NURS 5334 EXAM 3 QUESTIONS AND ANSWERS
Drugs for Gestational Diabetes - Answers - Metformin and Insulin
A1C Value for Diabetes Mellitus - Answers - 6.5% or greater is diabetes, 5.7-6.4% pre-
diabetes
Fasting and Random Values for DM - Answers - Fasting plasma glucose—126 or
greater is diabetes. Random plasma glucose—anything greater than 200 is diabetes
Complications of Insulin Therapy - Answers - Hypoglycemia, Lipohypertrophy, Allergic
reactions, Desensitization procedure, Hypokalemia
Insulin Drug Interactions - Answers - Hypoglycemic agents intensify hypoglycemia, Use
with caution with hyperglycemic agents
Beta Blockers' Effect on Insulin - Answers - Delay awareness of hypoglycemia, Impair
glycogenolysis, Prevent counter-regulatory response
Other Therapeutic Uses - Answers - Hyperkalemia, Diagnosis of GH deficiency,
Diabetic ketoacidosis
Coordinating Insulin Dosage - Answers - Carbohydrate intake
Blood Pressure Goal in Diabetes - Answers - Controlled within normal 120/80
Medication for Diabetic Nephropathy Risk - Answers - ACE inhibitor or ARB
Role of Exercise in DM Treatment - Answers - Exercise increases cellular
responsiveness to insulin and glucose tolerance. 150 minutes per week of moderate
intensity exercise is recommended.
4-Step Approach Steps - Answers - Step 1: Diagnosis and lifestyle changes plus
metformin. Step 2: Lifestyle changes, metformin, and a second drug. Step 3: Three drug
combination. Step 4: Complex insulin regimen if needed.
Insulin Therapy Blood Glucose Goals - Answers - Before meals: 70-130. Bedtime: 100-
140.
A1C Goal and Exceptions - Answers - A1C goal is 7% or below. Exceptions: Severe
hypoglycemia risk, limited life expectancy, advanced complications.
Types of Insulins - Answers - Short acting: Rapid acting insulins. Intermediate: NPH
insulin, insulin detemir. Long acting: Insulin glargine.
, Use of Short Duration Insulins - Answers - Administered with meals to control post-
prandial blood glucose rise.
Need for Intermediate Insulins - Answers - Administered 2-3 times daily for glycemic
control between meals and at night.
Duration of Insulins - Answers - Glargine: Up to 24 hours. Levemir: 12-24 hours.
Degludec: Up to 42 hours.
Routes of Insulin Administration - Answers - Subcutaneous injection and IV infusion.
Inhalation: Afrezza for mealtime insulin.
Insulin Dosing for Type 1 and Type 2 - Answers - Type 1: Initial doses 0.5-0.6
units/kg/day. Type 2: Initial doses 0.2-0.6 units/kg/day, adjusted based on carb intake
and activity.
3 Dosing Schedules - Answers - o Twice daily dosing
o Intensive basal/bolus strategy
o Continued subcutaneous insulin
Metformin Mechanism of Action - Answers - 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) to increase
glucose uptake and response to insulin
Metformin Side Effects and BB Warning - Answers - o GI effects—diarrhea
o Lactic acidosis
Alcohol Effect - Answers - Inhibits the breakdown of lactic acid
Therapeutic Uses Other Than DM - Answers - o Gestational diabetes
o PCOS
Sulfonylureas - Answers - o First generation: Chlorpropamide [Diabinese], Tolazamide
[Tolinase], 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]
Sulfonylureas Mechanism of Action and Main Side Effect - Answers - MOA: Promote
insulin release
Main side effect: Hypoglycemia, Weight gain
Cimetidine Effect and Beta Blockers - Answers - Cimetidine—intensifies the response
Beta blockers—diminish the benefits by suppressing insulin release
Drugs for Gestational Diabetes - Answers - Metformin and Insulin
A1C Value for Diabetes Mellitus - Answers - 6.5% or greater is diabetes, 5.7-6.4% pre-
diabetes
Fasting and Random Values for DM - Answers - Fasting plasma glucose—126 or
greater is diabetes. Random plasma glucose—anything greater than 200 is diabetes
Complications of Insulin Therapy - Answers - Hypoglycemia, Lipohypertrophy, Allergic
reactions, Desensitization procedure, Hypokalemia
Insulin Drug Interactions - Answers - Hypoglycemic agents intensify hypoglycemia, Use
with caution with hyperglycemic agents
Beta Blockers' Effect on Insulin - Answers - Delay awareness of hypoglycemia, Impair
glycogenolysis, Prevent counter-regulatory response
Other Therapeutic Uses - Answers - Hyperkalemia, Diagnosis of GH deficiency,
Diabetic ketoacidosis
Coordinating Insulin Dosage - Answers - Carbohydrate intake
Blood Pressure Goal in Diabetes - Answers - Controlled within normal 120/80
Medication for Diabetic Nephropathy Risk - Answers - ACE inhibitor or ARB
Role of Exercise in DM Treatment - Answers - Exercise increases cellular
responsiveness to insulin and glucose tolerance. 150 minutes per week of moderate
intensity exercise is recommended.
4-Step Approach Steps - Answers - Step 1: Diagnosis and lifestyle changes plus
metformin. Step 2: Lifestyle changes, metformin, and a second drug. Step 3: Three drug
combination. Step 4: Complex insulin regimen if needed.
Insulin Therapy Blood Glucose Goals - Answers - Before meals: 70-130. Bedtime: 100-
140.
A1C Goal and Exceptions - Answers - A1C goal is 7% or below. Exceptions: Severe
hypoglycemia risk, limited life expectancy, advanced complications.
Types of Insulins - Answers - Short acting: Rapid acting insulins. Intermediate: NPH
insulin, insulin detemir. Long acting: Insulin glargine.
, Use of Short Duration Insulins - Answers - Administered with meals to control post-
prandial blood glucose rise.
Need for Intermediate Insulins - Answers - Administered 2-3 times daily for glycemic
control between meals and at night.
Duration of Insulins - Answers - Glargine: Up to 24 hours. Levemir: 12-24 hours.
Degludec: Up to 42 hours.
Routes of Insulin Administration - Answers - Subcutaneous injection and IV infusion.
Inhalation: Afrezza for mealtime insulin.
Insulin Dosing for Type 1 and Type 2 - Answers - Type 1: Initial doses 0.5-0.6
units/kg/day. Type 2: Initial doses 0.2-0.6 units/kg/day, adjusted based on carb intake
and activity.
3 Dosing Schedules - Answers - o Twice daily dosing
o Intensive basal/bolus strategy
o Continued subcutaneous insulin
Metformin Mechanism of Action - Answers - 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) to increase
glucose uptake and response to insulin
Metformin Side Effects and BB Warning - Answers - o GI effects—diarrhea
o Lactic acidosis
Alcohol Effect - Answers - Inhibits the breakdown of lactic acid
Therapeutic Uses Other Than DM - Answers - o Gestational diabetes
o PCOS
Sulfonylureas - Answers - o First generation: Chlorpropamide [Diabinese], Tolazamide
[Tolinase], 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]
Sulfonylureas Mechanism of Action and Main Side Effect - Answers - MOA: Promote
insulin release
Main side effect: Hypoglycemia, Weight gain
Cimetidine Effect and Beta Blockers - Answers - Cimetidine—intensifies the response
Beta blockers—diminish the benefits by suppressing insulin release
