NR 601 Final exam review Weeks 5-8 content
I I I I I I I
Week 5 I
Glucose metabolism disorders
I I
• Types Iof Idiabetes I(prediabetes, Itype I1 Iand Itype I2) I I
Islet Icell-specific Iantibodies Imay Ibe Iidentified Iin I70-80% Iof Ipeople Iwith Iprediabetes I& Ithose Inewly Idx Iwith IDM1 Iand
Ihyperglycemia Itypically Idevelops Ionce I80-90% Iof Ibeta Icells Ihave Ibeen Idestroyed.
In IType II Idiabetes, Ian Iauto-immune Iattack Ion Ithe Ibeta Icells Iof Ithe Ipancreas Iprevents Ithe Iproduction Iand Isecretion Iof
Iinsulin Iinto Ithe Iblood. IThus, IType II Idiabetes Iinhibits Ithis Ifirst Istep Iin Ithe Iinsulin Ipathway. IAnd Isince Iit Idecreases Ithe
Iproduction Iof Iinsulin, Iit's Ireferred Ito Ias Ian I insulin Ideficiency.
In IDM2, Idrug-induced, Iand IGDM, Ithe Ipancreas Icontinues Ito Isecrete Iinsulin. IHowever, Iit's Ithe Icells Ithroughout Ithe Ibody
Ithat Iare Iunable Ito Iadequately Irespond Ito Iit I(decrease Iin Ibeta Icell Ifunction), Iso Ithese Imechanisms Iinhibit Ithe Isecond Istep Iin
Ithe Iinsulin Ipathway I= Iinsulin Iresistance, Iwhich Ican Ibe Ithought Iof Ias Ia Irelative Iinsulin Ideficiency.
o Diagnostic Icriteria Iis Ibased Ion: Iketonuria, Iage Iof Ionset, I& IBMI
▪ Antibody Itesting Iand Ic-peptide Ilevels Idetermine Itype: IAb Ito Iislet I& Ibeta Icells Iare Ipresent Iin I70-80%
Ifor IType I1 I(not Ifor IType I2), Iextremely Ilow Ilevels Iof Ic-peptide Iare Ionly Iseen Iin IType I1; IType I2
Iusually Ioccurs I≥ I40 Iy.o. I& IBMI I> I27 Iwith Ino Ior Iminimal Iketonuria
▪ DX Iis Iwith Ieither I2 IFBG I≥ I126 Img/dL Ior Ia Irandom IBG I≥ I200mg/dL Iwith Isx Ipresent
▪ Patients Iwho Iare Isymptomatic I& Ihave I1 I+ Itest Iare Idx Iwith IDM2; Iif Iasymptomatic, I2 I+ Itests Iare
Inecessary Ifor Idx I(Khan Ivideos)
▪ HbA1c I≥ I6.5 I= IDM2
▪ When Ihyperglycemia Iis Ievident, Ifasting Iurine Ishould Ibe Ichecked Ifor Iketones Ito Idetermine IType I1 Ior I2
Iand Ithe Ineed Ifor Iinsulin Itherapy
▪ Screening Irecommended Ifor Ianyone Iwho Iis Ioverweight Iand Ihas Iadditional Irisk Ifactors.
▪ Screening Ishould Ibegin Iat I45 Iyears Iold Iand Irepeated IQ3 Iyears I(or Ifrequently Iif Imultiple Irisk Ifactors
Iare Ipresent)
▪ Additional Ilabs Iat Idx, Ithen Iannually: Ifasting Ilipid Iprofile, IeGFR, Icreatinine, IUA, I& Iliver Ifunction
o I IInitial Itreatment Irecommendations Ifor IType I2: Ithe Igoal Iof Itx Iis Iglycemic Icontrol, Igood Inutritional Istatus
through Iweight Imanagement Iand Iexercise I(insulin Iis Iusually Iconsidered I2nd Iline Itherapy Iwhen Icombo Itherapy
Ifails)
▪ Lifestyle Imodifications Iare I1st Iline Itherapy Ifor Inew Idx Iwith Imild-moderate Ihyperglycemia I(weight
Iloss Iand Iexercise)- Iif Iafter I3-6 Imonths Inon-pharm Itx Ifails Ior IFBG Iis I200-300 I(or Irandom IBG Iis
I250-
350) Ithen Iadd Ian Ioral Iagent Ilike IMetformin; Idual Iagent Ipharmacotherapy Inot Irecommended Iunless
IA1c I≥ I9%
▪ Metformin I(Glucophage) Iis Ia Ibiguanide Ithat Iacts Iby Idecreasing Ihepatic Iglucose Iproduction,
st
Idecreasing Iglucose Iintestinal Iabsorption, I& Iincreasing Iinsulin Isensitivity. IMay Ibe Iused Iwith Iinsulin I1
line Ioral Iagent: Iinitial Idosing Iis I500mg Idaily Iwith Ibreakfast Ior Idinner Ix I1 Iweek, Ithen IBID Iwith Imeals
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, (long-term Itx Imay Idecrease IB12 Iabsorption, Iso Icheck Iannually Iespecially Iw/ Icomplaints Iof Iperipheral
Ineuropathy)
▪ Sulfonylureas I(glipizide, Iglimepiride, Iglyburide[Beers IPIM]) Iare Iinsulin Isecretagogues Iand Iact Iby
Iincreasing Ipancreatic Iinsulin Isecretion Iand Ilower IHbA1c Iby I1.25%
▪ Meglitinides I(nateglinide-Starlix I& Irepaglinide-Prandin) Iare Iinsulin Isecretagogues Ithat Iincrease
Iendogenous Irelease Iof Iinsulin Ifrom Ithe Ipancreas, Iand Ireduce IA1c Iby Iabout I1%
▪ Thiazolidinedines I(TZDs) IMay Ibe Iused Iwith Iinsulin I(piaglitazone I(Actos) I& Irosiglitazone I(Avandia)
Iare Iinsulin Isensitizers Ithat Iincrease Iinsulin Isensitivity Ito Iincrease Iglucose Iutilization Iand Idecrease
Ihepatic Iglucose Iproduction, Iand Ireduce IA1c Iby I1-1.5% I*don’t Iuse Iin Ipts Iwith IHF, Ibladder Icancer,
osteoporosis, Ior Iliver Idisease I I
▪ Dipeptidyl Ipeptidase-4 I(DDP-4) Iinhibitors Iare Ionce Idaily Iand Iincrease Ithe Ibioavailability Iof IGLP-
I1: Isitagliptin I(Januvia), Ilinagliptin I(Tradjenta), Isaxagliptin I(Onglyza) I& Ialogliptin I(Nesina)
▪ Alpha-glucosidase Iinhibitors I(acarbose-Precose I& Imiglitol- IGlyset) Iact Ito Idecrease/delay Iglucose
Iabsorption Iand Ilower IBG Ilevels, Ialso Ilower Iserum Itriglycerides I& Ireduce IA1c Iby I0.8% I*don’t Iuse
IinIpts Iwith Ia Ihx Iof Ipancreatitis
▪ Sodium-glucose Icotransporter I2 I(SLGT2) Iinhibitors I(dapagliflozin-Forxiga, Icanagliflozin-
IInvokana, Iempagliflozin-Jardinance, I& Iertugliflozin-Steglatro) Iblock Iglucose Ireabsorption Iin Ithe
Iproximal Irenal Itubule Ito Ireduce Iglucse Ireabsorption I& Iincrease Iurinary Iglucose Iexcretion. IThey
reduce IA1c Iby I0.5-1%, Iare Iapproved Ifor Imonotherapy Iand Iare Ivery Iexpensive
o I IInitial Itreatment Ifor IType I1 I(and IDKA) Iis Ialways Iinsulin IThey Iall Iwork Ialike; Ithe Idifference Iis Iin Ithe
Ionset Iand Iduration Iof Iaction.
o Treatment Igoals Ifor Iolder Iadults: Ishould Ibe Imade Iafter Icareful Iassessment Iof Ithe Ipatient’s Ihealth Ibeliefs, Ilife
Iexpectancy, Ifunctional Istatus, Ieconomic Isituation, I& Iavailability Iof Isupport Iservices. I(Kennedy Itable I14-2)
o Response Ito Itx Iis Ibased Ion Ihome IBG Imonitoring Iresults I& IA1c I(which Ireflects Icontrol Iof Ipast I 3 Imonths)
▪ F/U Ivisits Ishould Iinclude IBP, IBMI, Ireview Iof Ihome IBG Ilog, Ireview Iof Imeds, Iexam Iof Ifeet, Iannual
Ieye Iexam Iincluding Idilation, Ithyroid Ipalpation, Ifull Iskin Iexam Ifor Iacanthosis Inigricans, Iroutine
IUAIwith Ialbuminuria I& Ialbumin Ito Icreatinine Iratio, Iserum Icreatinine Ilevel, Iliver Ifunction Itests,
IeGFR,
annual IECG, Ifasting Ilipid Iprofile, IHbA1c I(Q3-6 Imonths), Ieval Ifor Ineurovascular Icomplications, Iself-
Imanagement Ieducation, Iannual Iflu Ivaccine, IPNA Ivaccines, Ibiannual Ioral Iexam.
o I
o HbA1C Igoals Ibased Ion Icomplications I(Dunphy Ip.925)
▪ An IA1c Iof I<7% Iindicates Istrong Icontrol Iover Ipast I2-3 Imonths, Ibut I<6.5% Iwill Isignificantly Idecrease
Ithe Ioccurrence Iof Icomplications
o Weight Iloss Irecommendations I(improves Iserum Ilipid Iprofile Iand Iglucose Iintolerance, Idecreases IBP I& Iinsulin
Iresistance)
This study source was downloaded by 100000823822032 from CourseHero.com on 01-10-2022 11:35:11 GMT -06:00
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I I I I I I I
Week 5 I
Glucose metabolism disorders
I I
• Types Iof Idiabetes I(prediabetes, Itype I1 Iand Itype I2) I I
Islet Icell-specific Iantibodies Imay Ibe Iidentified Iin I70-80% Iof Ipeople Iwith Iprediabetes I& Ithose Inewly Idx Iwith IDM1 Iand
Ihyperglycemia Itypically Idevelops Ionce I80-90% Iof Ibeta Icells Ihave Ibeen Idestroyed.
In IType II Idiabetes, Ian Iauto-immune Iattack Ion Ithe Ibeta Icells Iof Ithe Ipancreas Iprevents Ithe Iproduction Iand Isecretion Iof
Iinsulin Iinto Ithe Iblood. IThus, IType II Idiabetes Iinhibits Ithis Ifirst Istep Iin Ithe Iinsulin Ipathway. IAnd Isince Iit Idecreases Ithe
Iproduction Iof Iinsulin, Iit's Ireferred Ito Ias Ian I insulin Ideficiency.
In IDM2, Idrug-induced, Iand IGDM, Ithe Ipancreas Icontinues Ito Isecrete Iinsulin. IHowever, Iit's Ithe Icells Ithroughout Ithe Ibody
Ithat Iare Iunable Ito Iadequately Irespond Ito Iit I(decrease Iin Ibeta Icell Ifunction), Iso Ithese Imechanisms Iinhibit Ithe Isecond Istep Iin
Ithe Iinsulin Ipathway I= Iinsulin Iresistance, Iwhich Ican Ibe Ithought Iof Ias Ia Irelative Iinsulin Ideficiency.
o Diagnostic Icriteria Iis Ibased Ion: Iketonuria, Iage Iof Ionset, I& IBMI
▪ Antibody Itesting Iand Ic-peptide Ilevels Idetermine Itype: IAb Ito Iislet I& Ibeta Icells Iare Ipresent Iin I70-80%
Ifor IType I1 I(not Ifor IType I2), Iextremely Ilow Ilevels Iof Ic-peptide Iare Ionly Iseen Iin IType I1; IType I2
Iusually Ioccurs I≥ I40 Iy.o. I& IBMI I> I27 Iwith Ino Ior Iminimal Iketonuria
▪ DX Iis Iwith Ieither I2 IFBG I≥ I126 Img/dL Ior Ia Irandom IBG I≥ I200mg/dL Iwith Isx Ipresent
▪ Patients Iwho Iare Isymptomatic I& Ihave I1 I+ Itest Iare Idx Iwith IDM2; Iif Iasymptomatic, I2 I+ Itests Iare
Inecessary Ifor Idx I(Khan Ivideos)
▪ HbA1c I≥ I6.5 I= IDM2
▪ When Ihyperglycemia Iis Ievident, Ifasting Iurine Ishould Ibe Ichecked Ifor Iketones Ito Idetermine IType I1 Ior I2
Iand Ithe Ineed Ifor Iinsulin Itherapy
▪ Screening Irecommended Ifor Ianyone Iwho Iis Ioverweight Iand Ihas Iadditional Irisk Ifactors.
▪ Screening Ishould Ibegin Iat I45 Iyears Iold Iand Irepeated IQ3 Iyears I(or Ifrequently Iif Imultiple Irisk Ifactors
Iare Ipresent)
▪ Additional Ilabs Iat Idx, Ithen Iannually: Ifasting Ilipid Iprofile, IeGFR, Icreatinine, IUA, I& Iliver Ifunction
o I IInitial Itreatment Irecommendations Ifor IType I2: Ithe Igoal Iof Itx Iis Iglycemic Icontrol, Igood Inutritional Istatus
through Iweight Imanagement Iand Iexercise I(insulin Iis Iusually Iconsidered I2nd Iline Itherapy Iwhen Icombo Itherapy
Ifails)
▪ Lifestyle Imodifications Iare I1st Iline Itherapy Ifor Inew Idx Iwith Imild-moderate Ihyperglycemia I(weight
Iloss Iand Iexercise)- Iif Iafter I3-6 Imonths Inon-pharm Itx Ifails Ior IFBG Iis I200-300 I(or Irandom IBG Iis
I250-
350) Ithen Iadd Ian Ioral Iagent Ilike IMetformin; Idual Iagent Ipharmacotherapy Inot Irecommended Iunless
IA1c I≥ I9%
▪ Metformin I(Glucophage) Iis Ia Ibiguanide Ithat Iacts Iby Idecreasing Ihepatic Iglucose Iproduction,
st
Idecreasing Iglucose Iintestinal Iabsorption, I& Iincreasing Iinsulin Isensitivity. IMay Ibe Iused Iwith Iinsulin I1
line Ioral Iagent: Iinitial Idosing Iis I500mg Idaily Iwith Ibreakfast Ior Idinner Ix I1 Iweek, Ithen IBID Iwith Imeals
This study source was downloaded by 100000823822032 from CourseHero.com on 01-10-2022 11:35:11 GMT -06:00
https://www.coursehero.com/file/65113337/NR601-Final-Exam-Study-Guidedocx/
, (long-term Itx Imay Idecrease IB12 Iabsorption, Iso Icheck Iannually Iespecially Iw/ Icomplaints Iof Iperipheral
Ineuropathy)
▪ Sulfonylureas I(glipizide, Iglimepiride, Iglyburide[Beers IPIM]) Iare Iinsulin Isecretagogues Iand Iact Iby
Iincreasing Ipancreatic Iinsulin Isecretion Iand Ilower IHbA1c Iby I1.25%
▪ Meglitinides I(nateglinide-Starlix I& Irepaglinide-Prandin) Iare Iinsulin Isecretagogues Ithat Iincrease
Iendogenous Irelease Iof Iinsulin Ifrom Ithe Ipancreas, Iand Ireduce IA1c Iby Iabout I1%
▪ Thiazolidinedines I(TZDs) IMay Ibe Iused Iwith Iinsulin I(piaglitazone I(Actos) I& Irosiglitazone I(Avandia)
Iare Iinsulin Isensitizers Ithat Iincrease Iinsulin Isensitivity Ito Iincrease Iglucose Iutilization Iand Idecrease
Ihepatic Iglucose Iproduction, Iand Ireduce IA1c Iby I1-1.5% I*don’t Iuse Iin Ipts Iwith IHF, Ibladder Icancer,
osteoporosis, Ior Iliver Idisease I I
▪ Dipeptidyl Ipeptidase-4 I(DDP-4) Iinhibitors Iare Ionce Idaily Iand Iincrease Ithe Ibioavailability Iof IGLP-
I1: Isitagliptin I(Januvia), Ilinagliptin I(Tradjenta), Isaxagliptin I(Onglyza) I& Ialogliptin I(Nesina)
▪ Alpha-glucosidase Iinhibitors I(acarbose-Precose I& Imiglitol- IGlyset) Iact Ito Idecrease/delay Iglucose
Iabsorption Iand Ilower IBG Ilevels, Ialso Ilower Iserum Itriglycerides I& Ireduce IA1c Iby I0.8% I*don’t Iuse
IinIpts Iwith Ia Ihx Iof Ipancreatitis
▪ Sodium-glucose Icotransporter I2 I(SLGT2) Iinhibitors I(dapagliflozin-Forxiga, Icanagliflozin-
IInvokana, Iempagliflozin-Jardinance, I& Iertugliflozin-Steglatro) Iblock Iglucose Ireabsorption Iin Ithe
Iproximal Irenal Itubule Ito Ireduce Iglucse Ireabsorption I& Iincrease Iurinary Iglucose Iexcretion. IThey
reduce IA1c Iby I0.5-1%, Iare Iapproved Ifor Imonotherapy Iand Iare Ivery Iexpensive
o I IInitial Itreatment Ifor IType I1 I(and IDKA) Iis Ialways Iinsulin IThey Iall Iwork Ialike; Ithe Idifference Iis Iin Ithe
Ionset Iand Iduration Iof Iaction.
o Treatment Igoals Ifor Iolder Iadults: Ishould Ibe Imade Iafter Icareful Iassessment Iof Ithe Ipatient’s Ihealth Ibeliefs, Ilife
Iexpectancy, Ifunctional Istatus, Ieconomic Isituation, I& Iavailability Iof Isupport Iservices. I(Kennedy Itable I14-2)
o Response Ito Itx Iis Ibased Ion Ihome IBG Imonitoring Iresults I& IA1c I(which Ireflects Icontrol Iof Ipast I 3 Imonths)
▪ F/U Ivisits Ishould Iinclude IBP, IBMI, Ireview Iof Ihome IBG Ilog, Ireview Iof Imeds, Iexam Iof Ifeet, Iannual
Ieye Iexam Iincluding Idilation, Ithyroid Ipalpation, Ifull Iskin Iexam Ifor Iacanthosis Inigricans, Iroutine
IUAIwith Ialbuminuria I& Ialbumin Ito Icreatinine Iratio, Iserum Icreatinine Ilevel, Iliver Ifunction Itests,
IeGFR,
annual IECG, Ifasting Ilipid Iprofile, IHbA1c I(Q3-6 Imonths), Ieval Ifor Ineurovascular Icomplications, Iself-
Imanagement Ieducation, Iannual Iflu Ivaccine, IPNA Ivaccines, Ibiannual Ioral Iexam.
o I
o HbA1C Igoals Ibased Ion Icomplications I(Dunphy Ip.925)
▪ An IA1c Iof I<7% Iindicates Istrong Icontrol Iover Ipast I2-3 Imonths, Ibut I<6.5% Iwill Isignificantly Idecrease
Ithe Ioccurrence Iof Icomplications
o Weight Iloss Irecommendations I(improves Iserum Ilipid Iprofile Iand Iglucose Iintolerance, Idecreases IBP I& Iinsulin
Iresistance)
This study source was downloaded by 100000823822032 from CourseHero.com on 01-10-2022 11:35:11 GMT -06:00
https://www.coursehero.com/file/65113337/NR601-Final-Exam-Study-Guidedocx/
