NR565 Final Exam-Questions with Correct Answers/ Verified
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Course
NR565
Institution
NR565
Criteria for dx DM
Fasting plasma glucose greater than 126
Random plasma glucose greater than 200
Oral glucose tolerance test greater than 200
HgA1c at or greater than 6.5%
What drug class should be considered for DM before insulin
Biguanide (Metformin)
Action of Insulin
Synthesized in panc...
NR565 Final Exam-Questions with Correct Answers/
Verified
Criteria for dx DM
Fasting plasma glucose greater than 126
Random plasma glucose greater than 200
Oral glucose tolerance test greater than 200
HgA1c at or greater than 6.5%
What drug class should be considered for DM before insulin
Biguanide (Metformin)
Action of Insulin
Synthesized in pancreas, primary metabolic action is anabolic. Promotes conservation of energy and
buildup of energy stores like glycogen.
MOA Sulfonylureas
by stimulating release of insulin from pancreatic islets. If pancreas is not capable of insulin synthesis,
they will not be effective. thus, cannot use on DM1 only DM2
Glinides MOA
by stimulating release of insulin from pancreatic islets. If pancreas is not capable of insulin synthesis,
they will not be effective. thus, cannot use on DM1 only DM2
Thiazolidinediones (TZD) MOA
Decrease glucose levels primarily by decreasing insulin resistance
promote glycemic control by enhancing actions of incretin hormones. It modestly decreases A1c
Incretin hormone
gut peptide secreted after nutrient intake and stimulates insulin production. Together with
hyperglycemia, glucose dependent insulin tropic polypeptide and GLP-1 are known as the incretin
hormones from upper and lower gut. Together they are responsible for incretin effect which is a 2-3
fold higher insulin secretory response vs oral or IV glucose.
Note people with DM2 the incretin effect is diminished or no longer present.
Glucagon-like peptide 1 (GLP-1) MOA
by augmenting the effects of incretin hormones GLP-1 and other incretins are released from cells of
GI tract after a meal. Incretins activate receptors for GLP-1 and slow gastric emptying, stimulate
, glucose dependent release of insulin and inhibits postprandial release of glucagon and suppresses
appetite.
What drug class is most likely to cause hypoglycemia
Ratio of basal insulin to rapid acting insulin in TDD
50% of TDD comes from basil insulin and the other 50% comes from bolus insulin
What is the carb to insulin ratio when calculatin basial insulin
1 unit of insulin will cover 10 carbs
General goal for A1c
less than 7%
A1c goal for older adult
8% or less
When should insulin be considered
Type 1DM always. DM2 when they require 3-drug combo therapy when basil insulin fails. To achieve
tx goals after 3-6 months, it is recommended to precede to a combo of injectable regiment that
includes insulin and possibly a GLP-1 agonist.
At what interval should A1c be checked
Every 3 months for unstable DM
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