Endocrine Disorders Part 1 Diabetes Complications Flashcards
Glucagon
Function…
Secreted from…
Triggered by…
Increase blood sugar
Alpha cells in the pancreas
Low blood sugar
Insulin
Function….
Secreted from…
Triggered by…..
Lowers blood sugar; brings glucose into the cells
Beta cells in the pancreas
Triggered by high blood sugar
Somatostatin
Secreted from…
Function….
Delta cells in the pancreas
Inhibits release both Insulin & Glucagon
________ also known as vasopressin, is a peptide hormone produced by the hypothalamus and stored in the posterior pituitary gland.
Regulates water balance, blood pressure, and kidney function
Antidiuretic Hormone (ADH)
Less ADH production
Urine more (concentrated / dilute)
Risk for (dehydration/ Fluid overload)
Urine is more dilute with less ADH production.
Risk dehydration. Less ADH = more diuress
Old age, less estrogen production.
Describe
Bones…
Skin…
Risk for Cystitis…
Interventions….
Less bone density: Teach weight bearing exercises
Skin: Fragile / Thin: Be Gentle Movint pt
Q2h posistioning
Old age has a decreased Glucose Tolerance
Describe blood sugars…
Wound healing…
Infections….
Other problems….
Increased Fasting & Random BS
Wounds heal slowly
Yeast infections
Polydipsia & Polyuria common
Old age can share SS of hyperthyroidism…
False
SS of hypothyroidism
Lethargy, constipation, low cognitive, slow speech, low body temperature.
HR <60
Criteria for diagnosis of diabetes
A1C > _____
And
Fasting blood glucose > or equal to_____
Or
Two-hour blood glucose > or equal to _____ during the oral glucose tolerance testing
Or
Pt with hyperglycemic crisis (Random glucose >_____)
A1C >6.5 %
And
Fasting BS 126 or >
Or
two hour BS 200 or >
Or
Random bs >200
Glucose Range
Hypoglycemia ______
Normal range for fasting bs _____
Hyperglycemia _______
Hypoglycemia <74
Normal 74 - 106
Hyperglycemia >106
PATHO
Beta cell destruction
Absolute insulin deficiency
IDIOPATHIC
Autoimmune
Onset usually < than ____ yrs old
Maybe caused by virus Mumps / Coxsackie
ALL DEPENDENT ON INSULIN
Type 1
Onset less than 30 years Usually
Symptoms
Thristy
Frequent urination
Weight loss
Blurred vision
Fatigue
Type 1 DM
PATHO
Occurs any age in adults
Progessive disorder
Insulin resistance occurs before the onset of this type of DM
60 - 80% Correlation with Obesity
Heredity plays major role
Insulin required for 20 - 30 %
Type II DM
Maturity-Onset diabetes of the young (MODY)
Cause….
Loss of insulin function & hyperglycemia
Usually young adults but can occur at any age
Resembles type I (Requires insulin & Risk for DKA)
Not autoimmune
Cause: Inherited gene mutation
Key Features
Early Onset – Typically appears in adolescence or early adulthood (before 25 years old).
Strong Family History – Autosomal dominant inheritance, meaning a 50% chance of passing it to offspring.
Mild Hyperglycemia – Can be managed with diet, oral medications, or low-dose insulin.
No Autoimmune Destruction – Unlike Type 1 diabetes, MODY is not caused by an autoimmune attack on beta cells.
Variable Clinical Presentation – Symptoms range from mild hyperglycemia to more severe diabetes requiring treatment.
Maturity-Onset Diabetes of the young (MODY)
Which pregnant women are screened for Gestational Diabetes…
All
3 classic diabetes symptoms…
Polyuria: dehydration & electrolyte loss
Polydipsia
Polyphagia: No glucose in cells (it stays in the blood) = cell starvation & Hunger
Fasting Blood Glucose (FBG) Test
Purpose: Measures blood sugar after at least 8 hours of fasting.
Normal Range:
Prediabetes:
Diabetes:
Normal Range: 70–99 mg/dL (3.9–5.5 mmol/L)
Prediabetes: 100–125 mg/dL (5.6–6.9 mmol/L)
Diabetes: 126 mg/dL (7.0 mmol/L) or higher on two separate tests
Random Blood Glucose (RBG) Test
Purpose: Measures blood sugar at any time, regardless of when the last meal was.
Normal Range….
Diabetes….
Normal Range: Below 140 mg/dL (7.8 mmol/L)
Diabetes: 200 mg/dL (11.1 mmol/L) or higher, along with symptoms like excessive thirst, urination, or weight loss
Oral Glucose Tolerance Test (OGTT)
Purpose: Measures blood sugar before and after drinking a glucose solution (typically 75g of glucose). Blood sugar is tested at fasting, 1 hour, and 2 hours.
Fasting:
Normal….
Prediabetes….
Diabetes…
2-Hour Post-Glucose:
Normal…
Prediabetes….
Diabetes….
Fasting:
Normal: Below 100 mg/dL (5.6 mmol/L)
Prediabetes: 100–125 mg/dL (5.6–6.9 mmol/L)
Diabetes: 126 mg/dL (7.0 mmol/L) or higher
2-Hour Post-Glucose:
Normal: Below 140 mg
Prediabetes: 149- 199
Diabetes….
When should test indicating diabetes be repeated….
Always unless SS of hyperglycemia
People to screen for DM…
> 45
BMI > 25
Fluoroquinolones
Beta blockers
Corticosteroids
Thiazide diuretics
Protease inhibitors (HIV / antiretrovirals)
Antipsychotics (Olanzapine/ clozapine)
All have this affect on BS…
Ríase BS
1st line treatment for type II DM
Diet and exercise
Meds maybe used. Lowest effective dose
Insulin Stimulators (secretagogues)
Increase Insulin release from beta cells
Increase number of Insulin receptors
Name classes and examples of meds….
SE….
Sulfonylureas
1st gen
Chlorpropamide
Tolazamide
2nd gen
Glimepiride
Glipizide
Glyburide
Meglitinide analogs
Repaglinide
Nateglinide
Chlorpropamide
Class…
Use…
SE…
Sulfonylureas 1st generation
Insulin Stimulators
Hypoglycemia, weight gain, NV
Tolazamide
Class…
Use…
SE….
Sulfonylureas 1st generation
Insulin Stimulators
Hypoglycemia, weight gain, NV
Glimepiride
Class…
Use…
SE…
2nd generation Sulfonylureas
Insulin Stimulators
Hypoglycemia, weight gain, NV
Glipizide
Class…
Use…
SE…
2nd generation Sulfonylureas
Insulin Stimulators
Hypotension, weight gain, NV
Glyburide
Class….
Use…
SE…
2nd generation Sulfonylureas
Insulin Stimulators
Hypoglycemia, weight gain, NV
Repaglinide
Class….
Use….
SE….
Meglitinide
Insulin Stimulators
Hypoglycemia, weight gain, NV
Nateglinide
Class..
Use…
SE…
Meglitinide
Insulin Stimulators
Hypoglycemia, weight gain, NV
Pioglitazone
Class..
Use…
SE…
Thiazolidinediones (glitazone)
Insulin Sensitizer
Heart attacks, bone fractures, macular edema
Bladder cancer risk increase after use of 1 year
NOT FOR USE WITH HEART PTs
Rosiglitazone
Class…
Use…
SE…
Thiazolidinediones (glitazone)
Insulin Sensitizer
Heart attacks, bone fractures, macular edema
NOT FOR USE WITH HEART PTs
Insulin Sensitizers
Thiazolidinediones
-glitazones
This effect….
Use in combination with these medications…. (3)
Lower liver glucose production
Increase Insulin sensitivity
Insulin, metformin, sulfonylureas
Alpha-Glucosidase inhibitors
Acarbose
Miglitol
Effect….
Teaching…
Lowers digestion & glucose absorption in intestines
Teach:
Take with food
Common SE: Ab pain, bloating, gas, nause
Acarbose
Class…
Use…
SE…
Teach…
Alpha-Glucosidase inhibitors
Lower starch digestion & glucose absorption in intestines
Ab pain, bloating, gas, nausea
Only take with meals
Miglitol
Class…
Use…
SE…
Teach….
Alpha-Glucosidase inhibitors
Lower starch digestion & glucose absorption in intestines
Ab pain, bloating, gas, nausea
Only take with meals
Biguanide
Lowers intestinal absorption of glucose
Lowers liver glucose production
Can be used by Diabetics >10 yrs
First Line standard care for type 2 DM
Give examples of medication….
Metformin (Glucophage)
Metformin
Class…
Use…
SE….
Teaching…
Biguanides
Lower intestine absorption of glucose
Lower liver glucose production
Increased sensitivity
SE: Lactic Acidosis, Contradicted in Renal Patients
Reduced dose for geriatrics
HOLD when using contrast dye
HOLD before anesthesia
Dipeptidyl peptidase-4 inhibitor (DPP-4)
Slows breakdown of GLP-1
Leads to Increased Insulin release
SE:
Risk pancreatitis
Hypoglycemia
HA / Vomiting
Teach: Report jaundice, radiating abdominal pain, blue-gray discoloration of abdominal
Examples of meds…
Alogliptin
Inagliptin
Saxagliptin
Sitagliptin
-gliptin
Alogliptin
Class…
Use…
SE…
Teach…..
Dipeptidyl peptidase-4 inhibitor
Slows breakdown of GLP-1 - Insulin release
SE:
Pancreatitis
Hypoglycemia
HA / Vomiting
Teach:
Report Jaundice
Radiating ab pain
Blue gray discoloration of ab
Inagliptin
Class…
Use….
SE….
Teach…..
Slows breakdown of GLP-1 - Insulin release
SE:
Pancreatitis
Hypoglycemia
HA / Vomiting
Teach:
Report Jaundice
Radiating ab pain
Blue gray discoloration of ab
Saxagliptin
Class…
Use….
SE…
Teach….
Slows breakdown of GLP-1 - Insulin release
SE:
Pancreatitis
Hypoglycemia
HA / Vomiting
Teach:
Report Jaundice
Radiating ab pain
Blue gray discoloration of ab
Sitagliptin
Class….
Use…
SE….
Teach…
Slows breakdown of GLP-1 - Insulin release
SE:
Pancreatitis
Hypoglycemia
HA / Vomiting
Teach:
Report Jaundice
Radiating ab pain
Blue gray discoloration of ab
Sodium- Glucose Cotransport Inhibitors
Prevents kidney reabsorption of glucose & sodium
SE: Risk of hypoglycemia when combined with Insulin/ Insulin secretagogues (e.g., sulfonylurea)
Dehydration
Hyponatremia
UTI
Yeast infection
Fournier gangrene
Perineal fascitis
Examples of medication…
Canaglifozin
Dapagliflozin - Farxiga
Empagliflozin - Jardiance
Ertugliflozon
Canagliflozin
Class..
Use…
SE….
Teach….
Sodium- Glucose Cotransport Inhibitors
Prevents kidney reabsorption of glucose & sodium
SE: Risk of hypoglycemia when combined with Insulin/ Insulin secretagogues (e.g., sulfonylurea)
Dehydration
Hyponatremia
UTI
Yeast infection
Fournier gangrene
Perineal fascitis
LOWER LIMB AMPUTATION
Dapagliflozin
Class…
Use…
SE….
Teach…..
Sodium- Glucose Cotransport Inhibitors
Prevents kidney reabsorption of glucose & sodium
SE: Risk of hypoglycemia when combined with Insulin/ Insulin secretagogues (e.g., sulfonylurea)
Dehydration
Hyponatremia
UTI
Yeast infection
Fournier gangrene
Perineal fascitis
Examples of medication…
Empagliflozin
Class…
Use…
SE…
Teach….
Sodium- Glucose Cotransport Inhibitors
Prevents kidney reabsorption of glucose & sodium
SE: Risk of hypoglycemia when combined with Insulin/ Insulin secretagogues (e.g., sulfonylurea)
Dehydration
Hyponatremia
UTI
Yeast infection
Fournier gangrene
Perineal fascitis
RISK OF AKI
Ertugliflozin
Class…
Use…
SE…
Teach….
Sodium- Glucose Cotransport Inhibitors
Prevents kidney reabsorption of glucose & sodium
SE: Risk of hypoglycemia when combined with Insulin/ Insulin secretagogues (e.g., sulfonylurea)
Dehydration
Hyponatremia
UTI
Yeast infection
Fournier gangrene
Perineal fascitis
Glucagon-like peptide-1 Agonist &
GLP-1 / GIP
Triggers Insulin release from pancreas
Blocks glucagon secretion
Slows stomach emptying
Incresse satiety
SE:
allergic reactions
Gall bladder
Pancreatitis
AKI
Thyroid swelling
Difficult swallowing
NV
Anorexia
Teaching
Hypoglycemia when combined with Insulin/ Sulfonylureas
Dont skip meals
Medic alert bracelet
- maybe prescribed for weight loss
Example of medications….
GLP-1 Agonist
Dulaglutide - Trulicity
Exanitide
Liraglutide
Semaglutide - Ozempic
GLP / GIP
Tirzepatide
Dulaglutide
Class…
Use…
SE….
Teach….
Glucagon-like peptide-1 Agonist
Triggers Insulin release from pancreas
Blocks glucagon secretion
Slows stomach emptying
Incresse satiety
SE:
allergic reactions
Gall bladder
Pancreatitis
AKI
Thyroid swelling
Difficult swallowing
NV
Anorexia
Teaching
Hypoglycemia when combined with Insulin/ Sulfonylureas
Dont skip meals
Medic alert bracelet
- maybe prescribed for weight loss
Exanitide
Class..
Use…
SE….
Teach….
Glucagon-like peptide-1 Agonist
Triggers Insulin release from pancreas
Blocks glucagon secretion
Slows stomach emptying
Incresse satiety
SE:
allergic reactions
Gall bladder
Pancreatitis
AKI
Thyroid swelling
Difficult swallowing
NV
Anorexia
Teaching
Hypoglycemia when combined with Insulin/ Sulfonylureas
Dont skip meals
Medic alert bracelet
- maybe prescribed for weight loss
Liraglutide
Class…
Use…
SE….
Teach…
Glucagon-like peptide-1 Agonist
Triggers Insulin release from pancreas
Blocks glucagon secretion
Slows stomach emptying
Incresse satiety
SE:
allergic reactions
Gall bladder
Pancreatitis
AKI
Thyroid swelling
Difficult swallowing
NV
Anorexia
Teaching
Hypoglycemia when combined with Insulin/ Sulfonylureas
Dont skip meals
Medic alert bracelet
- maybe prescribed for weight loss
Semaglutide
Class…
Use…
SE…
Teach….
Glucagon-like peptide-1 Agonist
Triggers Insulin release from pancreas
Blocks glucagon secretion
Slows stomach emptying
Incresse satiety
SE:
allergic reactions
Gall bladder
Pancreatitis
AKI
Thyroid swelling
Difficult swallowing
NV
Anorexia
Teaching
Hypoglycemia when combined with Insulin/ Sulfonylureas
Dont skip meals
Medic alert bracelet
- maybe prescribed for weight loss
Tirzepatide
Class..
Use…
SE….
Teach….
GLP-1 / GIP
Triggers Insulin release from pancreas
Blocks glucagon secretion
Slows stomach emptying
Incresse satiety
SE:
allergic reactions
Gall bladder
Pancreatitis
AKI
Thyroid swelling
Difficult swallowing
NV
Anorexia
Teaching
Hypoglycemia when combined with Insulin/ Sulfonylureas
Dont skip meals
Medic alert bracelet
- maybe prescribed for weight loss
Sub Q agents
Human Amylin/ amylom analogs
Delays gastric emptying
Lowers after meal glucose levels
Triggers Fullness
GIVEN BEFORE MEALS
TEACH: Can’t give with Insulin
Examples….
Pramlimtide acetate
Pramlintide acetate
Class…
Use….
SE….
Teach…
Sub Q agents
Human Amylin/ amylom analogs
Delays gastric emptying
Lowers after meal glucose levels
Triggers Fullness
GIVEN BEFORE MEALS
TEACH: Can’t give with Insulin
_____ & _____ are meal time doses of Insulin
Single injection doses are these types of Insulin…..
Basal & prandial doses are Meal Time
Single daily doses (Intermediate/ long-acting)
This type of insulin is cloudy and must be rolled in hands to mix…
NPH - Intermediate
Steps for administer insulin (5)
Clean the rubber stopper on the vial with an alcohol swab.
Draw air into the syringe equal to the dose you need.
Insert the needle into the vial, and push the air into the vial to prevent a vacuum.
Invert the vial and draw up the correct dose of insulin.
Check for air bubbles, and remove them by tapping the syringe and pushing the plunger slightly to expel the air.
Rapid acting insulin
Onset: 15 mins
Peak: 1 - 3 hrs
Duration: 3 - 5 hrs
Name med…
Aspart
Short Acting
Onset: 30 min
Peak: 2 - 4 hrs
Duration: 5 - 12 hrs
Give examples of this medication….(1)
Regular
Rapid acting insulin
Onset: 15 min
Peak 30 mins - 1.5 hrs
Duration 5 hrs
Human lispro
Intermediate
Onset: 1 - 4 hr
Peak: 4 - 12 hrs
Duration: 10 - 24hrs
NPH
NPH intermediate
Onset
Peak
Duration
Onset: 1 - 4 hr
Peak: 4 - 12 hrs
Duration: 10 - 24hrs
Onset: 30 mins
Peak: 2 - 4 hrs
Duration: 5 - 12 hrs
Short-acting
Regular insulin
Onset: 15 mins
Peak: 30 mins - 1.5hrs
Duration: 5 hrs
Rapid acting
Human lispro
Onset 15 mins
Peak: 1 - 3 hrs
Duration: 3 - 5 hrs
Rapid acting
Aspart
Long-acting
Onset: 2 - 4 hrs
Peak: NONE
Duration: 24 hrs
Glargine
Long acting - Glargine
Onset
Time
Location
Onset: 2 - 4 hrs
Peak: NONE
Duration: 24 hrs
Long-acting
Onset 1hrs
Peak 6 - 8 hrs
Duration 5.7 - 24 hrs
Detemir
Long acting - Detemir
Onset
Peak
Duration
Onset 1hrs
Peak 6 - 8 hrs
Duration 5.7 - 24 hrs
Sleepy
Sweaty
Pallor
Lack of coordination
Irritability
Hunger
SS of…
Hypoglycemia
Think drunk
SS of hypoglycemia (6)
Sleepy
Sweaty
Pallor
Lack of coordination
Irritability
Hunger
Think being drunk
Dry mouth
Increased thirst
Blurred vision
Weakness
HA
Frequent urination
SS of ….
Hyperglycemia
Warm & Dry = Sugar High
SS of hyperglycemia [6]
Dry mouth
Increased thirst
Blurred vision
Weakness
HA
Frequent urination
ADA treatment outcomes
A1C Below…
Premeal glucose levels…..
Peak after meal glucose….
A1C <7
Premeal glucose 70 - 130
Peak after meal <180
6 diabetes quality indicators for HCP…
HbA1c control
BP control
Eye examination
Nephropathy assessment
Foot examination
Tobacco cessation
Most common facotor for diabetic Ketoacidosis….
Infection
Diabetic Ketoacidosis has a blood glucose level of…
Type of metabolic problem…
> 300
Metabolic acidosis
Osmotic diuresis/ dehydration
Electrolyte loss
Neurosymptoms (Weak confusion coma)
Kussmaul respiration
Ketosis - rotting fruit breath
Describes ……
Name 3 more issues seen in this problem….
Diabetic Ketoacidosis
Polyuria, Polydipsia, Polyphagia
In DKA
How often VS…
What do you do every hour…
VS q15min
Urine output, temp, mental status q1hr
DKA
SS
Dry, thirsty
Weak rapid pulse, hypotension
Cool & Clammy
Restore blood volume:
Initial bolus 1st hr…
Then maintenance….
When glucose is 250mg give…
Initial bolus: 15 - 20 ml/kg/hr
Then 4 - 14 mL/kg/hr
Give 5% Dextrose & 0.45 saline
DKA drug therapy
Use ____ insulin to lower serum glucose by 50 - 75 mg / dL/ hr
Regular
Bolus dose then continuous infusion (Short half-life)
When to give SQ insulin in DKA
When ketosis has stopped and pt can take oral fluids
When has ketosis stopped
BS….
Bicarbonate….
Venous pH….
Anion gap…
BS <200
Bicarbonate >18
Venous pH >7.30
Usually lower than arterial due to Co²
Anion gap <12 mEq/L
The anion gap is a calculated value used to help identify the cause of metabolic acidosis.
Its the difference between Cations & Anions: Anion Gap = (Na⁺) - (Cl⁻ + HCO₃⁻)
DKA
How often to check blood glucose levels
If symptoms are present or Glucose >250
Q 4-6 hrs
DKA
Check urine ketones when glucose is…
> 300mg/dl
DKA- When to call the provider
- Blood glucose Higher than ____ & doesn’t respond to therapy.
- Ketonuria lasting longer than _____
Unable to eat or drink
- Illness lasting linger than ….
- > 250
- 24hrs
- 1 - 2 days
Increased blood osmolality caused by hyperglycemia…
Hyperglycemic- hyperosmolar state
In Hyperglycemic-hyperosmolar state
Glucose levels….
Blood osmolality….
MI, Sepsis, pancreatitis, stroke, drugs can contribute
Residual insulin secretion prevents ketosis
> 600
320
HHS
CNS Changes confusion/ coma
Seizures & permanent paralysis….
( t or f )
Negative ketones… ( t or f )
Extreme diuresis & dehydration
Electrolyte loss
Seizures & permanent paralysis….
( false )
Negative ketones… ( true )
HHS
Goal of fluid therapy
Rehydrate 1 L/hr until….
Restore BS in ____ hrs
Rehydrate 1 L/hr until CVP rises or BP & urine output is adequate
Restore BS in 36 - 72 hrs
HHS
Acess for….
Give IV insulin after fluids have been replaced.
Bolus dose then continuous infusion until…
Use regular insulin to lower serum glucose by ____ mg/dl/hr
Monitor for hypokalemia: check lytes Q _____
Continuous cardiac monitor
Cerebral edema (changes in mental status)
Until 250 mg/dl
50 - 70
Check lytes q1-2hrs
Definition of hypoglycemia….
<70 mg/dl
Early signs of hypoglycemia <70 bs
Include….
Sweating
Shaking
Tachycardia
Anxiety
Hunger
4 risk for Hypoglycemia
Taking insulin
Long acting insulin Stimulators (Glyburide)
Metformin combined with Glyburide
Elderly/ Kidney damage
Monitor glucose levels (4)
Before giving antidiabetic meds
Before meals
Before bed time
When symptomatic
1st thing to do if hypoglycemia <70 and patient is awake and alert…
15 G carbs & drink
Wait 15 minutes
Check BS
Repeat if necessary
Glucagon carries this risk…
Vomiting (Aspiration)
Prevent hypoglycemia
4 common causes
Excess insulin
Deficit intake / absorption of foods
Exercise when insulin is peaking
Alcohol intake
Chronic complications of DM
Macro vascular….
Microvascular….
Macro
Stroke risk: severe Carotid atherosclerosis
Micro
Eyes - blindness 25x more common in diabetic
Retinopathy: Vision changes happen first
DIABETIC NEPHROPATHY: Leading cause of End-Stage Kidney disease
DM
Neuropathies
Progessive loss of nerve function (loss of sensory perception)
1st pain, then loss of sensation
Damged motor nerves = ….
Damaged motor nerves = weakness
DM
Autonomic neuropathies
Causes…
LV issues, silent MI
Orthostatic hypotension/ syncope
GI system Gastroparesis, NV, constipation/diarrhea, anorexia
Urinary- Incomplete bladder emptying/ UTI
GLP-1 (Glucagon-Like Peptide-1) hormone for glucose metabolism. It is primarily broken down by the enzyme Dipeptidyl Peptidase-4 (DPP-4).
Action(3)….
Medications:
GLP-1 Receptor Agonists ( _____)
Resistant to DPP-4 degradation, mimicking GLP-1 for a longer duration.
DPP-4 Inhibitors (____)
Block the enzyme DPP-4, preventing GLP-1 breakdown and increasing its availability.
Action:
Stimulates insulin release from the pancreas.
Inhibits glucagon secretion, reducing blood glucose.
Slows gastric emptying, promoting satiety.
GLP-1 Receptor Antagonist
(Semaglutide, Liraglutide)
DPP-4 inhibitors (Sitagliptin, Linagliptin))
