Endocrine Flashcards
What is another name for Glycosylated Hemoglobin and what is the normal value?
KNOW THIS!!!
HbA1C
Normal = 4% - 6%
- Under 7% in patients with diabetes
What happens to the following hormones or responses in response to stress?
* glucose
* cortisol
* aldosterone
* potassium
* healing
* metabolic demands
- ↑ glucose
- ↑ cortisol
- ↑ aldosterone
- ↓ potassium
- ↓ healing
- ↓ metabolic demands
KNOW THE BOLD ITEMS
Explain the action of insulin!!!
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- Promotes glucose uptake by target cells
- Glucose storage as glycogen
- Prevents fat & glycogen breakdown
- Inhibits gluconeogenesis
- Increases protein synthesis
What are the 5 actions of insulin?
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1.) Promotes glucose uptake (by target cells)
2.) Glucose is stored as glycogen
3.) Prevents fat & glycogen breakdown
4.) Inhibits gluconeogenesis
5.) Increases protein synthesis
What is the job of glucagon?
Glucagon maintains blood glucose by increasing the release of glucose from the liver into the blood
What are the 3 hallmark signs of diabetes mellitus?
KNOW THESE HALLMARK SYMPTOMS!!!!!
- Polyuria (↑ urine)
- Polydipsia (↑ thirst)
- Polyphagia (↑ hunger)
What is the cause of type 1 diabetes mellitus?
Destruction & loss of beta cells
- T1DM is technically an autoimmune disorder
Sick Day Rules for Diabetes
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- Patients should NOT stop taking their insulin or oral agents
- Check blood sugar every 3-4 hours
- Modify diet to include & check ketones
- Notify HCP if not tolerating diet & becomeing dehydrated
Causes of Diabetic Ketoacidosis (DKA)
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- Infection, surgery, trauma
- Inadeqaute insulin, malfuntioning insulin pump, management changes (diet/exercise)
- Pregnancy & growth spirts
- Emotional stress
- Drugs: steroid therapy & epinephrine/norepinephrine
Signs & Symptoms of Diabetic Ketoacidosis (DKA)
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- Ketones in urine
-
Hyperglycemia & metabolic acidosis
* pH under 7.3
* bicarbonate under 18 -
Kussmaul breathing
* compensating with respiratory alkalosis – hyperventilating / blowing off CO2) - Glucose over 250 mg/dL
- HIGH potassium
- Dehydration (fluid volume deficit)
What medication class can mask the symptoms of hypoglycemia?
Beta-blockers
What is the cause of diabetes insipidus (DI)?
KNOW THIS!!!!!
Lack of antidiuretic hormone (ADH)
ADH/vasopressin regulates water in the body / kidneys
Symptoms of Diabetes Insipidus (DI)
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- Increased urine output (polyuria)
- Increased thirst (polydipsia)
- Decreased urine specific gravity (diluted urine)
- Decreased ADH
- Hypernatremia (↑ Na+)
- Clear urine
- High serum osmolality (> 300) = dehydrated
What is the treatment for Diabetes Insipidus (DI)?
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Desmopressin (lifelong synthetic vasopressin)
What is Syndrome of Inappropriate Antiduretic Hormone Secretion (SIADH)?
KNOW THIS!!!!
Too much ADH leading to hyponatremia (↓ Na+)
- increased urine osmolality (concentrated urine)
Signs & Symptoms of SIADH
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- High ADH
- Concentrated urine
- Hyponatremia (↓ Na+) (body is retaining too much water)
- LOW (↓) serum osmolarity
- slow onset
- Confusion
What is the treatment for SIADH?
KNOW THIS!!!!!
- Fluid restrictions
-
Sodium replacement
* 3% hypertonic saline
KEY Clinical Symptoms of DKA
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P 29 (endocrine PPT)
- Fruity breath (from volatile acids)
- Hypotension (↓ BP)
- Tachycardia (↑ HR)
- Kussmaul breathing (↑ rate/depth / hyperventilation)
What is the treatment for hypoglycemia in a patient who is unconscious?
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1 amp D50
- = 50 mL of fluid with 25 g of dextrose
Once individual is conscious give them 1/2 cup of juice + carb + protein
Clinical signs & symptoms of Hyperglycemic Hyperosmolar Syndrome (HHS)
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- glucose > 600 mg/dL
- pH > 7.3
- Serum osmolality > 320 (extreme dehydration)
Associated with type 2 diabetes
Which type of diabetes are HHS & DKA usually associated with?
HHS = Type 1
DKA = Type 2
What is the treatment / management for HHS?
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- Rapid rehydration
- Insulin administration
- Electrolyte replacement (potassium)
What key hormone is secreted by the pituitary gland?
ADH
Antidiuretic hormone
Diabetes Mellitus Drugs
Onset, Peak, & Duration:
* Novolog / Insulin Apart
* NPH
* Lantus
Novolog / Insulin Apart
* Onset: 5-15 minutes
* Peak: 1-2 hours
* Duration: 4-6 hours
NPH
* Onset: 2-4 hours
* Peak: 4-10 hours
* Duration: 10-16 hours
Lantus
* Onset: 2-4 hours
* Peak: flat
* Duration: 20-26 hours
What is the onset, peak, & duration of Novolog / Insulin Apart?
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- Onset: 5-15 minutes
- Peak: 1-2 hours
- Duration: 4-6 hours
What is the onset, peak, & duration of NPH (insulin)?
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- Onset: 2-4 hours
- Peak: 4-10 hours
- Duration: 10-16 hours
What is the onset, peak, & duration of Lantus?
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- Onset: 2-4 hours
- Peak: FLAT
- Duration: 20-26 hours
The nurse documents a capillary blood glucose level of 47 mg/dL for a patient who is diagnosed with type 2 diabetes mellitus (DM). The patient is alert, but clammy and has cool skin to the touch. Which is the nurse’s first action?
a.) Give D50W by IV push immediately
b.) Have the patient drink 8 oz juice
c.) Quickly administer 1 mg glucagon 1 via IM injection
d.) Draw blood from a different finger for comparison
b.) Have the patient drink 8 oz juice
