endocrine Flashcards
severe hypoglycemia
glucose
DM 1
school aged,
eats but still loses weight
“fruity odor breath”
thyroid cancer
nodule >2.5cm
24 hour radioactive iodine uptake (RAIU) will show “cold” nodule
FSH
estrogen
LH
progesterone
stimulates testicles to produce testosterone
hyperthyroidism
very low TSH, >t3 t4.
graves disease is most common cause
grave’s disease
Look for LOW TSH (women (8:1)
>risk for osteoporosis, RA, pernicious anemia
classic case: middle age female, weight loss, hyperactive, lower stool, amenorrhea
radioactive iodine
permanent distruction of thyroid
PTU treatment
do not give during pregnancy
thyroid storm (thyrotoxicosis)
dt stress/infection
cold vs hot spot
cold- not metabolically active (concern is cancer). biopsy
hot- active and usually benign
normal range of TSH
.01-6.0
check q6-8wks
drug induced thyroid disease
lithium, dopamine, amiodarone, interferon alfa (cancer)
hypothyroid most common cause
hashimotos
other: postpartum,
most have elevatd antimicrosomal antibody titers, goiter
classic case: overweight woman, fatigue, constipation. a fib in older adult.
** Heavy menstrual, irregular bleeding
myxedema
severe HYPOthyroid
puffy hands, face, feet. thickening of the skin, thinning of outer 1/3 eyebrow,
tx plan for hypothyroid
synthroid 25-50 mcg
increase every few weeks prn, re check 6-8 wks TSH until normalized (
preferred tx for pregnant women
PTU
thyroid cancer risk
hx of neck irradiation in childhood
PAINLESS nodule >2,5 cm
supplement in chronic amenorrhea (hyper thyroid)
calcium , vit D, weight bearing exercise ( dt osteoporosis)
metabolic syndrome aka..
aka: insulin resistance syndrome or syndrome x
obesity, HTN, Hyperglycemia, Hyperlipidemia.
High risk for DM 2 and CVD
prediabetes a1c
a1c
diabetes a1c/glucose fasting/random glucose
> 6.5%
126mg/dl (fasting, no food 8 hours)
200 random glucose (plus polyuria, polydipsea, polyphagia)
a1c elderly
8% ok
high risk hypoglycemia
50mg/dl or less
dawn phenomenon
hypoglycemia
>in FBG early in the morning dt INCREASE insulin resistance between 4-8am
somogyi effect (rebound hyperglycemia)
S=sugar
noctornal hypoglycemia stimulates glucagon to be released by liver= high FBG by 7am.
** DUE TO over treatment bedtime insulin.
dsg- check glucose 3am for 1-2 weeks
tx: snack before bedtime, or
diabetic retinopathy
microaneurysms, cotton wool exudates, neovasculariazion (can rupture in the eye) (cotton wool also with HTN)
first line DM rx
metformin (glucophage)
decrease new glucose, decrease insulin resistance
contraindications for metformin
hepatic disease, alcoholics
risk for lactic acidosis (PH
sulfonylureas
beta cells to MAKE more insuin- risk of hyPOglycemia!!!
glipizide (glucotrol)
glyberide (diabeta)
glimepriride (amaryl)
increaser risk sun sensitivity (use spf) blood dyscrasias ( monitor cbc)
Thiazolidinedoines TZD
z=zone
rosiglitazone (avandia)
pioglitazone (actos)
AVOID in CHF (nyha class 3/4) associated with rare bladder cancer (UA, cytology)
key points for insulin
rapid acting - 1/2 day work ( 4 hours). “one meal at a time”
regular insulin ( or short acting) - covers work day ( 8 hours) “meal to meal “
NPH - extra work shift almost all day (16 Plus hours) breast fast to dinner
lantus- once a day 24 hours
rapid acting drugs
(Log=Lispro)
humalog (insulin lispro)
short acting (regular)
humulin R
NPH
humulin N
lantus
insulin glargine, levimir (insulin detimir)
considered a “basal insulin”
no peaks. lasts 24 hours.
incretin mimetic or glycogen like peptide 1 (glp-1)
exenatide (byetta)
victoza (once a day injection)
risk for pancreatitis
monitor amylas/lipase!
incretin inhancer (januvia, onyglyza)- don’t mix.
when does regular insulin peak
1-5 hours
aka: meal to meal (breakfast to lunch)
by lunch time its gone
type 1 DM usually takes what insulin before each meal
rapid acting (humalog/lispro)
premixed mostly for type 1 or 2 DM
2
metformin dosage
500mg daily bid ( max dose is 2550 mg/dl)
if metformin is at max at blood sugar still high, add SU (risk for hypoglycemia)
if pt is on BOTH metformin and SU max dose (metformin 2550mg/dl and gloctrol XL 20mg) and glucose still high..
add basil insulin (LANTUS)
other options beside insulin
thioglitazone (avandia, actos)- don’t use in CHF
byetta - risk for pancreatitis (incretin mimetic)
which DM causes weight loss
metofmrin incretin mimetic (byetta) amyin analog (symlin)
which DM causes weight gain
SU, TZD (actos, avandia), insulin
DM lifestyle management
weight loss,
fiber whole grains
exercises increases cellular glucose uptake
weight loss- 7% of body weight physical activity (150/min/week)
somogyi versus dawn phenomenon
somogyi is also called “rebound hyperglycemia.” Although the cascade of events and end result – high blood sugar levels in the morning – is the same as in the dawn phenomenon, the cause is more “man-made” in the Somogyi effect (a result of poor diabetes management).
dawn phenomenon happens to everyone, 3a-8a blood hormones cause >glucogon=>glucose. tx: give insulin, earlier dinner, exercise after dinner.
what is considered “low blood sugar”
Your blood sugar is considered low when it drops below 70 mg/dL.
