NUR 6210 EXAM 2 STUDY GUIDE
2025/2026 UPDATED
Diabetes
William Paterson University
NUR6210
,NUR
NUR 6210 Exam
Diabetes
Classification: 1. Type 1 diabetes (due to b-cell destruction, usually leading to absolute insulin deficiency); 2. Type II diabetes (due to a
progressive loss of insulin secretion on the background of insulin resistance); 3. Gestational diabetes mellitus (GDM) – diabetes diagnosed in
the 2nd or 3rd trimester of pregnancy that is not clearly overt diabetes; 4. specific types of diabetes due to other causes: ex: monogenic
diabetes syndromes (such as neonatal diabetes and maturity-onset diabetes of young (MODY), diseases of exocrine pancreas (such as cystic
fibrosis), and drug or chemical induced diabetes (such as with glucocorticoid use, in treatment of HIV/AIDS, and after organ transplantation)
Type II – previously referred to as “non-insulin independent diabetes” or “adult-onset diabetes”; accounts for 90-95% of all diabetes; this
form encompasses individuals who have insulin resistance and usually relative (rather than absolute) insulin deficiency
DM Screening in Asymptomatic Adult: overweight or obese (BMI > 25 or >23 in Asian Americans) and who have one or more additional risk
factors for diabetes: 1. Physical inactivity, 2. First-degree relative with diabetes, 3. High-risk race/ethnicity (African Americans, Latino,
Native American, Asian American, Pacific Islander); 4. Women who delivered a baby weighing 9lb or were diagnosed with gestational
diabetes; 5. HTN (>140/90mmHg or on therapy for HTN); 6. HDL cholesterol level 35 mg/dL and/or triglyceride level 250mg/dL (2.82
mmol/L); 7. Women with polycystic ovary syndrome; 8. A1C 5.7%, IGT, or IFG on previous testing; 9. Other clinical conditions associated
with insulin resistance (severe obesity, acanthosis nigricans), 10. History of cardiovascular
-criteria for screening: for all patients, testing should begin at age 45 years; if results are normal, testing should be repeated at a minimum of
3-year intervals, with consideration of more frequent testing depending on initial results (ex: those with prediabetes should be tested yearly)
and risk status; American Association of… recommends screening for diabetes in persons with risk factors only***
Classic Presentation: majority of patients are asymptomatic and hyperglycemia is found on routine lab evaluation; polydipsia, polyuria,
nocturia, blurred vision, and infrequently weight loss, fatigue, slowly and healing wounds, frequent infections and sometimes numbness and
tingling of hands and feet, vaginal infections, sexual problems; polyuria commonly presents when serum glucose concentrations rise
significantly above 180mg/dL which is the renal threshold for glucose; patients with type II diabetes may have no symptoms or only subtle
symptoms that may persist for weeks, months or years before detection
Criteria for Diagnosis: 1. Patient presents with classic symptoms of hyperglycemia (thirst, polyuria, weight loss, blurry vision) and random
plasma glucose ≥ 200mg/dL; 2. Asymptomatic patients with fasting
plasma glucose (FPG) ≥ 126mg/dL, two hour post oral glucose challenge (pregnant) ≥ 200mg/dL, or HbA1C ≥ 6.5;
*for asymptomatic: confirm test using a repeat test on subsequent day or if 2 different tests (FPG and A1C) are concordant for diagnosis of
diabetes; if 2 tests are discordant, the test result that is above the diagnostic cut point should be repeated, the diagnosis is made on the
basis of confirmed test*
Diagnostics – 1. Serum glucose (random or fasting): 100mg/dL normal, 100-125mg/dl prediabetes, ≥
126mg/dl diabetes; 2. HbA1C: <5.7% normal, 5.7-6.4% prediabetes, ≥ 6.5% diabetes; 3. Oral glucose
tolerance test: <140mg/dl normal, 140-199mg/dl prediabetes, ≥ 200mg/dl diabetes; 4. Urinalysis:
proteinuria, glucosuria; 4. C-peptide: 0.51-2.72ng/dl normal, <0.51ng/dl T1 DM, >2.72ng/dl T2 DM; 5. If not performed/available within
past year: fasting lipid profile, liver function tests, spot urinary albumin-to-creatinine ration, serum creatinine and estimated GFR, TSH in
patients with dyslipidemia or women aged >50
Comprehensive Medical Evaluation – 1. age and characteristics of onset of diabetes; 2. eating pattern/nutritional status/weight
history/physical activity habits – nutrition education and behavioral support history and needs; 3. presence of common comorbidities,
psychosocial problems and dental disease; 4. Screen for depression using PHQ-2 (PHQ-9 if PHQ-2 is positive); 5. Screen for diabetes distress
using DDS or PAID-1; 6. History of smoking, alcohol consumption and substance use; 7. Diabetes education, self-management, support
history and needs; 8. Review of previous treatment regimens and response to therapy (A1C records); 9. Results of glucose monitoring and
patient’s use of data; 10. Diabetes ketoacidosis frequency, severity and cause; 11. Hypoglycemia episodes, awareness and frequency and
causes; 12. History of increased blood pressure, increased lipids and tobacco use; 13. Microvascular complications: retinopathy,
nephropathy, and neuropathy (sensory, including history of foot lesions, autonomic including sexual dysfunction and gastroparesis); 14.
Macrovascular complications: coronary heart disease, cerebrovascular disease and peripheral arterial disease
Physical Examination: 1. height, weight and BMI (Growth and pubertal development in children and adolescents); 2. blood pressure
(orthostatic if indicated); 3. eyes (fundoscopy); 4. oral cavity (gum disease, fungal infection, or lesions); 5. neck (palpate thyroid); 6. cardiac:
HR, rate, rhythm, murmurs, clicks or extra heart sounds; 7. skin: irritation, infection, redness, ulcers, dryness, acanthosis nigrans; 8. feet:
pulses, reflexes, sensation, overall skin condition
Glycemic targets: 1. HgbA1C <7.0% for most non-pregnant adults; 2. Preprandial capillary plasma glucose 80-130 mg/dl; 3. Peak
postprandial capillary plasma glucose (1-2 hours after meals), 180mg/dl; 4. More stringent A1C goals (such as 6.5%) for selected individual
patients if this can be achieved without significant hypoglycemia and other adverse effects of treatment – short duration of diabetes, type II
diabetes treated with lifestyle or metformin only, long life expectancy, or no significant cardiovascular disease; 5. Less stringent A1C goals
(such as 8%) may be appropriate for patients with a history of severe hypoglycemia, limited life expectancy, advanced microvascular or
macrovascular complications, extensive comorbid conditions, or long-standing diabetes in whom the general goal is difficult to attain despite
diabetes self-management education, appropriate glucose monitoring and effective doses of multiple glucose-lowering agents including
insulin
Pharmacologic Management: Initial therapy: Metformin 500mg PO BID – increase in increments of 500mg weekly for max dose of 2000mg
, NUR
daily in 2 divided doses if goal not achieved; decreases hepatic glucose, increases insulin secretion and sensitivity; metformin may reduce
A1c by 1 to 2%, rarely causes hypoglycemia when used as monotherapy and does not cause weight gain, may cause weight loss; low-cost,
with a long track record of accumulated patient experience and safety, and it has a beneficial lipid effect; side effects/intolerance – GI
intolerance – slow titration and use of extended release, take with food; FDA revised safety GFR> 30; monitor B12
-ADA recommends if the A1C target is not achieved after approximately 3 months, consider a combination of metformin and one of these 6
treatment options: sulfonylurea, thiazolidinedione, DPP-4 inhibitors, SGLT2 inhibitors, GLP-1 receptor agonists, basal insulin; Drug choice is
based on patient
2025/2026 UPDATED
Diabetes
William Paterson University
NUR6210
,NUR
NUR 6210 Exam
Diabetes
Classification: 1. Type 1 diabetes (due to b-cell destruction, usually leading to absolute insulin deficiency); 2. Type II diabetes (due to a
progressive loss of insulin secretion on the background of insulin resistance); 3. Gestational diabetes mellitus (GDM) – diabetes diagnosed in
the 2nd or 3rd trimester of pregnancy that is not clearly overt diabetes; 4. specific types of diabetes due to other causes: ex: monogenic
diabetes syndromes (such as neonatal diabetes and maturity-onset diabetes of young (MODY), diseases of exocrine pancreas (such as cystic
fibrosis), and drug or chemical induced diabetes (such as with glucocorticoid use, in treatment of HIV/AIDS, and after organ transplantation)
Type II – previously referred to as “non-insulin independent diabetes” or “adult-onset diabetes”; accounts for 90-95% of all diabetes; this
form encompasses individuals who have insulin resistance and usually relative (rather than absolute) insulin deficiency
DM Screening in Asymptomatic Adult: overweight or obese (BMI > 25 or >23 in Asian Americans) and who have one or more additional risk
factors for diabetes: 1. Physical inactivity, 2. First-degree relative with diabetes, 3. High-risk race/ethnicity (African Americans, Latino,
Native American, Asian American, Pacific Islander); 4. Women who delivered a baby weighing 9lb or were diagnosed with gestational
diabetes; 5. HTN (>140/90mmHg or on therapy for HTN); 6. HDL cholesterol level 35 mg/dL and/or triglyceride level 250mg/dL (2.82
mmol/L); 7. Women with polycystic ovary syndrome; 8. A1C 5.7%, IGT, or IFG on previous testing; 9. Other clinical conditions associated
with insulin resistance (severe obesity, acanthosis nigricans), 10. History of cardiovascular
-criteria for screening: for all patients, testing should begin at age 45 years; if results are normal, testing should be repeated at a minimum of
3-year intervals, with consideration of more frequent testing depending on initial results (ex: those with prediabetes should be tested yearly)
and risk status; American Association of… recommends screening for diabetes in persons with risk factors only***
Classic Presentation: majority of patients are asymptomatic and hyperglycemia is found on routine lab evaluation; polydipsia, polyuria,
nocturia, blurred vision, and infrequently weight loss, fatigue, slowly and healing wounds, frequent infections and sometimes numbness and
tingling of hands and feet, vaginal infections, sexual problems; polyuria commonly presents when serum glucose concentrations rise
significantly above 180mg/dL which is the renal threshold for glucose; patients with type II diabetes may have no symptoms or only subtle
symptoms that may persist for weeks, months or years before detection
Criteria for Diagnosis: 1. Patient presents with classic symptoms of hyperglycemia (thirst, polyuria, weight loss, blurry vision) and random
plasma glucose ≥ 200mg/dL; 2. Asymptomatic patients with fasting
plasma glucose (FPG) ≥ 126mg/dL, two hour post oral glucose challenge (pregnant) ≥ 200mg/dL, or HbA1C ≥ 6.5;
*for asymptomatic: confirm test using a repeat test on subsequent day or if 2 different tests (FPG and A1C) are concordant for diagnosis of
diabetes; if 2 tests are discordant, the test result that is above the diagnostic cut point should be repeated, the diagnosis is made on the
basis of confirmed test*
Diagnostics – 1. Serum glucose (random or fasting): 100mg/dL normal, 100-125mg/dl prediabetes, ≥
126mg/dl diabetes; 2. HbA1C: <5.7% normal, 5.7-6.4% prediabetes, ≥ 6.5% diabetes; 3. Oral glucose
tolerance test: <140mg/dl normal, 140-199mg/dl prediabetes, ≥ 200mg/dl diabetes; 4. Urinalysis:
proteinuria, glucosuria; 4. C-peptide: 0.51-2.72ng/dl normal, <0.51ng/dl T1 DM, >2.72ng/dl T2 DM; 5. If not performed/available within
past year: fasting lipid profile, liver function tests, spot urinary albumin-to-creatinine ration, serum creatinine and estimated GFR, TSH in
patients with dyslipidemia or women aged >50
Comprehensive Medical Evaluation – 1. age and characteristics of onset of diabetes; 2. eating pattern/nutritional status/weight
history/physical activity habits – nutrition education and behavioral support history and needs; 3. presence of common comorbidities,
psychosocial problems and dental disease; 4. Screen for depression using PHQ-2 (PHQ-9 if PHQ-2 is positive); 5. Screen for diabetes distress
using DDS or PAID-1; 6. History of smoking, alcohol consumption and substance use; 7. Diabetes education, self-management, support
history and needs; 8. Review of previous treatment regimens and response to therapy (A1C records); 9. Results of glucose monitoring and
patient’s use of data; 10. Diabetes ketoacidosis frequency, severity and cause; 11. Hypoglycemia episodes, awareness and frequency and
causes; 12. History of increased blood pressure, increased lipids and tobacco use; 13. Microvascular complications: retinopathy,
nephropathy, and neuropathy (sensory, including history of foot lesions, autonomic including sexual dysfunction and gastroparesis); 14.
Macrovascular complications: coronary heart disease, cerebrovascular disease and peripheral arterial disease
Physical Examination: 1. height, weight and BMI (Growth and pubertal development in children and adolescents); 2. blood pressure
(orthostatic if indicated); 3. eyes (fundoscopy); 4. oral cavity (gum disease, fungal infection, or lesions); 5. neck (palpate thyroid); 6. cardiac:
HR, rate, rhythm, murmurs, clicks or extra heart sounds; 7. skin: irritation, infection, redness, ulcers, dryness, acanthosis nigrans; 8. feet:
pulses, reflexes, sensation, overall skin condition
Glycemic targets: 1. HgbA1C <7.0% for most non-pregnant adults; 2. Preprandial capillary plasma glucose 80-130 mg/dl; 3. Peak
postprandial capillary plasma glucose (1-2 hours after meals), 180mg/dl; 4. More stringent A1C goals (such as 6.5%) for selected individual
patients if this can be achieved without significant hypoglycemia and other adverse effects of treatment – short duration of diabetes, type II
diabetes treated with lifestyle or metformin only, long life expectancy, or no significant cardiovascular disease; 5. Less stringent A1C goals
(such as 8%) may be appropriate for patients with a history of severe hypoglycemia, limited life expectancy, advanced microvascular or
macrovascular complications, extensive comorbid conditions, or long-standing diabetes in whom the general goal is difficult to attain despite
diabetes self-management education, appropriate glucose monitoring and effective doses of multiple glucose-lowering agents including
insulin
Pharmacologic Management: Initial therapy: Metformin 500mg PO BID – increase in increments of 500mg weekly for max dose of 2000mg
, NUR
daily in 2 divided doses if goal not achieved; decreases hepatic glucose, increases insulin secretion and sensitivity; metformin may reduce
A1c by 1 to 2%, rarely causes hypoglycemia when used as monotherapy and does not cause weight gain, may cause weight loss; low-cost,
with a long track record of accumulated patient experience and safety, and it has a beneficial lipid effect; side effects/intolerance – GI
intolerance – slow titration and use of extended release, take with food; FDA revised safety GFR> 30; monitor B12
-ADA recommends if the A1C target is not achieved after approximately 3 months, consider a combination of metformin and one of these 6
treatment options: sulfonylurea, thiazolidinedione, DPP-4 inhibitors, SGLT2 inhibitors, GLP-1 receptor agonists, basal insulin; Drug choice is
based on patient
