Lecture 6.2 - Endocrine Disorders

Question 1

What are the goals of treatment for type 1 and 2 DM?

Answer 1

Type 1: Integrate insulin with eating and exercise

Type 2: heart-healthy diet and moderate weight loss of 10% to 20%
-> Spaced meals can help

All should have 150 mins/week of moderate intensity aerobic physical activity + resistance training 3 days/week.

Question 2

What is Kussmaul breathing?

Answer 2

Rapid deep breathing indicative of DKA

Question 3

A diagnosis for DM involves which lab results?

Answer 3

A1C - >6.5
FPG - >7.0
OGTT - >11.1

Question 4

What would a prediabetic fasting glucose test be? What about a 2-hour glucose tolerance test? A1C?

Answer 4

Fasting - 6.1-6.9 mmol/L
OGTT - 7.1-11 mmol/L

A1C of 6-6.4%

Question 5

When a patient isn’t alert enough to swallow, how can we correct low blood sugar?

Answer 5

1 mg of glucagon IM/SC

In acute care, 20-59 mL of 50% dextrose can be given as an IV push

Question 6

When is the peak BGL after a meal?

Answer 6

Two hours - so continue to monitor

Question 7

What is the 15-15-15 rule?

Answer 7

If pt has low BGL, give 15-20 grams of simple carbohydrate (orange juice)

Wait 15 minutes, take BGL - if still low do another dose of sugar

Repeat until sugar is in normal range

Question 8

Normal BGL range?

Answer 8

4-7 mmol/L

Question 9

Irritability, diaphoresis, tremens, confusion, weakness, and hunger are associated with what?

Answer 9

Hypoglycemia

Question 10

What kind of drug is glyburide?

Answer 10

Sulfonurea
–> Increases insulin production from pancreas

Question 11

What kid of medication is metformin?

Answer 11

Biguanide
–> Reduce glucose production in liver + reduces insulin resistance

Side effects include bloating, nausea, cramping, and diarrhea

Question 12

What is the onset of of glargine (Lantus)? Duration?

Answer 12

Onset 1-5 h, duration 24.

Question 13

What is the onset of Determir (Lantus)? Duration?

Answer 13

Onset 3-4 hrs; duration 24 hrs

Question 14

Before we treat DKA, what do we need to do?

Answer 14

Administer 2L of fluid and recheck blood sugar for accurate values.
–> Ringer’s preferred d/t Bicarb content

Question 15

DKA is characterized by…

Answer 15

Hyperglycemia, ketosis, acidosis, and dehydration

Question 16

A patient presents for vomiting, abdominal pain, a dry mouth and flushed face, dehydration, and increased pulse.
They have rapid, deep breathing.

What might be wrong?

Answer 16

DKA

Question 17

What are the emergency management goals for DKA?

Answer 17

Airway –> O2

Correct fluid imbalance –> .45/.9 NaCl and slowly bring sugar down

Focus on potassium and bicarb replacement and anticipate that it will be low

Question 18

Who is at risk for Hyperosmolar Hyperglycemic Syndrome?

Answer 18

Life-Threatening syndrome that often occurs in patients older than 60 with DM2.

Question 19

What is exothalmus?

Answer 19

Bulging eyes associated with hyperthyroidism

Question 20

A pt presents with weight loss, diarrhea, tachycardia and bruit over their throat. What else would you expect from this pt?

Answer 20

Hyperthyroidism
–> Enlarged thyroid, elevated t3 and t4 with low TSH

Question 21

What treatment is recommended for hyperthyroidism?
Consider diet, drugs, and surgery

Answer 21

Diet: High protein and calorie, low caffeine and fiber

Drugs:
–> Propylthiouracil to block T3/4 synthesis
–> Iodine to destroy thyroid cells

Potential surgery to remove thyroid

Question 22

What should you be aware of on a patient with thyroidectomy?

Answer 22

Check behind neck for drainage, position pt in high fowlers, and keep calcium gluconate at bedside

Question 23

A patient presents with fatigue, brady, weight gain, constipation and periorbital edema and an intolerance to cold. What would you expect from this patient?

Answer 23

Hypothyroidism
–> Low T3/4 with rising TSH

Question 24

What should you monitor when a patient is taking levothyroxine?

Answer 24

Hold if HR >100 BPM

Question 25

What foods contain high iodine?

Answer 25

Fresh fish

Question 26

What should you monitor for a patient with hypothyroidism?

Answer 26

Avoid food containing iodine, take medication in am and at same time. Monitor for risk of constipation and monitor closely during pregnancy.

Question 27

What is Addison's Disease?

Answer 27

Adrenal Insufficiency - Caused by sudden withdrawal from corticosteroids, hypofunction of adrenal cortex, or lack of pituitary ACTH

Question 28

Why should person with hypoglycemia avoid foods high in fat?

Answer 28

Because fat decreases absorption of sugar

Question 29

What arterial blood gas changes might be apparent in a person with DM1?

Answer 29

pH less than 7.30 and HCO <15mmol/L might be seen

Question 30

Use caution when administering insulin with which other medications?

Answer 30

Steroids, beta-blockers, and some antibiotics

Question 30

What lab values will be found in someone with HHS?

Answer 30

BGL >34mmol/L No ketone bodies present

Question 30

What is hyperosmolar hyperglycemic syndrome?

Answer 30

When elevated blood sugar results is dramatic osmotic diuresis and dehydration -- more common in DM2

Question 31

A patient prevents with hypovolemia, hypoglycemia, hyponatremia, hyperkalemia, postural hypotension, hyperpigmentation and loss of body hair. What might be the issue?

Answer 31

Addison's disease

Question 32

What electrolyte imbalance is common in people with Addison's disease?

Answer 32

Hyponatremia + Hyperkalemia

Question 33

What diet is recommended for Addison's disease?

Answer 33

High sodium, low potassium and high carbohydrates. At least 3L of fluid per day

Question 34

What patient teaching is necessary for Addison's disease?

Answer 34

Carry emergency kit with 100 mg of IM corticosteroids

Question 35

What is Cushing syndrome?

Answer 35

Excess adrenal corticoid activity, caused by adrenal/pituitary/hypothalamus symptoms symptoms of Cushing syndrome are also seen in people taking supplemental corticosteroids

Question 36

What lab results are seen in Cushing syndrome?

Answer 36

Hyperglycemia and increases plasma cortisol levels. Hypernatremia + hypokalemia

Question 37

A patient presents with a round face, edema of the lower limbs, emotional disturbances, fat deposits in the lower back. They have muscle atrophy and weakness, osteoporosis, and thin, dry, pale skin. What might be the problem?

Answer 37

Cushing Syndrome/Excess Cortisol

Question 38

What is diabetes indipidus?

Answer 38

Decreased ADH or response to - results in electrolyte imbalance (hypernatremia)