Diabetes Flashcards
What is the endocrine system? What are hormones? What controls the release of these hormones? What is the process through which hormones affect the body?
- The endocrine system is a complex message and control system that integrates many body functions through usage of a chemical system with endocrine glands (secrete or release chemicals inside) releasing hormones.
- Hormones are chemical messenger signals that can stimulate or inhibit an effect on the body’s organs and system.
- The brain controls the release of hormones.
Process
- Stimus
- Endocrine gland stimulated
- Hormone secreted into bloodstream
- Hormone interacts with target organ, tissue, process
- Effect produced
- Effect becomes new stimulus
Name the glands of our body, look on pg. 183.
- Hypothalamus
- Pineal gland
- Pituitary
- Parathyroids
- Thyroid
- Adrenals
- Pancreas
- Ovaries (female, Testes (male)
What is diabetes (also called diabetes mellitus)? What is glucose? What is insulin? What happens to the cells without insulin?
- A metabolic disorder that affects 7% of the population in which the body’s ability to metabolize and control simple carbohydrates (glucose) is impaired through inadequate insulin production by the body
- Glucose: a basic sugar used in the body in conjuction with O2 to provide a source of energy required by all cells for normal function (via cellular metabolism)
- Insulin: hormone secreted by the endocrine glands on the pancreas that enables glucose to enter cells.
- Essentially, without insulin the cells begin to “starve” because there is no glucose entering the cells to provide energy.
What are two conditions that can lead to a diabetic emergency? What is hypoglycemia (state range, for extreme too)? What is hyperglycemia (state range, for extreme too)? What is the normal range of blood glucose levels?
- The two conditions that can lead to a diabetic emergency are extremes of hypoglycemia and hyperglycemia.
- Hypoglycemia: a state in which blood glucose is below normal; low glucose level (>80 hypoglycemia; >40 hypoglycemic crisis)
- Hyperglycemia: a state in which blood glucose level is above normal; high glucose level (<120 hyperglycemia; <800 hyperglycemic crisis)
- Normal ranges: 80-120 mg/dL
How do you control diabetes?
Diabetes can be controlled in three ways…
- Diet alone
- Oral medications
- Insulin
What is a Type I Diabeties (IDDM)? What is it caused by? What must the patients do because of it? What are type I diabetic patients more likely to have because of it?
- (insulin dependent diabetes mellitus) Usually with a juvenile onset (can still develop later in life) is characterized by a complete inability to produce insulin.
- Caused by pancreatic cells being destroyed by the body’s immune system (autoimmune problem) thus insulin cannot be made anymore.
- The patients must inject supplemental, synthetic insulin daily to control their glucose levels.
Type I diabetic patients are more likely to have…
- Metabolic problems
- Organ damage such as blindness, heart disease, kidney failure, and nerve disorders. (Lifespan goes down 15 years, 5-10% of diabetics are type I)
What is type II diabetes (NIDDM)? How can type II diabetes be controlled?
- (Non-insulin-dependent diabetes mellitus) Usually with an adult onset, is a type of diabetes that is characterized by patient’s producing inadequate amounts of insulin or body is producing a normal amount but the insulin is not working effectively for the body.
- Disease can be controlled through diet, exercise, and non-insulin type oral medications (hypoglycemic agents). Some patients still require insulin too though.
What causes hyperglycemia? What happens during hyperglycemia?
- Lack of insulin causes glucose to build-up in the blood.
Happens during hyperglycemia
- Blood glucose levels are rising, kidneys cannot handle it anymore and begin to excrete glucose.
- A need for a large amount of water develops
- Polyuria occurs: excessive urination
- Polydipsia occurs: excessive thirst
- Polyphagia occurs: excessive hunger, appetite
- Without glucose intake, body begins to use fat for fuel
- Ketones are a byproduct of fat metabolism
- Diabetic ketoacidosis occurs (along with its symptoms)
What is diabetic ketoacidosis (DKA)? What are the signs and symptoms of DKA? What are Kussmaul respirations?
- Diabetic ketoacidosis (DKA) is the accumulation of certain acids due to insulin not being available in the body.
Signs and symptoms… (S/S)
- Unconsciousness; altered mental status
- Weakness, nausea, and vomiting (N/V)
- Abdominal pain
- Rapid, weak pulse
- Kussmaul respirations
- Deep, rapid breathing that help the body “breath off” excessive acids, sweet smell of breath due to ketones.
What can happen as a result of extreme hyperglycemic? What are the signs of diabetic coma? Ultimately, why does a diabetic coma happen?
- A diabetic coma can happen as a result of this hyperglycemic crisis
S/S
- Slow onset of ALOC (varying degrees of responsiveness)
- Dehydration (from polyuria)
- Kussmaul respirations (from DKA)
- “Fruity” breath odor (from DKA)
- Rapid weak pulse with normal or slightly low blood pressure
Ultimately it happens due to a hyperglycemic crisis, insufficient insulin to control blood glucose.
What can happen as a result of extreme hypoglycemia? Why does this happen? What are the signs and symptoms of insulin shock?
- Insulin shock can happen as a result of extreme hypoglycemia; low blood sugar, too much insulin.
- Excess insulin can cause this this to happen from…
- Taking too much insulin
- Taking a regular dose of insulin but not eating enough food
- Unusual amount of activity or vigorous exercise using up all the glucose.
- Even a patient vomiting up a meal after taking a regular dose of insulin can cause this.
- The S/S of insulin shock are…
- Rapid onset of ALOC (aggressive, confused, lethargic, or unusual behavior)
- Pale, cool, diaphoretic skin
- Normal to swallow respirations
- Seizure, fainting, or coma
- Normal to low blood pressure
- Rapid pulse
- Dizziness, headache
- Weakness on one side of the body
What should you note about diabetes and alcohol abuse?
- Patients may appear to be intoxicated if hypoglycemic or hyperglycemic as if they were drunk.
- Suspect hypoglycemia with any altered metal status
- An be alert with similarity in symptoms of diabetes and alcohol.
- A medical medical braclet, card, etc. may save this person’s life to clarify this, if not, only a blood test from EMS onscene or emergency department can save this person’s life.
What questions should you ask the diabetic?
Ask these in addition to your SAMPLE history…
- Did you take insulin or any pills that lower your blood sugar?
- Have you taken your usual dose of insulin (or pills) today?
- Have you eaten normal today?
- Have you had any illness, unusual amount of activity, or stress?
Note that most of the time, the patient knows what’s wrong.
How should you perform treatment on the diabetic? How do you administer oral glucose?
- Treat any ALOC diabetic the same
- High flow O2 through mask
- Supine or left lateral position
- Administer oral glucose
- Note that it should be given to a diabetic with decreased LOC, not patient with inability to swallow or is unconscious
- Note that you can use liquid or paste
- Liquid can be used (OJ + sugar) if they are able to hold it and drink on their own
- Paste can be used if conscious or unconscious through putting it on their cheek between the gumline for absorption.
- Rapid transport - do not delay for administration of oral glucose
What are the complications of diabetes?
Most of these are due to ketoacidosis…
- Peripheral vascular disease: damage of the body vessels, usually in legs and feet
- Heart disease: heart atheroscholorsis, weakened vessels, stick blood
- Visual disturbances: blindness, high blood sugar can damage retina
- Renal failure: renal, damaged vessels, common in type 1
- Stroke: increase of BP all over since vessels in brain are weak, seizures can happen due to inadequate supply of glucose to brain
- Ulcers
- Seizures
