Diabetes Mellitus Type II: Questions and Answers, Exams of Nursing

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ANSWERS 2023/2024 GRADED A+

what does "siphon" mean? - CORRECT ANSWERS implies that a lot of urine is made what is diabetes mellitus? - CORRECT ANSWERS chronic, metabolic disease characterized by elevated levels of blood glucose, which leads over time to the damage to the heart, vasculature, eyes, kidneys and nerves what are the 2 main problems related to insulin in type II diabetes? - CORRECT ANSWERS - insulin resistance

• impaired insulin secretion what is insulin resistance? - CORRECT ANSWERS insulin doesn't bind with the special receptor on cell surface what is impaired insulin secretion? - CORRECT ANSWERS insulin secreting glands release a decreased amount of insulin what is the pathway to type 2 DM? - CORRECT ANSWERS obesity—> insulin resistance/hyperinsulinemia—> pre-diabetes—> type II diabetes what does the pancreas do in response to insulin resistance? - CORRECT ANSWERS makes more insulin

ANSWERS 2023/2024 GRADED A+

how can blood sugar levels be assessed indirectly? - CORRECT ANSWERS by measuring fasting insulin levels what is the most important environmental factor causing insulin resistance? - CORRECT ANSWERS obesity what are common causes of insulin resistance? - CORRECT ANSWERS - obesity

• gestational diabetes
• nonalcoholic fatty liver disease
• PCOS what happens to LDL with insulin resistance? - CORRECT ANSWERS LDL increases what happens to HDL with insulin resistance? - CORRECT ANSWERS HDL decreases what happens to atherosclerosis with insulin resistance? - CORRECT ANSWERS increases what happens to BP with insulin resistance? - CORRECT ANSWERS rises

ANSWERS 2023/2024 GRADED A+

what shows on PE with insulin resistance? - CORRECT ANSWERS - acanthosis nigricans

• pseudoacromegaly
• hyperandrogenism what is the main reason to treat insulin resistance? - CORRECT ANSWERS prevent type II DM IR contributes to increased glucose production in the liver and decreased glucose uptake both in - CORRECT ANSWERS muscle, liver, and adipose tissue what is the goal of hyperinsulinemia? - CORRECT ANSWERS increase insulin sensitivity what is first line treatment for hyperinsulinemia? - CORRECT ANSWERS - lifestyle modification
• metformin what does metformin do for hyperinsulinemia? - CORRECT ANSWERS - suppresses hepatic glucose production
• increases insulin sensitivity

ANSWERS 2023/2024 GRADED A+

what is pre-diabetes? - CORRECT ANSWERS condition in which blood glucose are higher than normal but not high enough for a diagnosis of diabetes what is prediabetes a continuation of? - CORRECT ANSWERS beta-cell failure what is defined as prediabetic fasting plasma glucose? - CORRECT ANSWERS 100- what is defined as prediabetic 2h postprandial after glucose load? - CORRECT ANSWERS >140- what is prediabetic HbA1c? - CORRECT ANSWERS 5.7-6. what is used to treat prediabetes? - CORRECT ANSWERS diet and exercise what are specifics when treating prediabetes? - CORRECT ANSWERS - achieve and maintain a minimum of 7% weight loss and 150 min of physical activity per week

• mediterranean-style diet + caloric reduction

ANSWERS 2023/2024 GRADED A+

what area other names for Type 2 diabetes mellitus? - CORRECT ANSWERS

• adult onset diabetes
• non-insulin dependent diabetes mellitus when did obesity start becoming more prevalent? - CORRECT ANSWERS 1950 what is the common age range of type 2 diabetes? - CORRECT ANSWERS 40- what are type 2 diabetes risk factors? - CORRECT ANSWERS - older age

• obesity
• family history
• metabolic syndrome
• females having a baby over 9 lbs
• gestational diabetes
• PCOS
• HTN
• hyperlipidemia
• CV disease

ANSWERS 2023/2024 GRADED A+

what is the common clinical presentation of type 2 diabetes? - CORRECT ANSWERS - often asymptomatic

• obese adult
• skin problems
• frequent UTIs
• fatigue
• blurred vision
• parasthesias what are uncommon clinical presentations of type 2 diabetes? - CORRECT ANSWERS "poly" triad
• polydipsia
• polyphagia
• polyuria nocturia unintentional weight loss what are specific things to look for on general PE for type 2 diabetes? - CORRECT ANSWERS - measure height and weight
• BMI

ANSWERS 2023/2024 GRADED A+

what are specific things to look for on vitals PE for type 2 diabetes? - CORRECT ANSWERS BP what are specific things to look for on eye PE for type 2 diabetes? - CORRECT ANSWERS - movement

• pupil response to light
• retina what are specific things to look for on cardio PE for type 2 diabetes? - CORRECT ANSWERS - pulses in arms, legs, and feet
• listen to the blood flow in carotid arteries for atherosclerosis what are specific things to look for on skin PE for type 2 diabetes? - CORRECT ANSWERS acanthosis nigricans what are specific things to look for on neuro PE for type 2 diabetes? - CORRECT ANSWERS - decreased sensation
• decreased reflexes what are specific things to look for on feet PE for type 2 diabetes? - CORRECT ANSWERS - soles for injuries

ANSWERS 2023/2024 GRADED A+

what 4 tests can be used to establish a firm diagnosis of diabetes? - CORRECT ANSWERS - fasting plasma glucose (>126)

• random plasma glucose with diabetes symptoms (>200)
• 2-hour post-load glucose on a 75g glucose tolerance test (>200)
• HbA1c > 6.5% what is fasting blood glucose level for DM? - CORRECT ANSWERS at or above 126 what is 2 hour postprandial level for DM? - CORRECT ANSWERS at or above 200 what is random plasma glucose level for DM? - CORRECT ANSWERS at or above 200 with symptoms of hyperglycemia what is HbA1c level for DM? - CORRECT ANSWERS at or above 6. what are baseline labs to order for DM? - CORRECT ANSWERS - fasting lipid profile (may show high LDL, low HDL, & trigly)
• urine lesions (negative)
• ankle-brachial index (<0.9 is abnormal)
• urinary albumin excretion (may be increased)

ANSWERS 2023/2024 GRADED A+

-serum creatinine and estimated GFR (may show renal insufficiency)

• ECG (may indicate prior ischemia)
• dilated retinal exam (may show retinopathy) what is the main goal for diabetes management? - CORRECT ANSWERS euglycemia what is long term goal for DM? - CORRECT ANSWERS prevent complications what do you Rx for DM? - CORRECT ANSWERS - monitor/glucometer ($50-

• strips
• lancets
• lancet device what is important patient education for DM? - CORRECT ANSWERS - keep a glucose diary with a food diary when should patients check sugar at home? - CORRECT ANSWERS - fasting
• 2 hour post-prandial daily

ANSWERS 2023/2024 GRADED A+

• more frequently as disease progresses what is the pre-prandial goal range for DM? - CORRECT ANSWERS 80- what is 1-2 hour post-prandial glucose goal level for DM? - CORRECT ANSWERS < what is goal A1c range for DM? - CORRECT ANSWERS - <7% for most patients what should be done if A1c target is not met by lifestyle modifications in 3 months? - CORRECT ANSWERS give metformin what should be done if A1c target is not met by Metformin in 3 months? - CORRECT ANSWERS give metformin + another agent (insulin or noninsulin) what should be done if A1c target is not met by metformin + insulin in 3 months? - CORRECT ANSWERS metformin + 2 other agents what should be done if A1c target is not met by Metformin + 2 other agents? - CORRECT ANSWERS give Metformin + insulin +/- noninsulin agent

ANSWERS 2023/2024 GRADED A+

what are ways to loss weight through diet and exercise? - CORRECT ANSWERS - limit carb intake

• carb counting
• mediterranean style diet
• 150 minutes a week of physical activity what is glycemic response to weight loss at 1 week? - CORRECT ANSWERS 1-1.5 kg what is glycemic response to weight loss at 12 weeks? - CORRECT ANSWERS 6-7 kg diet and exercise can have enough of an effect on glycemic control that DM2 can be reversed (T/F) - CORRECT ANSWERS true what is most common medication starting place for type 2 diabetes? - CORRECT ANSWERS metformin what are side effects of Metformin? - CORRECT ANSWERS - gastrointestinal intolerance due to bloating
• abdominal discomfort
• diarrhea

ANSWERS 2023/2024 GRADED A+

with long term treatment, _________% of patients do not maintain optimal glycemic control with monotherapy alone - CORRECT ANSWERS 75% when A1C is at 1.5% or above the glycemic target, many patients will require what kind of therapy? - CORRECT ANSWERS dual therapy to achieve A1C goal what is normal fasting glucose level? - CORRECT ANSWERS < what is normal 2 post-prandial after 75g glucose load? - CORRECT ANSWERS < what is normal HbA1c level? - CORRECT ANSWERS <5. what are classes of meds for DM? - CORRECT ANSWERS - sulfonylureas

• biguanides (Metformin)
• pioglitazone
• GLP-1 receptor agonists
• DPP-4 inhibitors
• SGLT2 inhibitors

ANSWERS 2023/2024 GRADED A+

• insulin what is MOA of sulfonylureas? - CORRECT ANSWERS increase insulin secretion what is MOA of biguanides? - CORRECT ANSWERS inhibit hepatic glucose production what is MOA of Pioglitazone? - CORRECT ANSWERS increase glucose uptake by skeletal muscle what is MOA of GLP-1 receptor agonists? - CORRECT ANSWERS increase insulin secretion decrease glucagon secretion delay gastric emptying what is mediterranean-style diet? - CORRECT ANSWERS high in monounsaturated fat + calorie reduction what is MOA of DPP-4 inhibitors? - CORRECT ANSWERS slows incretin metabolism increase insulin synthesis

ANSWERS 2023/2024 GRADED A+

what is MOA of SGLT2? - CORRECT ANSWERS reduces glucose reabsorption what is MOA of insulin? - CORRECT ANSWERS stimulates peripheral glucose uptake regulate glucose metabolism glucose production how to determine what medication to use for type 2 DM? - CORRECT ANSWERS - does patient have any other diagnoses that may be helped by this medication?

• compelling indications what are risk factors of ASCVD that can be treated with type 2 DM med? - CORRECT ANSWERS - HTN
• hyperlipidemia
• heart failure what are "compelling indications" for type 2 DM? - CORRECT ANSWERS - ASCVD
• overweight/obese
• CKD
• hypoglycemia

ANSWERS 2023/2024 GRADED A+

• risks of AE
• safety
• tolerability
• cost when to start insulin in patients with type 2 DM? - CORRECT ANSWERS - consistent blood glucose values >300 mg/dL
• HbA1C is at or above 10%
• symptoms of hyperglycemia (polyuria, polydipsia)
• evidence of weight loss
• when ketones are present in urine when to screen for type 2 DM? - CORRECT ANSWERS - first degree relative
• higher risk race
• higher risk of CVD
• hypertension
• hyperlipidemia
• physical inactivity what is patient psychological delay of insulin therapy? - CORRECT ANSWERS - denial, wishful thinking, avoidance
• difficulty with confrontation

ANSWERS 2023/2024 GRADED A+

• fear of providers anger
• fear of losing provider
• insulin usage is time consuming
• fear of more hypoglycemic events what is provider psychological delay of insulin therapy? - CORRECT ANSWERS - denial, wishful thinking, avoidance
• difficulty with confrontation and disagreements
• fear of patient anger
• fear of losing patient
• training insulin usage is time consuming
• fear or more hypoglycemic events what does basal insulin act as? - CORRECT ANSWERS baseline insulin how long does basal insulin last in the body? - CORRECT ANSWERS about 24 hours how often is basal insulin given? - CORRECT ANSWERS once a day what is kind of insulin is started first in DM2 patient? - CORRECT ANSWERS basal insulin

ANSWERS 2023/2024 GRADED A+

when is bolus insulin given? - CORRECT ANSWERS when you eat a meal what does bolus insulin help do? - CORRECT ANSWERS bring glucose level down when they spike with food how long does bolus insulin last in body? - CORRECT ANSWERS a few hours what are ways to use Bolus insulin? - CORRECT ANSWERS - carb counting

• sliding scale what is usual starting dosage of bolus insulin for patients with type 2 DM? - CORRECT ANSWERS 1 U of rapid-acting insulin for every 10g of carbohydrate eaten ex: 60 g carb meal = 6 units of insulin what is sliding scale for bolus insulins? - CORRECT ANSWERS if blood sugar is: 201-250: 2 units 251-300: 3 units 301-350: 6 units

ANSWERS 2023/2024 GRADED A+

what is monitored in the office every 3 months for a type 2 DM patient?

- CORRECT ANSWERS - blood sugar

• A1C
• brief foot check what is checked every 6 months in a type 2 DM patient? - CORRECT ANSWERS dental exam what is done in the office every year in a patient with type 2 DM? - CORRECT ANSWERS - complete foot check
• microalbumin urine
• CMP, lipids
• flu shot what is an effective way to measure glucose over a long-period of time? - CORRECT ANSWERS HbA1c what does HbA1c measure? - CORRECT ANSWERS amount of hemoglobin that attaches to blood glucose (glycosylated hemoglobin)

ANSWERS 2023/2024 GRADED A+

how often do we check HbA1c? - CORRECT ANSWERS every 3-4 months the higher the A1C, - CORRECT ANSWERS the worse the diabetes how to conduct a urine test for type 2 DM? - CORRECT ANSWERS discard first void excess glucose = renal damage what is present in type 2 DM patients urine that causes damage? - CORRECT ANSWERS - microalbuminuria

• proteinuria what is abnormal level of microalbuminuria? - CORRECT ANSWERS 30 to 300 what classifies microalbuminuria? - CORRECT ANSWERS > what classifies macroalbuminuria? - CORRECT ANSWERS > what makes up a type 2 DM patient foot exam? - CORRECT ANSWERS - pulses
• neuropathy

ANSWERS 2023/2024 GRADED A+

• calluses
• infections
• sores
• ankle branchial index over 50 years old what are macrovascular effects of diabetes? - CORRECT ANSWERS - CVD
• CVA what are micro vascular effects of diabetes? - CORRECT ANSWERS - retinopathy
• neuropathy
• nephropathy what are other diabetes complications? - CORRECT ANSWERS - skin disorders
• gum disease
• obesity what makes up CVD? - CORRECT ANSWERS - atherosclerosis (take ASA or another anti platelet)
• hyperlipidemia (treat with a statin and Niacin)
• HTN (ACE inhibitors, angiotensin receptor blocker)

ANSWERS 2023/2024 GRADED A+

What is the LDL goal for diabetics? - CORRECT ANSWERS < 100 < 70 with other CV disease what is low risk CVD BP for a diabetic? - CORRECT ANSWERS <140/90 what is high risk CVD BP for a diabetic? - CORRECT ANSWERS <130/80 ABCs of Diabetes - CORRECT ANSWERS A1c test less than 7% Blood pressure less than 140/90 Cholesterol less than 100 Stop smoking what is a retinopathy complication of diabetes? - CORRECT ANSWERS macular edema what are the types of retinopathy caused by DM? - CORRECT ANSWERS - mild nonproliferative

• moderate-severe nonproliferative
• proliferative

ANSWERS 2023/2024 GRADED A+

retinopathy is related to the ___________ of DM - CORRECT ANSWERS duration how often are eye exams given for type 2 DM patients? - CORRECT ANSWERS shortly after dx then yearly about 50% of DM patients have some form of - CORRECT ANSWERS neuropathy what are symptoms of peripheral neuropathy? - CORRECT ANSWERS - bilateral and symmetric

• numbness or decreased sensitivity to pain or temp
• tingling, burning or prickling sensation
• sharp pains or cramps
• extreme sensitivities to touch
• symptoms worsen at night what is the most common presentation of peripheral neuropathy? - CORRECT ANSWERS numbness or tingling in toes and feet (Stocking-Glove Syndrome) what are symptoms of autonomic neuropathy? - CORRECT ANSWERS - male impotence and female anorgasmia

ANSWERS 2023/2024 GRADED A+

• difficulty voiding and urinary retention
• impaired gastric emptying with early satiety and eyes is
• diarrhea
• orthostatic hypotension what are common foot deformities with DM? - CORRECT ANSWERS diabetic leg/foot ulcers why do people with DM get foot trauma so easily? - CORRECT ANSWERS there is no feeling in them what are frequent causes of hospitalization and even amputation with diabetic patients? - CORRECT ANSWERS neuropathic foot ulcers what is Charcot foot? - CORRECT ANSWERS condition causing weakening of the bones in the foot that can occur in people who have significant nerve damage what can eventually develop with Charcot foot? - CORRECT ANSWERS fractures occur and with continued walking —> changes in foot shape how to dx neuropathies? - CORRECT ANSWERS - nerve conduction tests
• electromyography

ANSWERS 2023/2024 GRADED A+

• quantitative sensory testing
• HR variability testing
• U/S
• nerve/skin biopsy what is treatment for diabetic neuropathy? - CORRECT ANSWERS - NSAIDs and ASA and acetaminophen
• Capsaicin
• Amitriptyline: Elavil
• Neurontin (Gabapentin)
• Cymbalta
• Lyrica
• Good glucose control what is leading cause of ESRD? - CORRECT ANSWERS diabetes what is earliest indicator of ESRD? - CORRECT ANSWERS microalbuminuria > 30 mg/day what does a kidney look like with kidney disease? - CORRECT ANSWERS - granular surface
• decreased function

ANSWERS 2023/2024 GRADED A+

• smaller size
• high urine protein what are recommendations to prevent ESRD with DM? - CORRECT ANSWERS - annual microalbuminuria test
• serum creatinine annually

what is normal GFR for women? - CORRECT ANSWERS 80-125 ml/min what is normal GFR for men? - CORRECT ANSWERS 90-139 ml/min what is neuropathy management? - CORRECT ANSWERS - control HTN

• anti hypertensive agents (ACE inhibitors) what are antihypertensive agents? - CORRECT ANSWERS - ACE inhibitors
• ARBS what are ACE inhibitors? - CORRECT ANSWERS angiotensin converting enzyme inhibitors