Endocrine 1 Flashcards
serum glucose maintained by insulin and glucagon ratio
homeostasis
endocirine system is linked with
nervous system and immune system
exocrine secretes
onto the surface usually though a duct
endocrine secretes
hormones into the blood stream
chemical substance synthesized & secreted by a specific organ or tissue
hormones
what penetrates the cell membrane and interact with intracellular receptors
steroid and thyroid hormones (lipid-solube)
what binds to receptors located on the surface of cell membranes
protein hormones
activated by imbalance, the action of a hormone results in changes that negate the inital stimulus for its secretion
Negative feedback system
what is an example negative feedback
increase in insulin = increase in glucose
decrease in Ca = increase PTH
increase target action beyond normal
positive feedback, example oxytocin
what involves hormones among several glands to turn off and on target organ hormone secretion
complex feedback
what is an exampe of intrinsic rhythmic secretion of hormones
circadian rhythm
ultradian
greater than 24 hour cycle
menstral cycle
stress can cause your blood glucose to
elevate
integrated chemical, communication and coordination system that enables what
growth, development, reproduction and regulation of energy
a chronic multisystem diseas related to abnormal insulin production, imparied insulin utilization or both
diabetes mellitus
normal insulin is produced by what
the B cells in the islets of langherans of the pancreas
what is the normal glucose range
70-120 mg/dl
type 1 diabetics are
prior to age 30, need insulin for life bc they no longer can produce insulin
type 2 diabetics are
after age 35, change with diet, excercise and insulin
alpha cells secrete
glucagon
beta cells secrete
insulin
glucagon & insulin play a vital role in the metabolism of
carbs, proteins and fats
the primary endocrine function of pancreas is to
regulate blood glucose
in a healthy body normal blood glucose level is maintained by
insulin and glucagon ratio
insulin is the _____ to unlock cell membrane for glucose to enter
the key
what cant enter cell without insulin
glucose
insulin unlocks the door to allow
glucose to enter the cell
without insuin the body enter serious state of what
breaking down of body fat and protein
increase urine, caused by osmotic diuresis caused by excesive glucose in urine
polyuria
dehydration stimulates thirst mechanism
polydipsia
cells in state of starvation until insulin availble to move glucose into cells
plyphagia
what is used for backup energy source
stored fats and ketones
what happens with insulin deficiency
fats breakdown and rlease free fatty acids
which convert to ketome bodies
ketone accumulate in blood which causes metabolic acidosis
insulin absence causes
potassium depletion
what can lead to cardiac arrythmias
absence of insulin
what hormone action is opposite of insulin
glucagon
what is the primary fuel for the CNS
glucose
need continuous supply of glucose is needed for what
brain bc cannot produce or store
liver and muscle stores glucose as what
glycogen
what inhibits the break down of adipose tissue into fatty acids
insulin
as BS rises what happens to the blood
becomes viscous and flows less readily which decreases cirulation and hinders the bodies ability to fight infection and heal
excess glucose excreted in urine along with fluid & electrolyes
osmotic diuresis
type 1 diabetes is the progressive destruction of what
pancreatic B cells (source of insulin)
S/Sx of DM
sudden weight loss/hunger, polydipsia, polyuria, polyphagia, fruity breath
what occurs in the absence of exogenous insulin and is a life threatening condition
diabetic ketoacidosis
what do all type 1 diabetics require
exogenous insulin
what is the most frequently occuring diabetes
type 2
insulin produced is either insufficient &/or poorly utilized by the tissue
type 2 diabetes
what are the major metabolic abnormalities of type 2 diabetics
insulin resistance, pancreas decreases ability to produce insulin, inapooropriate glucose production from liver, alteration in prodction of hormones and adipokines
glucose intolerance during pregnance
gestational diabetes
how is gestational diabetes detected
detected at 24-28 weeks by OGTT (oral glucose tolorance test)
how long does it take for normal glucose levels to return post partum
6 weeks
what is therapy is tried first for DM
nutritional
S/Sx of type 2 DM
fatigue, reccurent infections, prolonged wound haling, visual changes
fasting plasma glucose level
greater than 126 mg/dl must be confirnmed by repeat test
random plasma glucose measurement greater than 200 mg/dl plus symptoms
random plasma glucose measurement
2 hour plasma glucose level between 140-199
impaired glucose tolerance
fsting blood glucose level greater than 100 but less than 126
impaired fasting glucose
useful in determining glycemic levels over a 3 month time
A1C test
goal of A1C test is to be below
7%
2 hour after meal glucose should return WNL
postprandial
intermediate acting insulin
NPH insulin, cloudy, Novolin N, Humulin N, onset 1-2 hours, peak 4-8 duration 10-20hrs, usually before am & pm meal
long acting insulin
basal, lantus, levemir, given once daily, CANNOT be mixed with other insulins, onset 1-2 hours, duration 24 hours, PEAKLESS, clear
rapid acting insulin
humolog, novolog, may be given 15 minutes prior to meal, CANNOT mix with NPH, onset 15 minutes, peaks 1 hour, duration 2-4 hours, clear, bolus
short actinginsulin
clear, bolus, regular R insulin, only one given IV, administration 30 minutes prior to meal, onet 30 minutes, peaks 2-4 hours, duration 6-10 hours
prediabetes is from ____-____mg.dl
100-126
during teaching what should be told to the pt about self monitoring of
blood glucose, nutrition, drug therapy, exercise
what type of insulin is used today
human
when reaches blood stream and begins to decrease blood sugar
onset
max strength derease BS
peak
length of time continues to decrease BS
duration
what can be mixed with regular or rapid
intermidiate
how long is lantus good for
28 days
insulin vials currently used be stored at what temperature
room temperature for 4 weeks
where do we give insulin injections
abdomen, arm, thigh, butt
why might a insulin pen be used
pt with vision problems
why is inslun spray exubera off the market
due to packing problems
continuous subcutaneous infusion battery operated
insulin pump
atrophy sub q tissue from same site usage
lipodystrophy
thickening of sub q tissue
lipohypertrophy
rebound effect in which overdose of insulin causes hypoglycemia usually during sleep when counterregulatory hormones are released, morning hyperglycemia in response to night time hypoglycemia
somogyi effect
how do you teat the somogyi effect
decreasing indulin, increasing night time snack
hyperglycemia on awaking in themorning usually normal til 3 am, relase of growth hormone/cotisol
dawn phenomenon
how do you treat dawm phenomenon
adjust timing of insulin or increase dose
what oral medications stimulates beta cells to release more insulin
sulfonylureas
glipizide, glimepiride
what oral medication increases insulin production from pancreas, should not be taken if meal skipped, useful for unusual eating habits
meglitinides
repaglinide, nateglinide
what oral medication will reduce glucose production by liver without hypoglycemia side effects, hold when testing with IV dyes (48 hours)
biguanides
glucophage
what oral medication slows down absorption of carbs in small intestine, taken first bite of each main meal to lower post prandial blood glucose
a glucosidase inhibitors
acarbose
most effective in those with insulin resistance, improves insulin sensitivity, transport, and utilization at target tissues
thiazolidinediones
pioglitazone
what oral medication is the newest class glucose lowering drugs, increase and prolong incretin levels, absence of weight gain, released by intestine
dipeptidyl peptidase inhibitor
januvia
hormone secreted by B cells of pancras, cosecreted with insulin, slows gastric emptying
amylin analog
symlin
synthetic peptide, stimulates release of isulin from B cells, suppress glucagon secretionslows gastric emptying, not to be used with insulin
incretin mimetic
byetta
may mask symptoms of hypoglycemia
B adrenergic blockers (beta blockers)
can potentiate hyperglycemia by increasing Potassium loss
thiazide/loop diuretics
what is the cornerstone of care for person with diabetes
nutritional therapy
for a type 1 DM pt, what is as important as the amount of food eaten
time of the meals
for a type 2 DM pt what is the emphasis placed on for goals
achieving glucose, lipid and B/P goals
what is the goal of diet therapy for a type 2 DM
maintain as near a normal BS as possible
carbs and monosaturated fats should provide ______ % total energy intake
45-65%
what kind of diets are not recommended for diabetics
low carbohydrate diets
about how many carbs are covered by one unit of insulin
10-15
when does the blood sugar after a meal spike
2 hours
alcohol can cause what in a DM pt
severe hypoglycemia
who should be included in diet/DM teaching
patients family and significant others
what method is used for DM for diet
plate method 1200-1400 calories daily
what does fiber help with
decrease BS and triglycerides
exercise does what for a DM pt
increases insulin sensitivity, lower blood glucose levels, may need carb snack before exercise
can the BS initially increase with excercise?
yes
when should you check BS levels during excercise
before, during and after
patients using insluin sulfonylureas, or meglitinides are at increased risk for what during excercise
hypoglycemia
during stress the body produces adrenalin and cortisol which does what to BS
raise BS
what is useful for good blood glucose control, enables patient to make self management decisions regarding diet, exercise, and medicaion
self monitoring of blood glucose
who is a candidate for a pancreas transplant
type 1 DM, usually kidney and pancras together
what is the #1 predictor of type 2 diabetes
obesity
rapid deep respirations
kussmaul respiration
what testing needs to be done if glucose is above 240
ketone testing
hyperglycemia causes what
breakdown of fat which release free fatty acids which convert to ketones, ketones accumulate in blood which causes metaboilc acidosis
what needs to be taught about insulin therapy or oral agents
education of administratin, adjustment and side effects
what is caused by profound deficiency, mostly occurs in type 1 DM, and is characterized by hyperglycemia, ketosis, acidosis, dehydration
diabetic ketoacidosis
what is the most common precipitating factor in diabetic ketoacidosis
illness
what is a by product of fat metabolism
ketones
ketones alters pH balance causing what
metobolic acidosis
untreated insulin deficiency results in
dehydration, electolytes, acidosis
dehydration and electrolyte loss, body attempts to excret glucose via kidneys, loses H20 & electrolytes
osmotic diuresis
fluid shifts from intravascular space to urine as kidneys try to excreted glucose, sweet fruity odor
DKA S & Sx
what makes the sweet fruity odor
excessive fat metbolism
blood glucose of greater than 300
DKA
what diagnositc study confirms DKA
ABGs
you need potassium replacement for a sodium bicarb if pH is less than
7
with DKA what is a priority
dehydration
insulin IV therapy dosage
0.1 unit/kg/hr
what is the only insulin that can be given IV push
regular insulin
what do you need to be careful with the elderly and fluid/electrolyte imbalnce
fluid overload
what do you do if the BS and ketones are both elevated
contact MD
why would you not want to decrease BS too fast
bc you could increase cranial pressure bc glucose goes into cells rapidly & brings in H20 with it
what would you use a nursing diagnosis of Risk for injury due to mental confusion for
hyperosmolar hyperglycemic syndrome
life threatening syndrome, less common than DKA, occurs in PTs over 60years of age with type 2 DM
hyperosmolar yperglycemic syndrome
S & Sx of BS 600-2,000, none for mild ketonuria, profound dehydration, sticky dry mucous membranes, high mortality rate
hyperosmolar hyperglycemic syndrome
when you add insulin, glucose enters cell along with potassium so you may need what
potassium replacement
when you have a BS level of over 250 administer, and monitor for
D5W, cardiac dysrhytmias
Condition in which a person does not experience the warning signs and symptoms of hypoglycemia until the glucose level reaches a critical point
Hypoglycemic unawareness
Hypoglycemic unawareness is related to what
Autonomic neuropathy (interfere with secretion of counter regulatory hormones) Elderly who use beta blockers
Results from thickening of vessel membrane in the capillaries and Arterioles in response to chronic hyperglycemia
Micro vascular complication
What is the most effected area due to micro vascular complications
Eyes (retinopathy)
kidney (nephropathy)
Skin (dermopathy)
Most severe form of retinopathy is
Proliferative retinopathy
Aspiration of blood membranes & fibers from the inside of the eye behind the cornea
Vitrectomy
Micro vascular complication associated with damage to small blood vessels that supply glomeruli of kidney
Diabetic nephropathy
How are DM pt’s screened for nephropathy
Annually with measurement of albumin to creatinine ratio in urine
Nerve damage that occurs bc of metabolic derangements associated with DM
Neuropathy
Neuropathy that effects the peripheral nervous system
Sensory neuropathy
Which neuropathy can affect all body systems and lead to hypoglycemic unawearness, bowel incontinence and urinary retention
Autonomic neuropathy
What should be done yearly to help prevent ulcers and amputation
Microfilament screening
Dark coarse thickened skin seen in flex urges and on neck
Acabthosis nigricans
Occurs when too much insulin in proportion to glucose
Hypoglycemia
If your pt is hypoglycemic and able to swallow what do you give them
15-20g of simple carbs Fruit juice Milk Soft drink Recheck bs in 15
If you have given your pt 2-3 doses of simple carbs with no improvement what do you do
Administer 1mg glucagon IM
What is the most common cause of death in type 2
Acute MI
What has the highest o2 consumption in the body
Retina
Name the three types of macro vascular diseases
CAD
PVD
cerebrovascular disease
The most common form of retinopathy, partial occlusion of the small blood vessels in retina
Nonproliferative retinopathy
The most severe form of retinopathy. Involves retina & vitreous
Proliferative retinopathy
What is a symptom of hyperosmolar hyperglycemia syndrome
Stick dry mucous membrane
For diabetic nephropathy standards include yearly screenings for presence of what
Microalbuminuria
Characterized by abnormal amounts of protein in the urine
Diabetic nephropathy
Stocking glove syndrome is known as
Sensory neuropathy
Excess glucose converts to —— in nerves and coats nerve fibers & slows motor conduction
Sorbitol
What is common for diabetic neuropathy
Numbness in hands & feet
In autonomic neuropathy what can be affected
Erectile desfunction
If BS is above 250 what else should you check
Ketones
Onset, peak, duration & name of the following insulins: Rapid acting Short acting Intermediate acting Long acting
15, 30, 2, 1 1, 2, 4, peak less 3, 3, 10, 24 Rapid- humalog Short- humilin r Intermediate- humilin n Long- lantus
Which insulin is IV only
Short acting (regular)
Which insulin is NEVER mixed
Long acting
Glucose is produced where
Liver
Characterized by insulin resistance, elevated insulin, high triglyceride, decrease HDL, increase LDL, and HTN
Metabolic syndrome
