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WVC IGGY chpt 67 to pg 1491

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show new cases of blindness, end-stage kidney disease requiring dialysis or transplantation, and foot or leg amputations.  
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Studies show that __________ controls reduces complication of diabetes   show
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An essential part of preventing complications that occur with DM is   show
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The main feature of chronic DM is   show
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show underlying problem causing a lack of insulin and the severity of the insulin deficiency.  
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show alpha and beta cells  
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Alpha cells produce ___________, beta cells produce _________ and ________   show
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show glucagon,  
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It causes the release of glucose from cell storage sites whenever blood glucose levels are low   show
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show insulin  
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show • Beta-cell destruction leading to absolute insulin deficiency • Autoimmune • Idiopathic  
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show • Ranges from insulin resistance with relative insulin deficiency to secretory deficit with insulin resistance  
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Other conditions resulting from hyperglycemia   show
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show • Glucose intolerance with onset or first recognition during pregnancy • Diagnosis is based on results of a 100-g oral glucose tolerance test during pregnancy  
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show the liver into activated insulin.  
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Insulin attaches to receptors on target cells, where it promotes   show
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show the rate that beta cells secrete insulin.  
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show glucose in the blood to move into cells to generate energy.  
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The liver is the first major organ to be reached by insulin in the blood. In the liver, insulin promotes   show
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In muscle, insulin promotes   show
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In fat cells, insulin promotes   show
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The pancreas secretes about   show
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show neuronal dysfunction and cell death.  
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______ _________can be used as fuel by some cells when glucose is not available.   show
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show glycogen in the liver and muscles  
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show triglyceride  
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The most efficient means of storing energy is in the form of   show
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During a prolonged fast or after illness or injury   show
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During a fasting state, plasma glucose is maintained by   show
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show pancreatic alpha cells that stimulate glucose production.  
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During fasting, insulin is released from   show
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Glucose in the blood after a meal is controlled by   show
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In response to food in the stomach, Incretin hormones   show
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show excessive liver glucose production and reduced glucose uptake in other cells due to a combination of INSULIN RESISTANCE and DEFICIENT INSULIN SECRETION.  
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show faster than normal. Stomach contents reach the intestine & the rate of glucose entry into circulation increase →hyperglycemia. The ↑rate of gastric emptying is thought due to ↓secretions of amylin and GLP-1  
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show counterregulatory hormone. It increases blood glucose by actions opposite those of insulin when more energy is needed.  
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show epinephrine, norepinephrine, growth hormone, and cortisol  
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Insulin and counterregulatory hormones keep the level of blood glucose normally   show
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show conversion of amino acids into glucose.  
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Lipolysis, is the   show
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Proteolysis, is the breakdown of   show
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show attempt to make glucose from other sources  
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show polyuria, polydipsia, and polyphagia.  
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Polyuria results in excess   show
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With insulin deficiency, fats break down, releasing free fatty acids. Conversion of fatty acids to   show
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Ketones are   show
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Collection of ketones in the blood when insulin is not available, results in   show
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show hemoconcentration, hypovolemia, hyperviscosity, hypoperfusion & hypoxia.  
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show • Decreased glycogenesis• Increased glycogenolysis • Increased gluconeogenesis • Increased lipolysis • Increased ketogenesis • Proteolysis  
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Kussmaul respiration   show
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show patients response to treatment, severity of acidosis and level of hydration.  
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Three glucose-related emergencies can occur in patients with diabetes   show
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DM can lead to health problems and early death due to   show
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show coronary heart disease, cerebrovascular disease, and peripheral vascular disease, lead to increased early death among those with diabetes.  
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Microvascular complications of blood vessel structure and function lead to   show
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show irreversible basement membrane thickening and organ damage.  
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show functional cell integrity.  
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show connective tissue hypoxia and microischemia  
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Complications in patients with type 2 diabetes seem more related to   show
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show when the patient seeks treatment for another illness or for complications of diabetes, such as visual problems.  
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show cardiovascular disease  
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show MI, coronary artery disease, diabetic cardiomyopathy, and abnormal blood clotting. Left ventricular dysfunction with cardiac failure and fatal cardiac dysrhythmias are more common in diabetic patients after MI.  
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show obesity, HTN, dyslipidemia, and sedentary lifestyle. Cigarette smoking / positive family history also increase risk for cardiovascular disease. Renal disease, indicated by albuminuria, increases the risk for coronary heart disease and mortality from MI.  
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show an acute-phase inflammatory marker associated with increased risk for future cardiovascular problems and death.  
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show aggressive management of hyperglycemia, hypertension, and hyperlipidemia..  
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Considerations for stroke in pt with DM are   show
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The cause and progression of diabetic retinopathy are related to   show
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show above 129 mg/dL  
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show Hyperglycemia and hypertension  
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Vision loss also occurs from   show
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show blurred vision even with glasses  
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Hypoglycemia may cause   show
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show more common in patients with diabetes  
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show blurred vision, distorted central vision, fluctuating vision, loss of color perception, and mobility problems resulting from loss of depth perception.  
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show perform tasks such as measurement and injection of insulin and blood glucose monitoring to determine if adaptive devices are needed to assist in self-management activities.  
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show neuropathy  
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show either pain or loss of sensation.  
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Damage to motor nerve fibers results in   show
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Damage to nerve fibers in the autonomic nervous system can cause   show
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the most common neuropathies in diabetes and involve widespread nerve function loss   show
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show Diffuse neuropathies  
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Late complications include foot ulcers and deformities   show
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show Focal neuropathies  
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show ischemic neuropathies  
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These stem from compression of a nerve in a body compartment or between tissues. Symptoms begin gradually and can occur anywhere. They may be bilateral, having a waxing and waning course without spontaneous recovery   show
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Autonomic nervous system neuropathy leads to problems in   show
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show blood vessel changes that cause nerve hypoxia  
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Orthostatic hypotention and syncope   show
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Common GI symptoms from diabetic neuropathy are   show
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show Constipation, intermittent and may alternate with bouts of diarrhea.  
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show hypoglycemia  
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Loss of nerve input to the bladder results in   show
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Diabetes is the leading cause of   show
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Risk factors for nephropathy   show
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show microalbuminuria  
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Diffuse neuropathies   show
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show Paresthesias: burning/tingling sensations, starting in toes and moving up legs. Dysesthesias: burning, stinging, or stabbing pain. Anesthesia: loss of sensation  
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Motor alterations in intrinsic muscles of foot in distal symmetric polyneuropathy   show
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Focal ischemia manifests as   show
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show :Gastroparesis/constipation, nausea/anorexia. Diabetic diarrhea; Diarrhea/bowel incontinence, bladder/urinary ret. Impotence, ED, Orthohypotension, resting tachycardia, Defective counterregulation, Loss of warning signs of hypoglycemia  
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Entrapment neuropathies   show
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show hypertension in kidney blood vessels and excess kidney perfusion  
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Increased pressure from hypertension in the kidney have what effect on the system   show
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What items are included in the filtration of larger particles resulting from damage of kidney hypertension   show
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What disease process speeds the process of diabetic nephropathy   show
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show DM I  
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Describe the autoimmune disease process in type 1 diabetes   show
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show HLA-DR or HLA-DQ, mumps, congenital rubella, and coxsackievirus infection, appear to trigger autoimmune destruction of pancreatic beta cells  
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show genetic predisposition and exposure to certain environmental factors.  
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show islet cell antibodies (ICAs), insulin autoantibodies (IAAs), autoantibodies to glutamic acid decarboxylase (GAD), or autoantibodies to tyrosine phosphates. Circulating ICA and IAA may be present before manifestations of DM1 develop. (key feature)  
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DM 1, average age at onset   show
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DM II average age at onset   show
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Main symptoms of DM 1   show
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show Frequently none; thirst, fatigue, visual blurring, vascular or neural complications  
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Etiology of DM 1   show
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show unknown  
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show Insulin resistance & Dysfunctional pancreatic beta cell  
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What antigen patterns/antibodies are present in DM II   show
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Endogenous insulin and C-peptide in DM 1 and DMII   show
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show recessive  
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Is inheritance in DMII recessive or dominant   show
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How does nutritional status affect the onset of DM1   show
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What percentage of DMII patients are insulin dependent   show
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show DMII  
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A progressive disorder in which the pancreas makes less insulin over time   show
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show insulin resistance  
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show metabolic syndrome (syndrome X)  
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Features of metabolic syndrome are   show
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Any the features of metabolic syndrome can cause   show
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What would you teach a client with DM   show
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show control of blood glucose levels, regularly follow-up with their HCP; regular yearly eye/urine microalbumin tested; Early diagnosis of changes allows adjustments in treatment regimens to be made that slow progression of eye and kidney problems  
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show Control of diabetes and its complications  
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show prevention  
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show maintain appropriate weight, reduce cardiovascular risk factors of tobacco use, hypertension, and high blood lipid levels reduce onset of DMII & and its long-term complications.  
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show 15%  
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show about risk factors and symptoms related to diabetes (age, how large their children were at birth or if they were glucose intolerant); Asses for fatigue, polyuria, and polydipsia; vision/touch changes, infections (yeast too), ↑time to heal  
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The preferred test for DM in non-pregnant adults is   show
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show polyuria, polydipsia, and unexplained weight loss.  
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How is DMII diagnosed   show
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show 100 mg/dL (older adults rise 1 mg/dL per decade)  
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Impaired fasting glucose(IFG) is defined as   show
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Normal ranges for (GTT) Glucose tolerance test (2-hr post-load result)   show
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show >140 mg/dL but <200 mg/dL  
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show 200 mg/dL  
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show <7%  
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show poor diabetic control and need for adherence to regimen or changes in therapy.  
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What instructions do you give your clients prior to undergoing an oral glucose tolerance test   show
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show after fasting for 10-12 hours, initial blood drawn, within 5 mins consume 300mL of glucose, then blood samples are drawn q 30mins for 2 hrs. During the test, you rest, no smoking/drinking  
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show >45 yrs old, BMI >25%, 1st relative w/DM, inactive,↑risk ethnic pop, baby wt >9 lbs/GDM, HTN, HDL<35, trigl >250, polycystic ovarian syndrome, IGF/IGT previously, Hx of vascular disease  
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show oral glucose tolerance testing (OGTT)  
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How is GDM tested   show
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Screening for diabetes is done with either   show
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show blood glucose permanently attaches to hemoglobin  
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show glycosylated hemoglobin assays (HbA1c ) LONG TERM  
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What test is used to assess long-term glycemic control, as well as to predict the risk for complications   show
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show Hemolysis, blood loss, and pregnancy all increase red blood cell turnover and reduce HbA1c levels. Triglycerides and bilirubin interfere with the assay, leading to overestimation of HbA1c levels in patients with hypertriglyceridemia.  
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Glycosylated serum proteins and albumin   show
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Glycosylated serum proteins and albumin measures are useful when   show
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What are the available tests for glycosylated serum proteins & albumin   show
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show severe lack of insulin.  
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Hyperketonuria in the presence of hyperglycemia is a   show
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show acute illness, stress, when blood glucose levels consistently exceed 300 mg/dL, during pregnancy, or when any symptoms of ketoacidosis are present. Ketone testing also is recommended for diabetic patients participating in a weight-loss program  
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Hyperketonuria without hyperglycemia suggests that   show
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show of urine protein without kidney symptoms may indicate microvascular changes in the kidney  
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Urine albumin excretion rates of 20 to 200 g/min (30 to 300 mg/hr) indicate   show
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show creatinine clearance tests . In patients with nephropathy, a rise in serum creatinine level is related to both poor blood glucose control and hypertension  
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This test may be appropriate for a quick screening but should not be used for monitoring diabetes management.   show
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show HbA1c Normal range 7% or below, correlate to an glucose level >135 mg/dL  
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show FPG and the postmeal levels  
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show FPG: > 100 mg/dL even with older adults and post-meal >150  
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The management of diabetes mellitus is complicated and involves considerable   show
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Nonsurgical management of diabetes mellitus involves   show
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Who plans, coordinates, and delivers care to the diabetic   show
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Sulfonylurea agents are classified as   show
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The action of sulfonylurea agents are   show
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show weight gain and hypoglycemia. Hypoglycemic episodes are more likely to occur with chlorpropamide (Diabinese, Novo-Propamide) because of its long duration of action.  
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What type of patients are more susceptible to hypoglycemia   show
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show Acetohexamide (Dymelor), Chlorpropamide (Diabinese), Tolazamide (Tolinase), Tolbutamide (Orinase, Mobenol)  
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SECOND-GENERATION SULFONYLUREA AGENTS   show
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MEGLITINIDE ANALOGUES   show
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show Metformin (Glucophage)  
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ALPHA-GLUCOSIDASE INHIBITORS   show
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THIAZOLIDINEDIONES   show
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show are combinations of metformin and other drugs  
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show Under 180 mg/dl (6.6 mmol/L) one or two hours after a meal.  
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show 70-130 mg/dL  
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Blood glucose values at bedtime should be between   show
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show sweating, hunger, weakness, dizziness, tremor, tachycardia, anxiety  
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show insulin secretagogues and have actions and adverse effects similar to those of sulfonylureas  
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Repaglinide (Prandin) and Nateglinide (Starlix)   show
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These drugs were designed to increase meal-related insulin secretion. They are rapidly absorbed and have a short duration of action   show
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show Repaglinide (Prandin)  
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_____________is rapidly absorbed and stimulates insulin secretion within 20 minutes of ingestion. It is taken just before meals to control mealtime hyperglycemia and improves overall glycemic control in patients with type 2 diabetes.   show
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show Biguanides  
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show Biguanides  
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show It does not increase insulin secretion. It decreases liver glucose production, →↓FPG release, and improves insulin receptor sensitivity.  
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The ADA recommends metformin as   show
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show abdominal discomfort and diarrhea.  
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show renal insufficiency, liver disease, alcoholism, or severe congestive heart failure or in patients older than 80 years.  
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show to report symptoms of fatigue, unusual muscle pain, difficulty breathing, unusual or unexpected stomach discomfort, dizziness, lightheadedness, or irregular heartbeats to the primary care provider.  
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show prevent hyperglycemia by delaying absorption of carbohydrate from the small intestine. These drugs inhibit enzymes in the intestinal tract, reducing the rate of digestion of starches and the absorption of glucose.  
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Acarbose does what   show
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The most common side effects of Acarbos and Miglitol are   show
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Patient teaching for acarbose and miglitol   show
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show Thiazolidinediones (TZDs) antihyperglycemic agents and insulin sensitizers  
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Although______________ is available, its use has been associated with an increased risk for heart-related deaths, bone fractures, and macular edema.   show
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All Thiazolidinedions (TZDs) reduce blood lipid levels. Major side effects of TZD treatment are   show
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show have periodic liver function studies because of the potential for liver damage.  
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Combining drugs with different mechanisms of action may be   show
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show at the lowest effective dose and increased every 1 to 2 weeks until the patient reaches desired blood glucose control or the maximum dosage  
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Insulin therapy is indicated when   show
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Antidiabetic drugs are not a substitute for dietary modification and exercise. Teach the patient   show
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To avoid adverse drug interactions, teach the patient to   show
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The choice of oral antidiabetic drug is based on   show
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Shorter-acting agents (e.g., glipizide) are preferable in   show
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show adherence. Beta-cell function in type 2 diabetes often declines over time, reducing the effectiveness of some oral agents. The treatment regimen for the patient with type 2 diabetes may eventually require insulin therapy either alone or with oral agents.  
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show type 1 diabetes and also may be used for type 2 diabetes.  
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The safety of insulin therapy in older patients may be affected by   show
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Insulin is manufactured using DNA technology to synthesize   show
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show genetically engineered human insulins in which the structure of the insulin molecule is altered to change the rate of absorption and duration of action within the body  
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show a rapid-acting insulin analogue that is created by switching the positions of lysine and proline in one area of the insulin molecule  
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Patient teaching for insulin   show
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A usual insulin starting dose is   show
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show injection site; timing, type, or dose of insulin used; and physical activity.  
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Absorption is fastest in the   show
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show the abdomen, because it provides the most rapid insulin absorption.  
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show insulin properties. The longer the duration of action, the more unpredictable is absorption. Larger doses of insulin also prolong the absorption.  
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What increases insulin absorption   show
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show changes insulin absorption  
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show blood glucose levels  
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show blood glucose levels after meals.  
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Insulin lispro, insulin aspart, and insulin glulisine have rapid onsets of action and should   show
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Regular insulin should be given at least   show
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Mixing insulins can   show
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When rapid-acting (Humalog or NovoLog) or short-acting (regular) insulin is mixed with a longer-acting insulin, draw the   show
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show clouds the solution and makes the onset of action and peak effect time less predictable.  
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Lipoatrophy is   show
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show an increased swelling of fat that occurs at the site of repeated insulin injections. Treatment consists of rotating the injection site among different body areas  
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Dawn phenomenon   show
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Somogyi phenomenon is   show
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show lack of insulin, dawn phenom, somogyi phenom  
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This method is more effective in controlling blood glucose levels than a multiple-injection schedule   show
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Teaching for CSII   show
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show Rapid-acting  
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Problems with CSII include   show
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show inexperience in pump use, infection, accidental cessation or obstruction of the infusion, or mechanical pump problems.  
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show store according to manufacture’s instructions, always have a spare bottle of each type of insulin used. inspect the insulin before each use for changes, always buy the same type of syringe, don’t reuse needles. Assess pt ability to administer  
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Amylin analogues are drugs similar to   show
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Pramlintide (Symlin), an analogue of amylin, is approved for patients with   show
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Pramlintide works by three mechanisms:   show
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Pramlintide alters   show
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show to take oral drugs in which rapid onset of action is important (e.g., analgesics) either 1 hour before or 2 hours after eating, inject pramlintide into a site different from where insulin is injected  
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show NOT to be mixed in the same syringe because the pH of the two drugs is not compatible.  
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show Nausea, vomiting, and anorexia. It should not be used for patients with symptomatic gastroparesis  
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show “gut” hormones that, in addition to insulin, also lower plasma glucose levels  
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show glucagon secretion from the pancreas, leading to reduced liver glucose production. It also delays gastric emptying, slows the rate of nutrient absorption into the blood, and reduces food intake, all of which lower blood glucose levels  
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show long-acting analogue of GLP-1. It mimics the actions of GLP-1, stimulating insulin secretion only when blood glucose is high  
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show is nausea. It stimulates insulin secretion and may cause hypoglycemia when given with sulfonylurea drugs (which also stimulate insulin secretion) but not with metformin alone.)  
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Teach patients not to administer exenatide   show
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DPP-IV inhibitors work by   show
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Sitagliptin (Januvia) increases   show
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Januvia is approved as single agent for patients with   show
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Side effects of Januvia include   show
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Adverse effects include hypoglycemia, GI disturbances, upper respiratory tract infection, arthralgia or back pain, and headache   show
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show Nateglinide (Starlix)  
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ADA recommends that metformin should not   show
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