fnp exam 2

Question 1

Prediabetes glucose and A1c levels

Answer 1

BG: 101-125 mg/dL (fasting plasma glucose) & 140-199 (oral glucose tolerance test)
HgbA1C: 5.7-6.4

Question 2

Metabolic syndrome triglycerides, HDL, and fasting glucose levels

Answer 2

Triglycerides: >150 mg/dL
HDL: <40 mg/dL in men, <50 mg/dL in women
Fasting glucose: >100 mg/dL

Question 3

Diabetes glucose and A1c levels

Answer 3

BG: 126 or above (fasting plasma glucose) & 200 or above (oral glucose tolerance test)
A1C: 6.5 or above

Question 4

What weeks of pregnancy is gestational diabetes tested for

Answer 4

between 24th and 28th

Question 5

Rule of 15 for hypoglycemia

Answer 5

-give 15 grams CHO (1 serving) in liquid or readily absorbed form
-re-check blood glucose 15 minutes later
*follow with a snack or meal once youve reached >70

Question 6

Sick Day management for diabetics

Answer 6

-8 oz fluid every hour (every 3rd electrolytes)
-monitor BG every 2-4 hours
-ketone testing every 4 hours until negative (for type 1 only)
-continue meds as usual

Question 7

When to contact pcp for diabetic sick symptoms

Answer 7

-more than one episode of vomiting
-more than 6 hours of diarrhea
-bg>200 on 2 measurments
-moderate to large urine ketones

Question 8

What patients are acceptable to have an A1c of 8%

Answer 8

elderly, limited life expectancy, h/o hypoglycemia, extensive CVD complications

Question 9

how many times a day to type 1 diabetics need to check sugar (if not on continuous)

Answer 9

4 times daily

Question 10

Starting total insulin dose

Answer 10

0.4 to 1.0 units/kg/day

Question 11

Metformin and renal failure causes? What must GFR be to start?

Answer 11

can cause lactic acidosis, GFR must be 30 or greater

Question 12

Best dose and time to start metformin at

Answer 12

500 mg at bedtime (try XR if this still causes GI upset)

Question 13

GLP 1 Receptor Agonists name and action

Answer 13

TIDES!
-injectables that cause glucagon suppression and delay gastric empyting

Question 14

pros and cons of glp-1 agonists

Answer 14

Pros:
-reduce a1c
-low risk of hypoglycemia
-weight loss
cons:
-expensive
-GI side effects

Question 15

SGLT2 inhibitors names and action

Answer 15

FLOzin! oral meds that curb the action of proteins called “sodium-glucose cotransporter 2” that help your kidneys reabsorb glucose from the blood > causes urination of excess glucose

Question 16

Pros and cons of SGLT2 inhibitors

Answer 16

Pros:
-helps with volume in those with h/o CHF
-weight loss
-Prevents progression of CKD
-CV benefit
Cons:
-UTIs and Yeast infections
-decrease in eGFR
-euglycemic DKA

Question 17

DPP4 inhibitors name and action

Answer 17

GLIPTIN! oral meds that works similarly to GLP1 agonists by delaying breakdown of GLP-1

Question 18

DDP-4 pros and cons:

Answer 18

Pros:
-moderately effective in reducing A1C
-low risk hypoglycemia
-neutral weight loss
-few side effects
Cons:
-expensive
-CANNOT use w h/o medullary thyroid cancer
-reports of pancreatitis and hypersensitivity reaction including SJS

Question 19

sulfonylureas names and action

Answer 19

IDES! stimulates insulin release from the pancreas

Question 20

pros and cons of sulfonylureas

Answer 20

pros:
- effective and cheap
cons:
-moderate hypoglycemia risk
-possible weight gain
-No CV benefit

Question 21

Thiazolidinediones (TZDs) names and action

Answer 21

GLITAZONES! (rosiglitazone and pioglitazone) sensitize peripheral tissue to insulin and decreases gluconeogenesis in the liver

Question 22

what 2 diabetes meds do you consider giving for patients with high risk ASCVD?

Answer 22

GLP-1s and SGLT-2s

Question 23

what diabetes med do you consider giving for patients with HF or CKD? even though given for CKD, what GFR is contraindicated with this med?

Answer 23

SGLT-2s
Cannot give if GFR < 45

Question 24

What conditions should make you avoid SGLTs?

Answer 24

frequent UTIs, yeast infections, decreased bone density, foot ulcers, increased r/o dka

Question 25

What diabetes med should you avoid using for patients with HF?

Answer 25

TZDs (glitazones)

Question 26

Along with insulin, what other diabetes medication has a hypoglycemic risk?

Answer 26

Sulfonyslureas (IDES)

Question 27

Which 3 types of diabetes meds cause weight gain? which one is weight neutral?

Answer 27

-insulin, SUs, TZD
DDP4 is weight neutral