C9-Endocrine System Pt1 Flashcards
Endocrine system
Pancreas
Thyroid
Adrenal gland
Pituitary gland
Pancreas Produces:
Insulin
Glucagon
Thyroid gland produces
Thyroid hormones
T3
T4
Adrenal Gland produces:
Corticosteroids
from the cortex
Pituitary Gland Produces:
Anterior pituitary
TSH
ACTH
Pancreas Alpha cells create:
Glucagon (hyperglycemia)
Pancreas Beta Cells produce:
Insulin
(hypoglycemia)
Diabetes Mellitus (DM) is deficient in
Carbohydrate metabolism
(can’t metabolize)
What are the 3 POLYS discussed with DM?
Polyuria (excessive urine)
Polydipsia (extreme thirst)
Polyphagia (excessive hunger)
Type 1 Diabetes
Destruction of pancreatic beta cells
Juvenile onset
Produce no insulin
Type 2 diabetes
Non insulin dependent
Mature onset diabetes of the young (MODY)
Adult onset
Insulin resistant
Gestational diabetes
Increased hormone levels during pregnancy can inhibit insulin usage
Secondary Diabetes
Result of other medications
steroids
diuretics
Insulin administration
Given subcutaneous or IV
not effective orally
Insulin Naturally occurring from the
Pancreas (beta cells)
Insulin absorption rates vary, what is the fastest absorption site?
Abdominal
Insulin absorption rates vary, what is the slowest absorption site?
Thigh
Insulin absorption varies according to what?
Injection site
Blood supply
Degree of tissue hypertrophy at injection site
Exercise increases absorption
Insulin therapeutics (what does it help?)
Diabetes
Type 1 or (2 not common unless necessary)
Hyperkalemia
increased influx of K+
Emergency
DKA
diabetic ketoacidosis
Insulin Action
Moves glucose into ell
used for Krebs cycle
changes ADP into ATP
Lowers blood glucose
glucose can be stored as glycogen
can be converted into fat for storage
Lowers level of K+
Insulin is classified by concentration, what are the different dosages? Which is most common?
U100 (most common) 100 units/mL
U200
U500
*USE APPROPRIATE SYRINGE!
(different colors for different doses)
Rapid Acting Insulin Name:
Aspart Lispro (Humulog Novolog)
Short Acting insulin name
Regular (Humulin R)
Intermediate acting insulin name
NPH= Isophane
(Humulin N)
** CLOUDY **
Constant acting Insulin name
Lantus (glargine)
Detemir
Rapid acting insulin ONSET
15 mins
Rapid acting insulin PEAK
1-3 HOURS
Rapid acting insulin DURATION
3-5 HOURS
Short acting insulin ONSET
0.5-1 HOUR
Short acting insulin PEAK
2-4 HOURS
Short acting insulin DURATION
6-8 HOURS
Intermediate acting Insulin ONSET
1-2 hours
Intermediate acting Insulin PEAK
6-12 HOURS
Intermediate acting Insulin DURATION
18-24 HOURS
Constant insulin ONSET
Irrelevant because constant overlaps
Constant insulin PEAK
NONE
Constant insulin DURATION
> 24 HOURS
When mixing insulin, what is the rhyme to help you know which order to draw up first?
Draw up the CLEAR (fast-acting)
Before the CLOUDY (long-acting)
Adjust client’s dosage of insulin on a sliding scale, increase it with:
Increased calories
Infection
Stress
Growth spurts
2nd and 3rd trimester
Adjust client’s dosage of insulin on a sliding scale, decrease it with:
NPO/ fasting
Exercise
1st trimester
Give mixed insulin within ___ mins of mixing:
15 mins
Before administering insulin check the clients ______________
Blood glucose
Insulin complications: Hypoglycemia results from (list situations)
Reduced intake of food
Vomiting/diarrhea
Intensive exercise
Childbirth
Insulin complications: Lipodystrophy results from
Lipoatrophy
Lipohypertrophy
ROTATE INJECTION SITES
Insulin complications- Hypokalemia causes
Arrhythmias
Drug interactions: Hypoglycemic agents
Sulfonylureas
Glinides
Beta Blockers
hide signs & symptoms of low blood sugars
Alcohol
Drug interactions (insulin): Hyperglycemic agents
Thiazide/Loop diuretics
Glucocorticoids
(inc. Blood glucose)
Sypathomimetic drugs
Hypoglycemia definition:
Insulin shock
Very low blood glucose
Hypoglycemia treatment: (conscious)
15:15 rule
15g oral sugar (fast acting)
Recheck glucose in 15 mins
Repeat as needed
Hypoglycemia treatment: (unconscious)
Dextrose
Glucose IV 10%-50%
Glucagon
Hyperglycemia: (DKA)
Diabetic ketoacidosis
more common in type 1
300-500 blood glucose level
Hyperglycemia: HHNC
Hyperosmolar hyperglycemic nonketotic coma
(more common in type 2)
800-1000 blood glucose level
Bicarbonate reverses ________
Acidosis
Hypoglycemia: Signs and symptoms
Sweating (Diaphoreis)
Trembling/shaking
Anxiety
Tachycardia
Hunger/ overactive abdominal sounds
Nause/vomiting
Dizziness
Confusion
Headache
Hyperglycemia: Signs and symptoms
Warm/dry skin
Dehydration
Acetone breath (DKA)
Confusion
Comatose
Polyuria
Blood Sugar rhyme: (15:15 Rule)
Hot & Dry = Sugar High
Cold & Clammy = Need some candy
Hypoglycemic Treatment : (2) drugs
Glucagon
Dextrose in water
Glucagon comes from
Pancreatic alpha cells
Glucagon increases blood sugar by
Stimulating glycogen breakdown
Glucagon Routes of administration
Sub Q
IM
IV
Dextrose in water different concentrations
5%
10%
50%
Oral anti-diabetics treat which type?
Type 2 only
Oral Anti-Diabetics: action
Increase insulin release
Or
Reduce insulin resistance
Oral Anti-Diabetics therapeutic goal
Lower blood sugar
moderate rise after meals
Oral Anti-Diabetics medications
Metformin
Glipizide/glyburide
Acarbose
Sitagliptn
Oral Anti-Diabetics: Sulfonylureas (medication)
Glipizide
Glyburide
Oral Anti-Diabetics: Sulfonylureas (nursing)
Give daily with first meal
Use caution with sulfa allergies
Oral Anti-Diabetics: Sulfonylureas (action)
Stimulate pancreas to release insulin
Increases sensitivity of insulin receptors
Oral Anti-Diabetics: Sulfonylureas (side effects)
Hypoglycemia
Pregnancy cat. C/lactation
Oral Anti-Diabetics: Sulfonylureas (interactions)
Sulfonamides
Insulin
Thiazide/loop diuretics
Alcohol
Mixed insulin
Humulin 70/30