1
NR601 Final Concept Review
Diabetes
– Physiology
o Prediabetes: impaired glucose tolerance
o Type 1: autoimmune destruction of pancreatic beta cells leading to
ketoacidosis and lack of insulin
o Type 2: insulin resistance and impaired insulin secretion by islet cells of
pancreas and decline of beta cell function
– Assess:
o Height/Weight
o BP
o CV assessment
o Thyroid
o Ophthalmic
o Peripheral
o Feet/skin
o Neuro
o Oral
– Diagnosis
o A1C > 6.5%
o Random glucose level of 200 or more in the presence of classic symptoms of
hyperglycemia
o Fasting plasma glucose of > 126 on two separate occasions
o Two-hour postload plasma glucose of 200 during OGTT (75g glucose)
Table 14-2 Kennedy – Memorize this *very important*
Patient characteristics/Health Rationale Reasonable Fasting Bedtime Blood Lipids
Status A1C Goal or Pre- Glucose Pressure
prandial
Glucose
Healthy (few coexisting chronic Longer remaining < 7.5% 90-130 90-150 <140/90 Statin unless CI
illnesses, intact cognitive and life expectancy or not tolerated
functional status)
Complex/intermediate (multiple Intermediate < 8.0% 90-150 100-180 < 140/90 Stain unless CI
coexisting chronic illnesses* or remaining life or not tolerated
2+ instrumental ADL expectancy, high
impairments or mild-to- treatment burden,
,2
moderate cognitive impairment) hypoglycemia,
vulnerability, fall risk
Very complex/poor health (LTC Limited remaining <8.5% 100-180 110-200 <150/90 Consider
or end-stage chronic illnesses ** life expectancy likelihood of
or moderate-to-severe cognitive makes benefit benefit with
impairment or 2+ ADL uncertain statin
dependencies) (secondary
prevention more
so than primary)
Treatment
– Labs
o Annually
▪ CMP
▪ Lipid
▪ UA
▪ C-peptide
▪ Microalbumin
o Every 3 months
▪ Hgb A1C
– Lifestyle changes
o 3-6 months
– Nutrition
o Meal planning
o 5% weight loss
o Consistent schedule
o Avoid refined sugars, flours, sugar sweetened beverages and added sugars
– Exercise
o 3x/week
o No more than 48 hours in between exercise days
o Goal: 150 mins/week
o Individualize
– Vaccines
o Pneumococcal
o Influenza
Medications
– Type 1: glargine (Lantus)- long acting, few hypoglycemic reactions
– Type 2:
,3
o Glucophage (Metformin)
▪ Dosage
▪ Side effects
▪ Education
▪ Hgb A1C > 9% = needs adjunct therapy
o Need to be on aspirin if over age 40 and not contraindicated
o ACEIs is needed if they are hypertensive
Risk Factors
– Family history
– BMI > 25
– Impaired fasting glucose or A1C > 5.7%
– Hx of gestational diabetes
– HTN
– Hyperlipidemia
– Women with PCOS
– Race (African American, Latino, Native American (highest risk), Asian
American, Pacific islander)
Complications
– Neuropathy
– Kidney Failure
– Eyes- think small blood vessels
– Most serious is diabetic ketoacidosis (DKA)
Referrals
– Ophthalmology
Urinary Tract Infections
Pathophysiology
– Normal sterile environment is invaded by pathogenic bacteria.
– Men vs Women
o Men have longer urethra
o E. coli- 1 most common bacteria
st
o Staph- 2 most common bacteria
nd
, 4
Assess
– Hematuria
– Dysuria
– Pyuria
– Flank pain
– Pelvic pain
Diagnose:
– UA
o Nitrate positive
– Urine culture *gold standard*
Treatment
– Uncomplicated
o Sulfamethoxazole/Trimethoprim (Bactrim DS) for 3 days
– When to treat asymptomatic patient:
o Pregnancy
o Removal of catheter
o Urologic procedure
– When not to treat asymptomatic patient
o Asymptomatic men
o Nonpregnant women
o Elderly
o Diabetic person
o Spinal cord patients w/ indwelling urinary catheters
Risk Factors
– Anal intercourse
– Indwelling foley catheter
– Urological procedure
– Incontinence
Complications
– Pyelonephritis
– Sepsis
– Shock
NR601 Final Concept Review
Diabetes
– Physiology
o Prediabetes: impaired glucose tolerance
o Type 1: autoimmune destruction of pancreatic beta cells leading to
ketoacidosis and lack of insulin
o Type 2: insulin resistance and impaired insulin secretion by islet cells of
pancreas and decline of beta cell function
– Assess:
o Height/Weight
o BP
o CV assessment
o Thyroid
o Ophthalmic
o Peripheral
o Feet/skin
o Neuro
o Oral
– Diagnosis
o A1C > 6.5%
o Random glucose level of 200 or more in the presence of classic symptoms of
hyperglycemia
o Fasting plasma glucose of > 126 on two separate occasions
o Two-hour postload plasma glucose of 200 during OGTT (75g glucose)
Table 14-2 Kennedy – Memorize this *very important*
Patient characteristics/Health Rationale Reasonable Fasting Bedtime Blood Lipids
Status A1C Goal or Pre- Glucose Pressure
prandial
Glucose
Healthy (few coexisting chronic Longer remaining < 7.5% 90-130 90-150 <140/90 Statin unless CI
illnesses, intact cognitive and life expectancy or not tolerated
functional status)
Complex/intermediate (multiple Intermediate < 8.0% 90-150 100-180 < 140/90 Stain unless CI
coexisting chronic illnesses* or remaining life or not tolerated
2+ instrumental ADL expectancy, high
impairments or mild-to- treatment burden,
,2
moderate cognitive impairment) hypoglycemia,
vulnerability, fall risk
Very complex/poor health (LTC Limited remaining <8.5% 100-180 110-200 <150/90 Consider
or end-stage chronic illnesses ** life expectancy likelihood of
or moderate-to-severe cognitive makes benefit benefit with
impairment or 2+ ADL uncertain statin
dependencies) (secondary
prevention more
so than primary)
Treatment
– Labs
o Annually
▪ CMP
▪ Lipid
▪ UA
▪ C-peptide
▪ Microalbumin
o Every 3 months
▪ Hgb A1C
– Lifestyle changes
o 3-6 months
– Nutrition
o Meal planning
o 5% weight loss
o Consistent schedule
o Avoid refined sugars, flours, sugar sweetened beverages and added sugars
– Exercise
o 3x/week
o No more than 48 hours in between exercise days
o Goal: 150 mins/week
o Individualize
– Vaccines
o Pneumococcal
o Influenza
Medications
– Type 1: glargine (Lantus)- long acting, few hypoglycemic reactions
– Type 2:
,3
o Glucophage (Metformin)
▪ Dosage
▪ Side effects
▪ Education
▪ Hgb A1C > 9% = needs adjunct therapy
o Need to be on aspirin if over age 40 and not contraindicated
o ACEIs is needed if they are hypertensive
Risk Factors
– Family history
– BMI > 25
– Impaired fasting glucose or A1C > 5.7%
– Hx of gestational diabetes
– HTN
– Hyperlipidemia
– Women with PCOS
– Race (African American, Latino, Native American (highest risk), Asian
American, Pacific islander)
Complications
– Neuropathy
– Kidney Failure
– Eyes- think small blood vessels
– Most serious is diabetic ketoacidosis (DKA)
Referrals
– Ophthalmology
Urinary Tract Infections
Pathophysiology
– Normal sterile environment is invaded by pathogenic bacteria.
– Men vs Women
o Men have longer urethra
o E. coli- 1 most common bacteria
st
o Staph- 2 most common bacteria
nd
, 4
Assess
– Hematuria
– Dysuria
– Pyuria
– Flank pain
– Pelvic pain
Diagnose:
– UA
o Nitrate positive
– Urine culture *gold standard*
Treatment
– Uncomplicated
o Sulfamethoxazole/Trimethoprim (Bactrim DS) for 3 days
– When to treat asymptomatic patient:
o Pregnancy
o Removal of catheter
o Urologic procedure
– When not to treat asymptomatic patient
o Asymptomatic men
o Nonpregnant women
o Elderly
o Diabetic person
o Spinal cord patients w/ indwelling urinary catheters
Risk Factors
– Anal intercourse
– Indwelling foley catheter
– Urological procedure
– Incontinence
Complications
– Pyelonephritis
– Sepsis
– Shock
