Endocrine System and Related Devices Flashcards
Biggest disease with the endocrine gland
Type 2 diabetes
Endocrine System
- Complex regulatory system that releases hormones that act as chemical “messengers” into the bloodstream
- Hormones are responsible for regulating the metabolic effects of the body’s cells (Nerve impulses and regulatory factors play a role in negative feedback to control the levels of specific hormones)
- Disorders may occur with overactivity or underactivity of endocrine glands and organs (Common endocrine disorders typically involve carbohydrate metabolism and thyroid function)
Disease state overview - Basic pathophysiology
-Chronic disorder characterized by increased FBG levels:
-Associated with abnormalities in carbohydrate, fat, and protein metabolism
-Longstanding, uncontrolled diabetes can lead to renal, ocular, and neurologic, and cardiovascular complications
Nephropathy
Retinopathy
Neuropathy
-Type 1 vs Type 2
Diabetes Type Prevalence
- Type 1: Diagnosed early on, have no insulin, 10%
- Type 2: 90%, typically associated with lifestyle factors
Nephropathy
Kidney disfunction/problems
- Worsening renal function
- Dialysis
Retinopathy
Eye problems
- Blurry vision
- Blindness
Neuropathy
Nerve problems
- Burning
- Numbness
- Amputations
Islets of Langerhans broken down into
- Beta cells: insulin
- Alpha cells: glucagon
Type 2 Common Signs and Symptoms
- polyuria
- polydipsia (increased thirst)
- polyphagia (increased hunger)
- neuropathy
- nephropathy
- retinopathy
- fatigue
Polyphagia: Why do you get hungry when you suffer from type 2 diabetes?
Your body is unaware that you have eaten. It is not capable of utilizing the sugar from the food because of the improper utilization of insulin.
Polydipsia: Why do you get hungry when you suffer from type 2 diabetes?
The body’s really thrown off. Example, too much sugar in the blood.
What does insulin do?
- hormone that decreases blood glucose levels
- inhibits glycogenolysis (break down of glycogen) because we don’t need more
- stimulates lipogenesis
- increases glycogenesis (want to form glucose storage)
- secreted at a basal rate of 1 unit/hr
- additional 5 - 10 units when BG>= 100
- glucagon released when BG <100 mg/dl
Special populations: Children
- Type 1 diabetes
- Onset typically in adolescence or earlier
- failure of beta cells to produce insulin
- requires insulin treatment
- honeymoon phase
Special populations: Elderly
- glucose intolerance may increase with age due to decrease in insulin-mediated glucose metabolism
- FBG increases 1 -2 mg/dl per 10 yoa >= 30 yoa
- PPG 8 - 20 mg/dl per 10 yoa >= 30 yoa
Special populations: Pregnancy
- progesterone, cortisol, and prolactin can impair glucose uptake
- gestational diabetes (OGTT, Diet vs medication use, Targets: FBG < 95 mg/dl - 1 hr PPG < 140 mg/dl; 2hr PPG < 120 mg/dl)
ADA Goals of Treatment for Type 2 Diabetes
- A1C < 7% for most patients
- Preprandial (b4 someone eats): 80 - 130 mg/dl
- 1 - 2 hour post prandial: < 180 mg/dl
- Bedtime: 100 - 140 mg/dl
- healthy to have blood sugar less than 154 (30 mg/dl change when change 1% point for A1C)
DKA
Diabetic ketoacidosis
DM
diabetes mellitus
DPN
diabetic peripheral neuropathy
eAG
Estimated average glucose
FBG
fasting blood glucose
CrCl
creatine clearance
CKD
chronic kidney disease
CGM
continuous glucose monitor
BG
blood glucose
ADA
American diabetes association
CVD
cardiovasular disease
GFR
glomerular filtration rate
HbA1C
glycosylated hemoglobin A1c
IDDM
insulin dependent diabetes mellitus
IGF
insulin growth factor
IGT
impaired glucose tolerance
OGTT
oral glucose tolerance test
SCr
serum creatinine
SMBG
self-monitoring blood glucose
TSH
thyroid stimulating hormone
UACR
urine albumin to creatinine ratio
Glucose meter features: Measurement range
- 0 mg/dL to 600 mg/dL
- Extremely high or low readings should be verified
- Display of high and low readings
Glucose meter features: Whole blood vs. plasma glucose
- Plasma 10-15% higher than whole blood
- Glucometers (whole blood) vs. lab draw (plasma)
Glucose meter features: Cleaning
Soap and water – unless otherwise specified in instructions
Glucose meter errors: Hematocrit
- High hematocrit may cause lower glucose readings
- Anemia and sickle cell disease may impact readings
Glucose meter errors: conditions
- Altitude
- Extreme temperatures
- Humidity
Glucose meter errors: Test strips
- Expiration date
- Coding
- Specific for meter type
- May require coding once inserted into meter
- Keep in supplied container until ready to use
Glucose meter errors: Control Solution
- Used to check accuracy of meter and test strip
- Each bottle of control solution has specific instructions for use
- Solution contains a known glucose level
- If results match known range then meter are strip are working correctly
Lancet
- Provides adjustable force needed for lancet
- May contain components for both fingertip and alternate site testing
- Reusable
- Used to pierce skin and obtain blood for testing
- Disposable
- Replace after one use
Fingertip
-use colored cap on lancing device
- always use finger tip to test if:
- Concern of hypoglycemia
- Patient unaware of hypoglycemic symptoms
- Alternate site results do not match how the patient feels
Alternate site
- use clear cap on lancing device
- palm or forearm are acceptable sites
- results may be different than at fingertip when glucose levels are changing rapidly
Syringes
- Most syringes come with needle attached
- Available in a variety of lengths and gauges
- -½ cc (50 units), 1 cc (100 units)
- -27 g, 28 g, 29 g, 30 g, 31 g
- -The higher the gauge number, the thinner the needle
- Intended for one time use
Pen needles
- Some diabetes medications are available in a ready to use pen
- Needles need to be attached directly to pen
- Intended for one time use
- Do not store pen with needle attached
Purpose of foot exams
- Early identification of risk
- Early detection, diagnosis, and referral for problems including ulceration, infection and painful neuropathy
- Early intervention and treatment to prevent problems from worsening
- Teach self-management and preventive foot care strategies (appropriate foot wear)
8 Questions to Collect and Assess
- How often do you check your sugars? Before or after you eat?
- What kinds of foods do you eat for each meal?
- Which foods tend to make your sugars go high?
- At what levels do you want to see your sugars?
- How do you feel when your sugars are really high?
- How do you feel when your sugars are really low?
- What do you do when your sugars are really high or low?
- Whats your understanding of how high blood sugars affect you?
Thyroid Hormone
- Decreased levels of thyroid hormone stimulate the hypothalamus to release thyrotropin-releasing factor, which triggers the release of thyroid-stimulating hormone (TSH) from the pituitary
- TSH causes the release of triiodothyronine (T3) and thyroxine (T4)
- Responsible for the regulation of metabolic rate, growth and development of children, and reactivity of the nervous system
- 100 mcg/day of iodide necessary for normal thyroid hormone production (equivalent to 1 gm of salt)
Hypothyroidism
- HIGH TSH
- weight gain
- cold/cold intolerance
Hyperthyroidism
- LOW TSH
- tachcardia
- increased systolic bp
- irritability
