NURP 533 Exam 1 Questions With Complete Solutions
Non-insulin injectables
-tide
Glucagon-like peptide 1 agonists (GLP-1)
Exenatide (Byetta)
MOA, side effects, contraindications
MOA: Promotes insulin release from Beta cells when blood
glucose is elevated, postprandial
Side effects: Severe abdominal pain (pancreatitis), GI upset,
renal insufficiency
Contraindications: DM1, acute pancreatitis, gastroparesis,
thyroid CA
Multiple drug interactions
Injectable only, daily or ER option
Decreases A1C by 1-1.5%
Basal insulin indication and types
First line for T2DM with A1C >9% and symptomatic
Galrgine: no peak, 20-24 hr duration
Detemir: peak 3-9 hrs, 6-24 hrs duration
Degludec: peak 9 hrs, duration >42 hrs
Prandial insulin indication
T1DM or refractory uncontrolled T2DM
types and timing of rapid-acting insulin
,Rapid acting: 5-15 mins, peak 30-90 and duration 4-6 hrs
Lispro (Humalog)
Aspart (Novolog, Fiasp)
Glulisine (Apidra)
Short acting insulin
Onset 30-60 mins, peak 2-3 hrs, duration 8-10 hrs
Regular insulin (Human R, Novocain R)
Intermediate acting insulin
Onset 2-4 hrs
Peak 4-10 hrs
Duration 12-18 hrs
Isophane insulin (NPH, Humalin N, Novolin N)
Non-pharmacologic therapy for type 2 DM
Weight loss >5% of body weight
30 mins of daily physical activity
Goals and preventative care for type 2 DM
ABCs
A: A1C
Check q3 months if not at goal, q6 months if at goal
Most adult's goal is <7%, meds <7.5%
B: Blood pressure
Measure at every visit
Adult goal is <140/90
Peds goal is <130/80 or 90th percentile
, C: Cholesterol
Statin therapy when indicated
Additional screening:
Neuropathy - monofilament and foot exam annually
Retinopathy - At diagnosis then annually
Nephropathy: Annual GFR, spot urine-creatinine ratio
Pediatric Diabetes screening criteria
Overweight: BMI great than 85th percentile for age and sex,
weight and height greater than 85th percentile or weight greater
than 120% of ideal for height
AND one of the following
- Maternal hx of GDM during patients gestation
- Family hx
- High risk ethnicity
- Signs of insulin resistance (acanthuses nigricans, hypertension,
dyslipidemia, PCOS, or SGA
Screening for type 1 DM diagnosis in peds
Nephropathy, retinopathy, neuropathy, hypertension,
dyslipidemia, thyroid, celiac
Cushing syndrome
Excess cortisol most commonly r/t exogenous corticosteroid
intake and with decreased levels of ACTH due to the negative
feedback loop
Non-insulin injectables
-tide
Glucagon-like peptide 1 agonists (GLP-1)
Exenatide (Byetta)
MOA, side effects, contraindications
MOA: Promotes insulin release from Beta cells when blood
glucose is elevated, postprandial
Side effects: Severe abdominal pain (pancreatitis), GI upset,
renal insufficiency
Contraindications: DM1, acute pancreatitis, gastroparesis,
thyroid CA
Multiple drug interactions
Injectable only, daily or ER option
Decreases A1C by 1-1.5%
Basal insulin indication and types
First line for T2DM with A1C >9% and symptomatic
Galrgine: no peak, 20-24 hr duration
Detemir: peak 3-9 hrs, 6-24 hrs duration
Degludec: peak 9 hrs, duration >42 hrs
Prandial insulin indication
T1DM or refractory uncontrolled T2DM
types and timing of rapid-acting insulin
,Rapid acting: 5-15 mins, peak 30-90 and duration 4-6 hrs
Lispro (Humalog)
Aspart (Novolog, Fiasp)
Glulisine (Apidra)
Short acting insulin
Onset 30-60 mins, peak 2-3 hrs, duration 8-10 hrs
Regular insulin (Human R, Novocain R)
Intermediate acting insulin
Onset 2-4 hrs
Peak 4-10 hrs
Duration 12-18 hrs
Isophane insulin (NPH, Humalin N, Novolin N)
Non-pharmacologic therapy for type 2 DM
Weight loss >5% of body weight
30 mins of daily physical activity
Goals and preventative care for type 2 DM
ABCs
A: A1C
Check q3 months if not at goal, q6 months if at goal
Most adult's goal is <7%, meds <7.5%
B: Blood pressure
Measure at every visit
Adult goal is <140/90
Peds goal is <130/80 or 90th percentile
, C: Cholesterol
Statin therapy when indicated
Additional screening:
Neuropathy - monofilament and foot exam annually
Retinopathy - At diagnosis then annually
Nephropathy: Annual GFR, spot urine-creatinine ratio
Pediatric Diabetes screening criteria
Overweight: BMI great than 85th percentile for age and sex,
weight and height greater than 85th percentile or weight greater
than 120% of ideal for height
AND one of the following
- Maternal hx of GDM during patients gestation
- Family hx
- High risk ethnicity
- Signs of insulin resistance (acanthuses nigricans, hypertension,
dyslipidemia, PCOS, or SGA
Screening for type 1 DM diagnosis in peds
Nephropathy, retinopathy, neuropathy, hypertension,
dyslipidemia, thyroid, celiac
Cushing syndrome
Excess cortisol most commonly r/t exogenous corticosteroid
intake and with decreased levels of ACTH due to the negative
feedback loop
