg/day required
15 should be given in basal, 15 in short acting
At the beginning of the type 2 diabetes disease, is insulin high or low? -
ANSWER HIGH
, Hyperinsulinemia as body tries to produce more in an effort to decrease
blood sugar, but effort is futile because body is not responding
As disease progresses, insulin production will too
Name some risk factors for type 2 diabetes. - ANSWER FH
AA, hispanic, native, asian american, pacific islands
h/o gestational diabetes
long term use of steroids, antipsychotics
obesity
metabolic syndrome
Describe some subjective findings of a type 2 diabetes patient when they first
present. Are these symptoms usually acute or insidious? - ANSWER
Sometimes none
Symptoms are often insidious in onset compared to the acute onset of type 1
May have fatigue, recurrent UTI/yeast infections/rashes, poorly healing
wounds, numbness/tingling of extremities, and may have classic symptoms
like the 3Ps
What objective findings might you observe on a type 2 diabetes patient? -
ANSWER Typically unremarkable, these patients often just look like anybody
Complete Solution
Describe what a hemoglobin A1C test is looking at. Is this a reliable test? -
ANSWER Essentially how many red blood cells were saturated with glucose
over 3 months/120 days (lifespan of an RBC), estimate of glucose control
over this time
Relatively reliable but because it is an average, outliers can mess it up (very
high or very low) so it is not a substitute for checking your blood sugar day
to day
Biggest overarching goal of diabetes management? - ANSWER decrease end
organ damage and long-term effects by controlling glucose
Brief patho of T1DM - ANSWER Destruction of pancreatic beta cells --> NO
insulin
Body turns to fat and protein as energy sources in the absence of insulin -->
catabolic state
Autoimmune process?
Can be genetic, or familial
Typically diagnosed in childhood or young adulthood
Symptoms of type 1 dm - ANSWER Classic: 3 Ps
Polyuria, polydipsia, polyphagia along with anorexia, weight loss
Other: nocturnal enuresis, visual changes, weakness, fatigue, abdominal pain,
,repeated infections, decreased wound healing, uncommon infections
Are type 1 DM symptoms typically rapid or slow to show for the first time? -
ANSWER Often rapid onset
These patients may not be diagnosed until they wind up in the hospital with
DKA
Why would a type 1 diabetic present with poor skin turgor and dry mucous
membranes? - ANSWER dehydration common 2/2 polyuria
Ketones in the urine signifies what? - ANSWER Sign of fat and protein
breakdown, cachexia. Concerning for impending DKA
Describe the labs and/or symptoms required for a diabetes diagnosis. -
ANSWER Symptoms + RANDOM glucose (so not fasting) of 200+
A1C 6.5%+
2 hour glucose of 199+ during an OGTT (not common, more pregnancy)
Fasting glucose 125+
How many abnormal labs are typically required for a definitive diabetes
diagnosis? - ANSWER If they have an abnormal one (whether it is
symptoms+random glu, A1C, fasting glu, or glucose during OGTT), typically
it is preferred to repeat the test. If they have two abnormals, that is typically
sufficient.
I.E. an abnormal fasting + an abnormal A1C = diagnosis
OR abnormal fasting on two occasions = diagnosis
What are some labs that may help you distinguish between type 1 and type 2
diabetes if you are unable to tell on presentation alone? - ANSWER Peptide
,level, insulin level (remember type 2 still produce insulin just don't respond),
1A autoantibodies (autoimmune component of type 1)
likely, refer to endo and let them figure it out
What is required in the medical management of type 1 diabetes regardless? -
ANSWER Insulin, no matter what
How often should a type 1 diabetic be checking their blood sugars? -
ANSWER Around 4-6x a day
Type 1 diabetics are usually on an insulin regimen that mimics the body's
release. How is this accomplished? - ANSWER require a once a day long
acting and then short acting usually based off their blood sugar or their carb
intake
What is the A1C goal for type 1 diabetics? - ANSWER <7% (usually more
stringent than a type 2)
You need to calculate the total daily dose for a patient who weights 60 kg.
What is the calculation you will use and what is the amount? How will you
divide this total up between basal (long acting) and prandial (rapid or short
acting)? - ANSWER The equation: 0.5 mg/kg/day.
Half of that should be basal, half should be prandial.
For this 60kg patient: 30mg/day required
15 should be given in basal, 15 in short acting
At the beginning of the type 2 diabetes disease, is insulin high or low? -
ANSWER HIGH
, Hyperinsulinemia as body tries to produce more in an effort to decrease
blood sugar, but effort is futile because body is not responding
As disease progresses, insulin production will too
Name some risk factors for type 2 diabetes. - ANSWER FH
AA, hispanic, native, asian american, pacific islands
h/o gestational diabetes
long term use of steroids, antipsychotics
obesity
metabolic syndrome
Describe some subjective findings of a type 2 diabetes patient when they first
present. Are these symptoms usually acute or insidious? - ANSWER
Sometimes none
Symptoms are often insidious in onset compared to the acute onset of type 1
May have fatigue, recurrent UTI/yeast infections/rashes, poorly healing
wounds, numbness/tingling of extremities, and may have classic symptoms
like the 3Ps
What objective findings might you observe on a type 2 diabetes patient? -
ANSWER Typically unremarkable, these patients often just look like anybody
