L10 Endocrine System Flashcards
1
Q
The endocrine system is a widely distributed group of glands that secrete hormones to do what?
A
Maintain homeostasis
2
Q
All of the glands are called?
A
“Ductless”
- they don’t have to be specifically attached to a duct as they secrete their hormones directly into the blood
- there are target tissues around the body that receive these hormones
- the hormones directly attach to receptors on the target tissue to have an effect
3
Q
What are the 3 glands in the “cranial cavity”?
A
- hypothalamus
- pineal gland
- pituitary gland
4
Q
The hypothalamus is really part of the nervous system, but it controls what gland?
A
Pituitary gland, which is part of the endocrine system
5
Q
Where is the hypothalamus located?
A
In the diencephalon of the brain
- the pituitary gland is below the hypothalamus
6
Q
How many lobes does the pituitary gland have?
A
- anterior lobe in the front
- posterior lobe in the back
7
Q
Where is the pituitary gland located?
A
In boney landmark called sella turcica in the sphenoid bone
- the gland is well protected inside the base of the skull by bone
8
Q
How many hormones does the anterior lobe of the pituitary gland release?
A
6
9
Q
What are the 6 hormones that the anterior lobe in the pituitary gland release?
A
- GH (growth hormone, aka somatotropin)
- TSH (thyroid stimulating hormone)
- ACTH (adrenocorticotropic hormone)
- FSH (follicle stimulating hormone)
- LH (luteinizing hormone)
- PRL (prolactin)
10
Q
What does the GH (growth hormone, aka somatotropin) do? (anterior)
A
Promotes growth of all body tissues
11
Q
What does the TSH (thyroid-stimulating hormone) do? (anterior)
A
Stimulates thyroid gland to produce thyroid hormones
12
Q
What does the ACTH (adrenocorticotropic hormone) do? (anterior)
A
Stimulates adrenal cortex to produce cortical hormones; aids in protecting body in stress situations (injury, pain)
13
Q
What does the FSH (follicle-stimulating hormone) do? (anterior)
A
Stimulates growth and hormonal activity of ovarian follicles; stimulates growth of testes; promotes sperm cell development
- anterior pit gland
14
Q
What does the LH (luteinizing hormone) do? (anterior)
A
Causes development of corpus luteum at the site of ruptured ovarian follicle in female; stimulates testosterone secretion in male
15
Q
What does the PRL (prolactin) hormone do? (anterior)
A
Stimulates milk secretion by mammary glands
16
Q
What does the ‘ADH’ hormone do? (posterior)
A
Promotes water reabsorption in kidneys tubules; causes blood vessels to constrict
17
Q
What does the ‘oxytocin’ hormone do? (posterior)
A
Causes uterine construction; causes milk ejection from mammary glands
18
Q
The ‘T3’ and the ‘T4’ do? (thyroid)
A
Increase metabolic rate and heat production, influencing both physical and mental activities; required for formal growth
19
Q
What does the ‘PTH (parathyroid hormone)’ do? (parathyroid)
A
Regulates calcium exchange between blood and bones; increases blood calcium level
20
Q
What does the ‘cortisol’ hormone do? (adrenal cortex)
A
Aids in metabolism of carbohydrates, proteins, and fats; active during stress
21
Q
What does the ‘aldosterone’ hormone do? (adrenal cortex)
A
Aids in regulating electrolytes and water balance
22
Q
What does the ‘epinephrine’ hormone do? (adrenal medulla)
A
Response to stress; increases respiration; blood pressure, and heart rate
23
Q
What does the ‘insulin’ hormone do? (pancreatic islet)
A
Aids glucose transport into cells; required for cellular metabolism of nutrients, especially glucose; decreases blood glucose levels
24
Q
What does the ‘glucagon’ hormone do? (pancreatic islet)
A
Stimulates liver to release glucose, thereby increasing blood glucose levels
25
What does the 'melatonin' hormone do? (pineal gland)
Regulates mood, sexual development, and daily cycles in response to environmental light
26
What does the 'testosterone' hormone do? (testis gland)
Stimulates growth and development of sexual organs plus development of secondary sexual characteristics; stimulates maturation of sperm cells
27
What does the 'estrogen' hormone do? (ovary gland)
Stimulates growth of primary sexual organs and development of secondary sexual characteristics
28
What does the 'progesterone' hormone do? (ovary gland)
Prepares uterine lining for implantation of fertilized ovum; aids in maintaining pregnancy; stimulates development of mammary gland' secretory tissue
29
How many hormones does the posterior lobe of the pituitary gland release?
2
30
What are the 2 hormones that the posterior lobe in the pituitary gland release?
1. Antidiuretic hormone (ADH)
2. Oxytocin
31
What does the 'antidiuretic hormone' do?
Helps with water conservation by kidneys and vasoconstriction of blood vessels
32
When ADH is released, it causes the kidneys to conserve water, which happens through vasoconstriction of blood vessels in the area.
33
What does the 'oxytocin hormone' do?
Primarily a hormone that acts on the female reproductive system
34
Oxytocin stimulates uterine contractions, which initiates labor.
After the baby's born, oxytocin promotes "milk let down" by the breasts.
Milk letdown is when the hormone kicks into gear and the mammary glands in the ducts in your breast, relax, to let down milk for feeding
35
Where is the "pineal gland" located?
Brain
36
What hormone does the pineal gland secrete?
Melatonin
- regulates sleep cycle or the circadian rhythm
37
How many glands are located in the anterior neck "cervical regions"?
2
38
What are the 2 glands located in the anterior neck cervical regions?
1. thyroid
2. parathyroid
39
What does the "thyroid gland" primarily release?
1. triiodothyronine (T3)
2. thyroxine (T4)
40
Both T3 and T4 contain iodine which is bound to proteins in the blood via TBG (thyroxine-binding globulin). Both of these contain iodine which is important for iodine metabolism.
41
What does the "parathyroid gland" primarily release?
Parathyroid hormone (PTH)
- located posterior to the thyroid gland
42
What does the 'parathyroid hormone' do?
Helps with calcium metabolism by increasing blood calcium levels
- when released it increases calcium levels in the blood by pulling the calcium from the bones and putting it directly into the bloodstream
43
True or False:
These glands are not palpable even if they're enlarged. These are paired glands. Viewing these glands in ultrasound or an MRI you would expect to see the same number on the right and the left and most people have 4-6 glands.
True
44
What do the thyroid and parathyroid work together to do?
1. regulate calcitonin
2. calcium metabolism
45
In the "thorax region", what gland is present?
Thymus
- at the top of the heart right behind the breastbone
46
What hormone does the 'thymus gland' secrete?
Thymosin
- has more of an immune system function than anything else
47
In the "epigastric region", what gland is present?
Pancreas
- posterior to the stomach
48
What 2 hormones do the 'pancreas' secrete?
1. Glucagon
2. Insulin
49
What does 'glucagon' and 'insulin' do for the body?
Regulate glucose metabolism in the body
50
In the "lumbar region" in the retroperitoneal cavity, what glands is present?
Adrenal glands
- on top of the kidneys
51
What do the 'adrenal glands' secrete?
1. Cortisol
2. Aldosterone
3. Norepinephrine
4. Epinephrine
- adrenal glands are typically secreted during a stressful situation (fight or flight response)
52
In the female reproductive system, located in the right and left inguinal regions are the 'ovaries'. What do they produce?
1. estrogen
2. progesterone
53
In the male reproductive system, located in the scrotum, are testes which produce?
Testosterone
54
The outer cortex secretes 3 hormones called ...
1. Cortisol
2. Aldosterone
3. Testosterone
55
What does 'cortisol' do?
1. Decreases inflammation
2. Increases fats and carbohydrates in the blood
56
What does 'aldosterone' do?
Responsible for water and sodium conservation
- helps the kidneys conserve sodium and eliminate potassium
57
The cardiovascular system runs on a sodium-potassium pump, so a lot of times if the kidneys or adrenal glands are malfunctioning, that may have a direct real relationship to the heart.
58
What does 'testosterone' do?
Responsible for the development of secondary male sex characteristics such as muscle hypertrophy, voice deepening, gonads development, sperm production, and an increase in hair in the face/neck, the axillary region, the inguinal region, and other parts of the body
59
The inner medulla secretes 2 hormones called ...
1. epinephrine
2. norepinephrine
60
What does 'epinephrine' do?
Hormone that during a stressful situation, increases your blood pressure, increases your heart rate, and increases your respiratory rate
- Helps to pull blood from the inside of the body, and it pulls that blood towards your skeletal muscles
- rush of adrenaline
61
What does 'norepinephrine' do?
Increases the stress response and can be produced by exercise, adequate sleep, and higher protein diets (beans, bananas, oatmeal, fish, and red meat)
- exercise is good for stress
62
Hormone levels in the blood can signal that homeostasis is disrupted.
63
Since hormones signal a specific endocrine gland to release that hormone, there could also be a problem with the gland.
64
Hormones also act on target tissue to affect growth, metabolism, behavior, and reproduction.
65
Production of hormones are controlled by negative feedback where the hormone itself regulates future production.
66
Hormones affect ..
1. growth
2. metabolism
3. behavior
4. reproduction
67
During puberty, hormones stimulate the onset of ...
1. ovulation
2. menstrual cycle
3. all secondary sex characteristics that happen during puberty
68
Many daily emotions and bodily functions such ..
1. sleep
2. fear
3. anger
4. anxiety
69
Chemically, hormones are categorized into what two different types?
1. Steroid hormones
2. Amino acid hormones
70
Steroid hormones are ...
Lipid-based
- produced by sex glands (ovaries and testes)
- outer adrenal glands
71
Amino acid hormones are ...
- protein-based
- include remaining endocrine glands
72
When clinical conditions arise in the endocrine system, it is usually one of 3 causes ...
1. Problems with hormone secretion (hypersecretion or hyposecretion). Homeostasis is the normal functioning of all of our body systems working together. Conditions often arise from the actual secretion of the hormone where either too much (hypersecretion) is being secreted, or not enough (hyposecretion) is being secreted.
2. There can be a problem with the target tissue. So in other words, the gland produces the hormone and releases it fine, but the receptor tissue does not receive that hormone.
3. Problems with endocrine glands themselves. For example, if somebody has an adenoma or a pituitary tumor, the tumor can get so large that it prevents the gland from secreting hormones. This situation can happen with any of the endocrine glands.
73
What is the "pituitary gland"?
Is a small gland beneath the brain controlled by the hypothalamus
74
Where is the 'pancreas' located?
Epigastric region
- behind stomach
75
The pancreas has 'pancreatic islets', which are?
Small clusters of cells that maintain glucose metabolism by releasing insulin and glucagon
76
What does 'insulin' do?
Decreases glucose in the blood by increasing cellular use
-negative feedback loop
77
What does 'glucagon' do?
Increases glucose in the blood by decreasing cellular use
- negative feedback loop
78
Normally, after you eat a meal that's high in carbohydrates, your blood glucose goes up. If the pancreas is functioning properly, as blood glucose goes up, the body releases insulin to bring glucose levels back down.
79
The problem in somebody that has diabetes (T1DM and T2DM), for example, where not only the pancreas is malfunctioning, it may or may not secrete insulin, or adequate insulin in response to what the person eats.
It's really important to understand that in people with diabetes if their pancreas is not releasing any insulin, that can cause glucose levels in the blood to continue to climb which affects all of the body cells. Increased and uncontrolled glucose levels can actually cause death.
- So if the pancreas is not making insulin it is really important that glucose metabolism is maintained in another way. Generally, treatment is by either a patch, an injection, or a pill. Future research into diabetes is needed as insulin needs to be delivered to the body in some way to combat rising blood glucose levels.
80
Where is the 'pineal gland' located?
Between the hemispheres inside the skull
81
What hormone does the 'pineal gland' release?
Melatonin
82
'Melatonin' helps with ...
1. sleep wake cycles
2. regulating mood
3. sexual development
the release responds to light and environmental changes
83
'Circadian rhythm' means ..
About a day and is everything that happens in a 24-hour period.
84
Common activities of daily living (ADLs) are explained by your individual "body clock" or circadian rhythm. When do you eat? When do you sleep? When do you go to the bathroom? When do you exercise?
85
If there is a problem with the pineal gland homeostasis, sleep may be off, mood may be altered, there may be more depression, anxiety, or anger and other functions in the body may be disrupted. For example, somebody that has issues with anxiety may indicate that it's difficult to eat which reinforces that the pineal gland can indirectly affect the gastrointestinal system.
86
Where is the 'thymus gland' located?
Chest right above the heart
87
What hormone does the 'thymus gland' release?
Thymosin
88
What does the 'thymosin hormone' do?
Stimulates T cells for immunity
- directly related to the endocrine system
89
What are 'gonads'?
Organs that secrete sex hormones
90
In males, gonads are called testes and secrete ..
Testosterone
91
In females, gonads are called ovaries and secrete ...
Estrogen
92
A patient suffers a concussion. A concussion is usually described as a "transient loss of brain function" after a head impact (direct blow, acceleration/deceleration, contrecoup injury). When the brain is "concussed", it may swell, and often the pituitary gland, the pineal gland, and the hypothalamus functions are disrupted. That affects many different areas in the body. Think about the function of the endocrine glands in the cranial cavity (pineal gland, hypothalamus, and pituitary glands) and all the hormones they release.
93
Growth hormone
Hypersecretion
- Acromegaly (adults)
- Gigantism (children)
Hyposecretion
- Dwarfism (children)
94
Antidiuretic hormone
Hypersecretion
- SIADH (syndrome of inappropriate ADH)
Hyposecretion
- Diabetes Insipidus
95
Aldosterone hormone
Hypersecretion
- aldosteronism
Hyposecretion
- Addison Disease
96
Cortisol hormone
Hypersecretion
- Cushing's syndrome
Hyposecretion
- Congenital Hypothyroidism
97
Insulin hormone
Hypersecretion
- Hypoglycemia
Hyposecretion
- Diabetes Mellitus
98
Parathyroid hormone
Hypersecretion
- Osteopenia, Osteoporosis
Hyposecretion
- Tetany
99
What is 'adenoma'?
- tumor of the pit. gland or on the pit. gland
- tumor causes the pit. to increase growth hormone and/or ACTH
- pituitary gland condition which is controlled by the hypothalamus
100
Signs and symptoms of an 'adenoma' ...
1. headaches or pressure in the head
2. vision problems (double or blurry)
3. hormone hypersecretion
101
An 'adenoma' is diagnosed by ...
1. CT scan
2. MRI
102
An 'adenoma' is managed by ...
1. hormone suppression
2. medications
3. radiation
3. surgery
- must be monitored for an increase in size and blood measure levels to measure growth hormone and ACTH
103
True or False: "Gigantism" is increased GH in children.
True
- hypersecretion of GH
104
True or False: "Acromegaly" is increased GH in adults.
True
- hypersecretion of GH
105
The main difference between these two clinical conditions diagnostically is whether or not the patient has completed puberty. Once they've completed puberty, increased growth hormone in adults is called acromegaly.
106
Hallmark sign of 'acromegaly' is what?
Facial structure
- also have increased body mass and elongated bones in face aka "Frankenstein syndrome"
107
Acromegaly and gigantism are diagnosed after clinical bloodwork indicated hypersecretion of GH. Both conditions are treated as soon as possible with GH suppression medications. Typically, in children, when they are above the 95%tile in growth measurements, lab work is ordered to check for pituitary hormone levels
108
What is "panhypopituitarism"?
Dwarfism
- not genetic
- hyposecretion of GH
- one or more (pan means all) of the pituitary hormones are secreted in decreased amounts or not at all
- 2 ft tall
109
What is "diabetes insipidus"?
Generally, the posterior pituitary gland is not releasing antidiuretic hormone (ADH) in sufficient quantities, and then the kidneys can't conserve water
- not common
- from pituitary NOT pancreas
- signs and symptoms are close to diabetes mellitus
- both show polyuria and polydipsia
110
What is "polyuria"?
Increased urine output
111
What is "polydipsia"?
Increased thirst
112
What does "congenital" mean?
Born with it
113
What is "Congenital Hypothyroidism"?
Thyroid deficiency that can cause severe mental retardation if not treated within 6 months
- thyroid hormone (T3 and T4) are low are clinically absent
- mental retardation
- stunted growth
-physical deformities
-a severe form of iodine deficiency that is not seen in the US due to iodized salts in the diet. Since our bodies don't make iodine, we must get it from the diet.
114
What causes "congenital hypothyroidism"?
1. a missing, poorly formed, or abnormally small thyroid gland
2. a genetic defect that affects thyroid hormone production
3. too little iodine in the mother’s diet during pregnancy
4. radioactive iodine or antithyroid treatment for thyroid cancer during pregnancy
5. use of medicines that disrupt thyroid hormone production (antithyroid drugs, sulfonamides, or lithium) during pregnancy
115
What condition is it where clinical cases reported where children were born with this condition and didn't survive past the first month of life?
"Congenital hypothyroidism"
116
What are some symptoms of "Congenital hypothyroidism"?
1. lack of weight gain
2. stunted growth
3. fatigue, lethargy
4. poor feeding
5. thickened facial features
6. abnormal bone growth
7. mental retardation
8. very little crying
9. excessive sleep
10. constipation
11. yellowing of the skin and whites of the eyes (jaundice)
12. floppiness, low muscle tone
13.hoarse voice
14.unusually large tongue
15.swelling near the navel (umbilical hernia)
117
What is "myxedema"?
Adult form of hypothyroidism (adult thyroid deficiency)
- autoimmune disorders, the body attacks its immune system
118
People with 'myxedema', what gland is shutting down?
Thyroid
- most common autoimmune disorder
119
Symptoms of 'myxedema'?
1. altered mental status
2. hypothermia
3. changes in skin
4. coma
5. death if untreated
6. weight gain
7. lethargy
8. dry skin
9. hair loss
10. facial swelling (pitting edema)
120
In who is 'myxedema' most common?
Women
- 80% of people are females
121
What is 'graves' disease'?
Autoimmune disorder that causes increased thyroid hormone production
- opposite of Myxedema and Congenital Hypothyroidism
- aka "diffuse toxic goiter"
122
How do you "diagnose" graves disease?
Based on the clinical presentation of signs and symptoms below and blood work to measure increased T3 and T4 levels
123
Symptoms of "graves disease"?
1. Weight loss (often rapid)
2. Thinning hair
3. Sweating
4. Shakes
5. Tremors
6. Typically really high respiratory rates
7. High heart rate
8. Blood pressure increase
9. Irritability
10. Tremor
11. Increase HR
12. Exophthalmos (picture shown to the right, illustrates the eyes)
13. Menstrual cycle irregularities (some patients have very heavy menstrual cycles, some have a condition called oligomenorrhea or spotty menstrual cycle, some stop menstruating)
124
Treatment for Graves disease?
1. thyroid removal
2. radioactive iodine
3. thyroid hormone suppression therapy
125
What is "goiter"?
Most common thyroid condition
- presents physiologically with an enlargement of the actual thyroid gland
- increased thyroid hormone levels
126
How do you diagnose "goiters"?
CBC with thyroid panel (T3/T4, TBG, TSH levels) to measure T3/T4 levels, your thyroxin binding globulin levels, and then thyroid-stimulating hormone levels
- can also measure RAIU (radioactive iodine uptake)
- this can be tested by having the patient ingests food that has lots of salt in it (usually do it in a lab setting), then within the next six to eight hours, another CBC is taken to measure how the body is processing that salt.
127
What are treatments for "goiters"?
1. surgically removing the tumor
-surgeon can remove the tumor on the
gland but it's actually easier for them to
remove the whole gland.
2. if bilateral goiters you can live without your thyroid gland
3. Hormone treatment can be used but levels typically don't decrease to a subclinical level which results in removing of the entire thyroid gland
128
What are "parathyroid glands"?
Small, paired glands found right behind the thyroid glands
129
True or False: Parathyroid glands are most commonly they are identified when somebody develops a small tumor as parathyroid tumors can cause an increase in calcium (Ca+) in blood and a decrease in (Ca+) in the skeletal system
True
130
Secondary to pituitary tumors are the development of cause kidney stones (made of Ca+), development of osteoporosis, bone pain, and skeletal weakness. Tumors can cause numbness in arms, legs, and around the mouth, and tetany (continuous muscle spasms/contractions).
131
How are "parathyroid tumors" diagnosed?
When the patient starts to complain about either kidney stones or bone pain
132
How are "parathyroid tumors" treated?
1. removal of the tumor, removal of the parathyroid gland/glands
2. supplemental oral calcium
After the removal of a parathyroid tumor, you're using oral calcium to stabilize their calcium levels.
Oral Ca+ treatment will also help decrease tetany and prevent skeletal fractures and osteoporosis.
133
Parathyroids are similar to the thyroids where sometimes people develop a tumor just on one side, and surgeons will remove the tumor as well as the parathyroid glands, just on the side that has the tumor. Once you remove them, obviously calcium levels are going to go down significantly, so it's not uncommon to see a reversal of symptoms. Patients complain of numbness, tingling, and burning in the hands in the feet. Sometimes patients complain of pain when they sleep, and the pain wakes them up almost like restless leg syndrome.
134
Adrenal glands are located in the right and left lumbar region on top of the right and left kidney. We will look at two conditions, Addison Disease is a decreased level of adrenal hormones and Cushing Syndrome is an increased level of adrenal hormones.
135
What is "addison disease"?
Hypofunction of the adrenal cortex
- causes a decrease in the adrenal cortex hormones
- clinicians believe that Addison's Disease is an auto-immune disorder
136
True or False: At this point, there's not a clear-cut mechanism or etiology of Addison's.
True
137
In people that have other autoimmune diseases, we do see Addison's more frequently reported, but it has been reported and people that have pituitary deficiencies, so somebody that has adrenal cortical tropic hormone decreases, they can also exhibit signs and symptoms of Addison's and if you have a decreased level, the way we treat this is by increasing or artificially substituting some of those cortical hormones
138
What are symptoms of Addison disease?
1. People typically look very, very frail and sick
2. Low BP, weakness, nausea, decrease blood glucose
3. Lots of nausea, diarrhea, and constipation are common
4. Increase in melanin or pigment areas on the skin
5. Generally, older people get very tired and dehydrated
6. Sometimes kidneys can shut down
7. Changes in hair distribution, hair lost really quickly
139
How to diagnose "addison disease"?
Autoimmune or ACTH deficiency (pituitary)
140
How do you treat "addison disease"?
Cortical hormones
141
As people age, especially females that are going through menopause, you will see increased pigmentation in the skin, especially the side of the face. Some with Addison's have pigmentation all over their body. Decrease pigment problems, or increase pigment problems depending on how you're looking at it, is certainly a sign of Addison's
142
What is "cushing syndrome"?
Hyperfunction of adrenal cortical hormones which increases the cortex hormones
- when symptoms are caused by a pituitary tumor that increases ACTH, the disorder is called Cushing's Disease
The most common cause is therapeutic hormone use (i.e anabolic steroids or medical steroidal treatments)
143
What are symptoms of "Cushing disease"?
1. Retention of fluid, very noticeable in their faces
2. Hirsutism is a term for increased hair growth
3. Most commonly is in women
4. Females that start to have a male hair growth pattern, grow hair on their face, sometimes develop a mustache, and a lot of times they gain a lot of weight
5. Females have a disrupted menstrual cycle
6. It's easy to pick out somebody with Cushing's because they have a unique moon face shape
144
A lot of times Cushing's is seen in a younger population, in people that are either abusing steroids or taking them for bodybuilding purposes. There are also people that develop it from taking steroids for medical reasons such as going through chemotherapy or because they have severe allergies or reactions to something in the environment.
145
How do "cushing syndrome" and "cushing disease" differ?
Cushing's Disease has the same symptoms as Cushing's Syndrome but this is caused when somebody has a pituitary tumor and gets an increase in adrenocorticotrophic hormone
146
What is the main clinical condition of the pancreas/pancreatic diabetes?
Diabetes mellitus or glucose malfunction
147
What is "diabetes"?
Failure to use the glucose that the body gets from the diet
-When we eat food, especially foods that are high in carbohydrates (CHO), within two hours blood glucose levels will be at their maximum. If you make insulin, your body will naturally release it into the bloodstream to bring those blood glucose levels down.
148
What do people with type I and type II diabetes not making in their bodies?
Not making insulin in sufficient quantities to lower blood glucose or not making insulin at all
149
Diabetic patients who are not treated can see increased glucose levels in the 300-400 range. In extreme cases, you may see up to the 700-900 range. Levels this high for long periods of time can be harmful to the many-body systems and high levels can, therefore, be fatal.
150
What is "Type 1 diabetes mellitus (T1DM)"?
Autoimmune disorder where the pancreatic islet cells are not making insulin at all
1. Autoimmune destruction of the pancreas
2. Insulin levels are low or absent
3. Usually appears in children and teens
4. Patients usually require insulin
5. Old names: juvenile-onset DM and insulin-dependent DM are no longer used because T1DM can develop past children and teen years and many T2DM patients require insulin as well
151
What is "Type 2 diabetes mellitus (T2DM)"?
Failure to use glucose efficiently. Gestational diabetes mellitus (GDM) is an insulin deficiency only present during pregnancy
- People with Type II make insulin, but they don't make significant quantities, so blood glucose levels remain relatively high.
1. 90% of diabetes cases
2. Heredity predominates
3. Caused by cellular resistance to insulin
4. Usually found in obese people with poor diet and sedentary lifestyle
5. May or may not require insulin
152
What is "Gestational diabetes mellitus (GDM)"?
Glucose intolerance during pregnancy due to the mother carrying a baby which increases the overall body weight of the mother and stresses the pancreas
153
Usually found in obese women with a family hx of diabetes
Although it disappears after childbirth, women have as high as 40-60% chance of developing T2DM later in life
A possible delivery complication called macrosomia (big baby) where GDM babies can be 10-12 pounds or more at birth
154
Symptoms of Gestational diabetes mellitus (GDM)?
1. hyperglycemia (increase blood glucose)
2. glycosuria (glucose in urine)
3. polyuria (increased urination)
4. polydipsia (increased thirst)
5. polyphagia (increased hunger)
6. ketoacidosis (ketones are found in the urine when the body burns fat because it cannot get enough glucose)
155
Here's a general summary of what happens when a non-diabetic patient eats a doughnut. First, their blood glucose goes up. Second, their pancreas releases enough insulin to bring their blood glucose levels back down. Third, their body cells get the glucose that they need and the patient goes on their happy way. The more you eat and the higher your blood glucose, the more insulin your pancreas will release.
156
Here's a general summary of what happens when a T2DM patient eats a doughnut. First, their blood glucose goes up. Second, their pancreas does not release enough insulin to bring their blood glucose levels back down. Third, their blood glucose levels remain high which can damage many body organs and body systems.
In addition to a T2DM diagnosis, patients are usually obese, they usually have a poor diet, they usually don't exercise, and there's usually a significant family history of diabetes. The number one comorbidity with T2DM is cardiovascular disease, which is an example of how the endocrine system and cardiovascular system are really tied together. And in these patients, there is good evidence that T2DM is reversible if diet improves, weight loss occurs and an exercise regimen is maintained.
157
How do you diagnose "diabetes"?
1. a random glucose blood test
2. a fasting glucose blood test
3. an oral glucose tolerance test (OGTT).
A random glucose over 200 mg/dl, a fasting glucose above 126 mg/dL or a 1hr, 2hr, 3hr failure of an OGTT are diagnostic criteria for clinical diagnosis.
158
What are treatments for diabetes?
1. Diet (high in protein, low in fat) and exercise (5 days/week of 30-60 minutes of cardiovascular/aerobic exercise)
2. Insulin administration can be given in a variety of ways including an injection or a pump known as a CSII (continuous subcutaneous insulin infusion).
3. Medications that work with your pancreas to make your insulin utilization (decrease insulin resistance) more efficient. Metformin, is a common medication used in this way.
4. Monitoring is a key component using HbA1c (Hemoglobin A1c) test which measures glucose uptake by RBC’s over a 2-3 month period rather than a single CBC that measures glucose at one point in time.
5. Monitoring co-morbidities such as high cholesterol, obesity, cardiovascular disease
6. Patient monitoring using a team approach by a registered dietician (RD), a fitness consultant or certified personal trainer (CPT) and an endocrinologist
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In the future, expect to see pancreatic islet cell transplants, immunosuppressant medications, and genetically engineered insulin (spray, pills, patches). Additionally, research is currently underway to try to understand the role of bariatric surgery, diet restriction surgery (gastric sleeve, gastric bypass) and the balance of energy intake and energy expenditure on outcomes for T2DM patients. Lastly, research on manipulating body cells to replace pancreatic beta cells looks promising.
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