Endocrine Flashcards
What is the function of glucose and how is it produced in the body?
Source of energy
- the stomach changes food into glucose
- glucose enters the blood stream
- the pancreas makes insulin
- insulin enters the blood stream
- glucose cant get into the cells of the body. glucose builds up in the blood vessels
What is the function of glucagon and how is it produced in the body?
What is the function of insulin and how is it produced in the body?
Explain the presentation of hypoglycaemia and its signs and symptoms
- The importance of an adequate supply of glucose to the brain is apparent from the number of nervous, hormonal and metabolic responses to a falling glucose level. Most of these are defensive or adaptive, tending to raise the blood sugar via glycogenolysis (the conversion of glycogen to glucose) and gluconeogenesis a metabolic pathway that results in the generation of glucose from non- carbohydrate carbon substrates such as lactate, glycerol, and some amino acids to provide alternative fuels.
- Confusion
- Poor coordination
- Poor concentration
- Aggression
- ACS
- Diminishing GCS (15-3)
- Pallor
- Diaphoresis +++
- Coma
- Seizure
*
Explain the treatment of hypoglycaemia
Assess
Probable hypoglycaemia - BGL .Response to commands
BGL >4
Consider other causes of altered conscious state
- e.g. stroke, seizure, hypovolaemia
- BGL <4 Responds to commands
- Glucose 15g Oral
- Adequate response
- Basic supportive care
- Poor response
- Consider Dextrose IV or Glucagon IM (if unable to gain IV)
- BGL <4 Does not respond to commands
- IV cannula in a large vein
Confirm IV patency (10ml flush)
- Dextrose 10% up to 15g (150ml) IV
- Normal Saline 10ml flush
Inadequate response
* GCS <15 after 3 minutes
* Repeat Dextrose 10% 10g (100ml) IV, titrating to Pt conscious state
* Normal Saline 10ml flush
Explain the presentation of hyperglycaemia
Explain the treatment of hyperglycaemia
BGL >11mmol, Less than adequate perfusion and signs of DKA/HHS:
Dehydration
Tachypnoea
Polydipsia
Polyphagia
Polyuria
Kussmaul’s resps
Phx diabetes
Administer Normal Saline 20mls/kg.
Explain the endocrine system and what glands it includes
the endocrine system is made up of a number of glands that produce and secrete hormones to regular many functions of the body.
Adrenal glands - located at the top of the kidneys and release cortisol “stress hormone”
Pituitary gland (controlled by the hypothalamus) - located at the base of the brain and it controls many other glands including the thyroid
Thyroid gland - located at the front of the neck and controls metabolic rate.
Islet cells - located in the pancreas and responsible for insulin adn glucagon production
ovaries/testes - responsible for sex hormones and reproductive function
What is the pathophysiology of diabetes
- Diabetes is essentially a condition characterised by too much glucose in the blood.
- There are three types – Type I, Type II and Gestational diabetes.
- Like most animal tissues, brain metabolism depends primarily on glucose for fuel in most circumstances. A limited amount of glucose can be derived from glycogen stored in astrocytes (Liver), but it is consumed within minutes. For most practical purposes, the brain is dependent on a continual supply of glucose diffusing from the blood into the interstitial tissue within the central nervous system and into the neurons themselves.
- Therefore, if the amount of glucose supplied by the blood falls, the brain is one of the first organs affected. In most people, subtle reduction of mental efficiency can be observed when the glucose falls below (3.6 mmol). Impairment of action and judgment usually becomes obvious below 2.2 mmol.
- Seizures may occur as the glucose falls further. As blood glucose levels fall below 10mg/dl (0.55 mmol), most neurons become electrically silent and non-functional, resulting in coma. These brain effects are collectively referred to as neuroglycopenia.
- Brief or mild hypoglycaemia produces no lasting effects on the brain.
- Prolonged, severe hypoglycaemia can produce lasting damage of a wide range. This can include impairment of cognitive function, motor control, or even consciousness.
- The likelihood of permanent brain damage from any given instance of severe hypoglycaemia is difficult to estimate, and depends on a multitude of factors such as age, recent blood and brain glucose experience, concurrent problems such as hypoxia, and availability of alternative fuels.
Explain T1DM adn its signs and symptoms
- Diabetes mellitus Type I – Is often diagnosed in childhood or early adulthood. It occurs as the result of an autoimmune response that destroys the beta-cells (responsible for producing insulin) in the pancreas. This results in no insulin being produced.
- As a result of no insulin, glucose remains in the blood stream and can not be transported into the cells to be used as energy.
- Classic signs and symptoms (before treatment). Polyuria, Polydipsia, Polyphagia, Weight loss
Explain T2DM and its signs and symptoms
- There is some insulin production but it is inadequate to meet the body’s needs or there is a level of insulin resistance (where the insulin does not work as effectively as it should).
- Approx. 90% of patients with diabetes have type II. This is generally considered adult-onset and can be related to obesity, poor diet and lack of exercise.
- Patients can often present with symptoms of hyperglycaemia (polyuria, polydipsia, fatigue, weight loss) as well as peripheral neuropathy and blurred vision.
- Management includes modifying lifestyle factors. The patient may also require oral anti-hyperglycaemics and/or insulin.
Explain HHS and its symptoms
- This is a state of significantly high blood sugar levels (30+mmol/L) usually in a patient with type II diabetes. It can often be precipitated by some sort of illness/injury resulting in a decrease in effectiveness of insulin and an increase in blood glucose.
- These patients have issues with fluid shift due to osmosis. The body attempts to ‘dilute’ the blood glucose by shifting fluid from the cells into the blood stream. This results in significant dehydration, electrolyte imbalances and hypokalaemia
- Signs and symptoms:
- High BSL
- Hypotension
- Tachycardia
- Polyuria
- Polydipsia
- ACS
Explain DKA and its symptoms
- This generally occurs in Type I diabetics and is essentially caused by insufficient insulin.
- The patient may have a preceding illness, or inadequate insulin dosage. The condition usually develops over 24hrs.
- These patients present with high blood sugar (14+mmol/L). Lack of insulin means cells are without energy.
- Glucagon levels increase to release glycogen from the liver to be converted to glucose.
- This still does not work as the glucose cannot enter to cells.
- Lipolysis (fatty acids from adipose tissue) occurs in the absence of insulin in an attempt to produce energy.
- This is where ketones are produced (as a last ditch energy source).
- These patient also suffer fluid shifts due to osmosis.
- Polyuria results in a loss of electrolytes (sodium and potassium)
- The production of ketones results in metabolic acidosis.
- The body compensates with respiratory alkalosis by hyperventilating (blowing off CO2).
Symptoms
- polyuria
- high BSL
- tachypnoea
- fruity breath
- arrythmias
- polydipsia
- hypotension
- tachycardia
- ACS
- GI complaints
Recite the hypoglycaemia CPG (paeds)
Recite the hypoglycaemia CPG (adults)
