MSN 277 (med surg) Exam I questions
with complete solutions
Type I DM - ANS ✔✔3p's
-polyphagia
-polydipsia
-polyuria
Type II DM - ANS ✔✔Insulin resistance
Pancreas has decreased insulin production
Inappropriate glucose production by liver
Altered production of hormones/cytokines
Nonspecific symptoms: fatigue, infections, delayed wound healing, visual changes
Metabolic syndrome - ANS ✔✔Abdominal obesity >40in >35in
Triglycerides >150
HDLs <40 <50
BP >130/85
Fasting glucose >110
How to diagnosis DM - ANS ✔✔HgbA1C > 6.5% (amount of hemoglobin covered in glucose
molecules)
Fasting plasma glucose >126
2hr post load glucose >200
,Random plasma glucose measurement >200
DM Target Goals - ANS ✔✔HgbA1C <7%
BP <130/80 (want to prevent heart disease/cardiac complications)
Cholesterol/triglycerides <150
Why check hemoglobin AIC test? - ANS ✔✔Useful in determining glycemic levels over time
Determine success of treatment
Shows amount of glucose attached to hemoglobin molecules over RBC life span (90-120 days)
Balancing act: 5 points of treatment - ANS ✔✔1. Drugs
2. Nutrition
3. Exercise
4. Monitor
5. Educate
Collaborative care: goals of DM management - ANS ✔✔1. reduce symptoms
-three P's
-numbness, tingling, infection
2. promote well-being
-patient education (exercise, doctors visits)
3. Prevent acute complications
-DKA, hypoglycemia
4. Delay onset and progression of longterm complications
-uncontrolled diabetes
,Main goal of DM - ANS ✔✔Tight blood glucose control
-can dramatically reduce the development of kidney disease, blindness, and neuropathies
(tingling/numbness)
Can a type 2 diabetic be prescribed insulin? - ANS ✔✔Yes, if they cannot control blood glucose
by other means
-sick
Mealtime insulin (Bolus) - ANS ✔✔Rapid or short acting insulin given prior to meals
Controls postprandial (after eating) blood glucose levels
Order of areas of fastest absorption of insulin - ANS ✔✔1. abdomen
2. arm
3. thigh
4. butt
Why do we not inject insulin in site that will be exercised? ex: abs ? - ANS ✔✔insulin can work
faster and lead to hypoglycemia
Insulin pump - ANS ✔✔Continuous infusion of insulin slowly & then give more insulin (bolus) at
meal time
Allows for continuous glucose monitoring
Somogyi effect - ANS ✔✔*Hypoglycemia* occurs at 2 or 3 am causing an increase in the
production of counter regulatory hormones leading to rebound hyperglycemia at 7 am
Tx: decrease nightly insulin or eat snack before bed or BOTH
patients with somogyi effect complain of... - ANS ✔✔-early morning headaches
, -night sweats
-nightmares caused by early morning hypoglycemia
Dawn phenomenon - ANS ✔✔*Hyperglycemia* between 2-4 am due to the release of growth
hormone, which decreases peripheral uptake of glucose resulting in elevated morning glucose
levels at 7am
Tx: Admin of insulin at a later time in day will coordinate insulin peak with the hormone release
or increase patients insulin dose
Oral agents for DM - ANS ✔✔NOT insulin
-work to improve mechanisms by which insulin and glucose are produced and used by the body
Oral agents work to help 3 defects of type 2 DM - ANS ✔✔1. improve insulin resistance
2. decrease insulin production
3. increased hepatic glucose production
Nutritional therapy for DM - ANS ✔✔-balanced diet
-assess what their diet is and see what needs to be changed while adhering to their lifestyle
-once diagnosed: smaller food intake
-do not skip meals + snack at bedtime
-no alcohol --> lead to severe hypoglycemia (can die)
-carb counting
Should DM patients eat foods with a high or low glycemic index? - ANS ✔✔low - cause a steady
rise in blood glucose over a longer period of time
high - cause sharp rise in blood glucose level (simple sugars)
with complete solutions
Type I DM - ANS ✔✔3p's
-polyphagia
-polydipsia
-polyuria
Type II DM - ANS ✔✔Insulin resistance
Pancreas has decreased insulin production
Inappropriate glucose production by liver
Altered production of hormones/cytokines
Nonspecific symptoms: fatigue, infections, delayed wound healing, visual changes
Metabolic syndrome - ANS ✔✔Abdominal obesity >40in >35in
Triglycerides >150
HDLs <40 <50
BP >130/85
Fasting glucose >110
How to diagnosis DM - ANS ✔✔HgbA1C > 6.5% (amount of hemoglobin covered in glucose
molecules)
Fasting plasma glucose >126
2hr post load glucose >200
,Random plasma glucose measurement >200
DM Target Goals - ANS ✔✔HgbA1C <7%
BP <130/80 (want to prevent heart disease/cardiac complications)
Cholesterol/triglycerides <150
Why check hemoglobin AIC test? - ANS ✔✔Useful in determining glycemic levels over time
Determine success of treatment
Shows amount of glucose attached to hemoglobin molecules over RBC life span (90-120 days)
Balancing act: 5 points of treatment - ANS ✔✔1. Drugs
2. Nutrition
3. Exercise
4. Monitor
5. Educate
Collaborative care: goals of DM management - ANS ✔✔1. reduce symptoms
-three P's
-numbness, tingling, infection
2. promote well-being
-patient education (exercise, doctors visits)
3. Prevent acute complications
-DKA, hypoglycemia
4. Delay onset and progression of longterm complications
-uncontrolled diabetes
,Main goal of DM - ANS ✔✔Tight blood glucose control
-can dramatically reduce the development of kidney disease, blindness, and neuropathies
(tingling/numbness)
Can a type 2 diabetic be prescribed insulin? - ANS ✔✔Yes, if they cannot control blood glucose
by other means
-sick
Mealtime insulin (Bolus) - ANS ✔✔Rapid or short acting insulin given prior to meals
Controls postprandial (after eating) blood glucose levels
Order of areas of fastest absorption of insulin - ANS ✔✔1. abdomen
2. arm
3. thigh
4. butt
Why do we not inject insulin in site that will be exercised? ex: abs ? - ANS ✔✔insulin can work
faster and lead to hypoglycemia
Insulin pump - ANS ✔✔Continuous infusion of insulin slowly & then give more insulin (bolus) at
meal time
Allows for continuous glucose monitoring
Somogyi effect - ANS ✔✔*Hypoglycemia* occurs at 2 or 3 am causing an increase in the
production of counter regulatory hormones leading to rebound hyperglycemia at 7 am
Tx: decrease nightly insulin or eat snack before bed or BOTH
patients with somogyi effect complain of... - ANS ✔✔-early morning headaches
, -night sweats
-nightmares caused by early morning hypoglycemia
Dawn phenomenon - ANS ✔✔*Hyperglycemia* between 2-4 am due to the release of growth
hormone, which decreases peripheral uptake of glucose resulting in elevated morning glucose
levels at 7am
Tx: Admin of insulin at a later time in day will coordinate insulin peak with the hormone release
or increase patients insulin dose
Oral agents for DM - ANS ✔✔NOT insulin
-work to improve mechanisms by which insulin and glucose are produced and used by the body
Oral agents work to help 3 defects of type 2 DM - ANS ✔✔1. improve insulin resistance
2. decrease insulin production
3. increased hepatic glucose production
Nutritional therapy for DM - ANS ✔✔-balanced diet
-assess what their diet is and see what needs to be changed while adhering to their lifestyle
-once diagnosed: smaller food intake
-do not skip meals + snack at bedtime
-no alcohol --> lead to severe hypoglycemia (can die)
-carb counting
Should DM patients eat foods with a high or low glycemic index? - ANS ✔✔low - cause a steady
rise in blood glucose over a longer period of time
high - cause sharp rise in blood glucose level (simple sugars)
