NR 601 FINAL EXAM STUDY GUIDE
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Week 5: Glucose metabolism disorders
Types of DM
1. Type 1- severe insulin deficiency resulting in reduction or absence of functioning beta cells in
the pancreatic islets of Langerhans. This leads
...
to hyperglycemia due to altered metabolism of
lipids, carbs, and proteins. Initial s/s of hyperglycemia. Subjective findings- polyuria, polydipsia,
nocturnal enuresis and polyphagia with paradoxical weight loss, visual changes and fatigue.
Objective-dehydration(poor skin turgor and dry mucous), wt loss despite normal/increase
appetite, reduction in muscle mass. DKA-fatigue, cramping, abnormal breathing
2. Type 2- Type 2 DM is characterized by the abnormal secretion of insulin, resistance to the action
of insulin in the target tissues, and/or an inadequate response at the level of the insulin
receptor. A patient may, however, present with pruritus, fatigue, neuropathic complaints such
as numbness and tingling, or blurred vision.
3. Prediabetic- fasting glucose consistently elevated above the normal range but less than 100-
125. Impaired glucose tolerance (IGT) state of hyperglycemia where 2 hr post glucose load
glycemic level is 140-199
Diagnostic criteria- there are 4 lab-based criteria to confirm DM: A1C, random plasma glucose, fasting
plasma glucose, and 2-hr post load plasma glucose
AIC of 6.5 or higher=diabetes
Random plasma glucose level of 200 WITH classic symptoms of hyperglycemia or a
hyperglycemic crisis
Fasting plasma glucose level of 126 or higher on TWO occasions(fasting is defined as no caloric
intake for at least 8 hrs
2-hour post load plasma glucose level of 200 or higher during an OGTT, following consumption
of a glucose load containing the equivalent of 75g of anhydrous glucose dissolved in water
(OGTT is also used to screen for diabetes during pregnancy)
*** In the absence of unequivocal hyperglycemia results should be confirmed by repeat testing on a
new blood sample without delay, preferably using the same type of test.***
*All above-but confirmation of type 2 diabetes mellitus requires: two fasting blood glucoses
≥126 mg/dL or two random blood glucoses ≥200 mg/dL.
You do not screen for type 1 diabetes but you do screen for type 2 if an individual is overweight
or obese, regardless of age, and for all adults aged 45 years and older. Tests should be repeated
at a minimum of 3 year intervals
Initial TreatmentType 1- FIRST LINE: INSULIN. The initial goal of treatment for type 1 DM is to normalize the
elevated blood glucose level. This is best accomplished by intensive insulin regimens to achieve
the following goals: plasma glucose levels of 80 to 130 mg/dL before meals, peak postprandial
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