Summary NR 601 WEEK 6 QUIZ REVIEW

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Summary NR 601 WEEK 6 QUIZ REVIEW>NR 601 Week 5 and 6 study summary for quiz Wk 5: Diabetes DM diagnosis; HbA1C >6.5, FPG: 125, random glucose>200, 2 hr postprandial plasma glucose> 200, and DM S/ ... S; polydipsia, polyuria, wt loss A1C Recommendations c To avoid misdiagnosis or missed diagnosis, the A1C test should be performed using a method that is certified by the NGSP and standardized to the Diabetes Control and Complications Trial (DCCT) assay. B c Marked discordance between measured A1C and plasma glucose levels should raise the possibility of A1C assay interference due to hemoglobin variants (i.e.,hemoglobin opathies) and consideration of using an assay without interference or plasma blood glucose criteria to diagnose diabetes. In conditions associated with increased red blood cell turnover, such as sickle cell disease, pregnancy (second and third trimesters),hemodialysis, recent blood loss or transfusion, or erythropoietin therapy, only plasma blood glucose criteria should be used to diagnose diabetes. ADA SCREENIGN RECOMMENDATIONS: when to screen to repeat screens based on findings A second test is required for confirmation unless pt clearly has hyperglycemic crisis or classic s/s of hyperglycemia. The same test be repeated or a different test be performed without delay using a new blood sample if the A1C is7.0% (53mmol/mol) and a repeat resultis6.8% (51 mmol/mol), the diagnosis of diabetes is confirmed. If two different tests (such as A1C and FPG) are both above the diagnostic threshold, this also confirms the diagnosis On the other hand, if a patient has discordant results from two different tests, then the test result that is above the diagnostic cut point should be repeated, with consideration of the possibility of A1C assay interference For all people, testing should begin at age 45 years If tests are normal, repeat testing carried out at a minimum of 3-year intervals is reasonable To test for prediabetes, fasting plasma glucose, 2-h plasma glucose during 75-g oral glucose tolerance test, and A1C are equally appropriate Testing for prediabetes should be considered in children and adolescents who are overweight or obese (BMI >85th percentile for age and sex, weight for height >85th percentile, or weight . 120% of ideal for height) and who have additional risk factors for diabetes Criteria for testing for diabetes or prediabetes in asymptomatic adults 1. Testing for prediabetes and risk for future diabetes in asymptomatic people should be considered in adults of any age who are overweight or obese (BMI >25 kg/m2 or >23 kg/m2 in Asian Americans) and who have one or more additional risk factors for diabetes: • First degree relative with DM • High risk race; AA, latino, native American, Asian American, pacific islander • History of CVD • HTN (>140/90 or on tx for HTN) HDL cholesterol level <35 and triglyceride level>250 • Women with polycystic ovary syndrome • • Physical inactivity • Other clinical conditions associated with insulin resistance; severe obesity acanthosis nigricans 2. Pt with prediabetes ((A1C >5.7% [39 mmol/mol], IGT, or IFG) should be tested yearly 3. Women who were diagnosed with GDM should have lifelong testing at least every 3 ) years 4. For all other patients, testing should begin at age 45 years. 5. If results are normal, testing should be repeated at a minimum of 3-year intervals, with consideration of more frequent testing depending on initial results and risk status. Guideline recommendations to start medications Metformin therapy for prevention of type 2 DM should be considered in those with prediabetes, especially for those with BMI>35, those aged <60 years, and women with prior gestational DM First line medication options and medication side effects Metformin - good for glucose control and also good for reducing risk of macro and microvascular outcomes, especially those overweight and obese patients - - the best risk benefit profile drug for type 2 DM does not stimulate endogenous insulin secretion enhance tissue responsiveness to insulin - well-absorbed in the small intestine, peak plasma concentrations in 2 hours, rapidly excreted by the kidneys - impaired renal function, Cr for men >1.5, and >1.4 for women is contraindication - 500mg once daily and increase to BID in 1 to 2 weeks, max is 2000 to 2500mg/day - The most common side effect: GI UPSET (Nausea, diarrhea, bloating, abdominal pain) - Lactic acidosis; the most serious adverse side effect; pts with hypoxemia, hypovolemia, and decreased tissue perfusion and renal insufficiency are more prone to it Sulfonylureas (glyburide, glipizide, glimepiride) - Treatment for mild to moderate severe DM 2 (glucose 140-240) - Increase the sensitivity of beta cells to glucose and stimulate endogenous insulin release by binding to a specific beta-cell receptor - Adverse effect: hypoglycemia, cardiovascular risk, wt gain Insulin Short and rapid acting insulins prandial glycemic control - Insulin lispro, insulin aspart, and insulin glulisine - Onset 5 to 15 minutes, a peak at 45 to 75 minutes, duration 2 to 4 hours - Better match between insulin administration and food intake, helping to improve compliance and reducing the risk of hypoglycemic reactions Intermediate-acting insulin basal glycemic control - NPH: onset in 2 hrs, peak at 6 to 10 hrs, duration of 8 to 24 hours. Long acting insulin analogues - Insulin glargine and insulin detemir; steady absorption pattern over 24 hours Mixture of intermediate and short/rapid acting insulin - Mixture of NPH and rapid acting insulin - Do not afford flexibility of dose adjustment and should be considered only after optimal doses of intermediate and short/rapid acting insulin have been established independently 2017 HTN guidelines recommended BP ranges for DM While the Association recommends a blood pressure target of less than 140/90 mmHg for most people with diabetes and hypertension, a lower blood pressure goal might be beneficial for some patients who have a high risk of cardiovascular disease. [Show More]

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