Unit 5 Endocrine Flashcards
URGlucagon
hormone from the pancreas in response to low serum glucose, eating protein, or increased in glucose demands
Glycogen
stored form of glucose
Glycogenesis
Formation from glycogen from glucose (carbohydrates)
Glycemic index
rise in serum glucose levels after eating carbs
Glycemic index
rise in serum glucose levels after eating carbohyrates
Glycogenolysis
chemical breakdown of glycogen to glucose
Glucogenolysis
Synthesis of glucose from non-carbohydrate sources
Pancrease
secretes insulin into the bloodstream in response to circulating carbohydrates or glucose related from the liver
Insulin
Circulates enabling glucose to enter the cells to act as energy this lowers the amount of glucose in the blood stream
As serum blood sugar levels drop what happens to the secretion of insulin
The secretion becomes less
excess glucose is stored in
muscle, liver, fat cells
When serum glucose levels are low what does the liver do
the liver breaks down stored glycogen into glucose and releases it into the blood stream
What is the feedback loop of insulin and Glucose
Blood glucose rises, insulin released from the pancreas, blood glucose is reduced back to normal, normal blood glucose levels
Glucagon acts as an opposite to
insulin
insulin is released in response to
low serum levels
what does insulin do to the liver
Stimulates the liver to release stored glucose
Glucagon does what to the blood
moves glucose into the blood
Insulin moves what out of the blood and into the cell
glucose
Pancreas function
Insulin allows glucose to enter cells, Signa
Glycogen
Stores ingested glucose
Pancreas job
regulates glucose, allows glucose to enter cells, Signals liver to release stored glucose
Liver job
Provides glucose, stores ingested glucose, releases stored glucose, gluconeogenesis (makes glucose from other sources)
Normal Glucose
4-6
Average amount of insulin secreted daily
0.6 units/kg/day
Basal rate
insulin continuously released to meet base metabolic need
Bolus rate
Insulin released in response to rise in serum glucose
Prandial insulin (bolus/mealtime)
Given in anticipation of the spike in blood glucose from the ingestion of the carbohydrate bolus (by eating or tube feeds)
Either:
1. Rapid acting insulin given with meals
2. Short acting insulin given 30 mins prior to meals
Examples of Prandial and Correction insulin
Nova rapid, apidra, humalof, humbling R, Novocain Toronto
Correction insulin
Rapid or short-acting insulin is used when blood glucose levels are above the target range the correction insulin is the same product as the prandial that pateint receives. The dose will be given at the same time so only one injection is needed
Somogyi- Night nurse effect
-Hypoglycemia in response to HS insulin, liver releases sugar, serum hyperglycemia (SO Much insulin)
Dawn effect
-fasting AM hyperglycaemia
-In response to decreasing HS insulin in response to somogyi (Down insulin)
teach about Dawn effect
check 02-04 serum glucose
What does it mean when “Diabetes is a multi system disease” is said
Abnormal insulin production, impaired utilization, both
65-80% of people with diabetes die of
heart disease and stroke
Risk factors for type 1 Diabetes
Auto immune response, genetic response
Type 2 diabetes risk factors
Lifestyle, some genetics
Prediabetes/metabolic syndrome
The cells are resistant to the insulin
Type 2 diabetes
pancrease does not make enough insulin
High risk for diabetes
-people 40 years and older
-first degree relative with type 2
-pregnant
Type 1
pancreas does not make any insulin
Types of diagnostic tests
fasting plasma glucose, 2h plasma glucose oral glucose tolerance test, A1C
Impaired glucose tolerance
-usually asymptomatic, vessel damage may already be occurring, pre diabetes offers a warning and gives us a chance to change the future. If left untreated 50% of people will develop diabetes in their lifetime
Hgb A1C
hemoglobin A1C (HbA1C) test is a blood test that shows what your average blood sugar (glucose) level was over the past two to three months
watch for the 3 P’s
Polyuria, polyphasic, polydipsia
Risk factors for type 2 Diabetes
Obesity, abdominal fat, lifestyle, Visceral adiposity (fat around organs)
Endogenous
Insulin is still present but is either not enough, not used, both
4 Metabolic Abnormalities
- Insulin resistance (body does not respond to the action of insulin)
- decreased pancreatic production of insulin (cell fatigue from compensatory overproduction of insulin)
- Liver inappropriately produces glucose
- Adipose tissue (Adipoctrokines) change in hormone production affects insulin sensitivity
Gluconeogensis
“creation of new glucose”
-Process of making glucose sugar from its own breakdown products or from the breakdown products of lipids fats or protein
Gluconeogensis occurs where
Liver or kidney
which system does diabetes effect
ALL
Neuropathy
Neuropathy is when nerve damage leads to pain, weakness, numbness or tingling in one or more parts of your body.
Lab tests for diabetes
Fasting plasma glucose, Hgb A1C, non-fasting plasma glucose, oral glucose tolerance test, BGM, Urine, hematology, lytes
What does high alert medication mean
that it is extra dangerous and can cause death if administered falsely
how much insulin is needed
1 unit/10g carbs - grams of fibre
ex eat 30 grams of carbs, 10 grams of fibre get 2 units of insulin
How insulin is administered
-Insulin pens, syringes, insulin pumps
Rapid acting insulin (onset, peak, duration)
10-15 minutes onset, 60-90 minutes peak, 4-5 hours duration
-should be clear in colour, can be mixed
Short-acting insulin (onset, peak, duration)
30-60 minutes onset, 2-4 hours action, 5-8 hours duration, Is able to to be mixed with other insulins should be clear in colour
How early should short acting insulin be administered
30 minutes prior to meal
Intermediate acting(onset, peak, duration)
1-2 hour onset, 5-8 hour duration, 14-18 hour lasting can be mixed and appears cloudy
Long acting insulin (onset, peak, duration)
1.5 hour onset, no peak, 24 hour duration should be clear
Should long acting insulin be mixed with others
NO
rapid acting insulins
NovaRapid, Apidra, Humalog
Short acting insulin
Humulin R, Novolin
Intermediate acting insulin
Isophane insulin suspension
Long acting insulin
Lantus, Levemir
Part 1 of SHA subcutaneous insulin order set
Baseline and BGM orders
part 2 of of SHA subcutaneous insulin order set
Scheduled insulin, Basal and Prandial
Part 3 of SHA subcutaneous insulin order set
Correction insulin, Additional insulin that is needed according to BGM and TDI, usually same as Prandial
Microfilament test
to test for nerve damage (peripheral neuropathy), which may be caused by conditions such as diabetes.
Diet for Diabetes
monitor carbs (low), low fat, high fibre, fluids
Why is fibre important
because number of carbs - number of fibre = the amount of carbs to be managed with insulin
Carb foods
Starches/grains, fruits/sweet veggies, milk, sweets
Non carb foods
protein, fat, other veggies
hospital Consults for diabetes
Dietician, diabetes educator, pharmacist, endocrinologist, nephrologist, vascular surgeon
In the community consults for diabetes
live well chronic disease management, Canadian diabetes association, homeware, podiatrist
Hyperglycemia causes
too much glucose in blood, too little meds, insulin resistance, illness, physical or emotional stress, steroids
Hypoglycemia causes
not enough glucose in the blood, too much diabetes meds, too much exercise, weight loss without weight adjustment to meds
Diabetes Ketocidosis
-fat is metabolized, lack of circulating insulin means sugar cannot enter the cell happens mostly in type 1. Leads to ketones in the blood
hot and dry
sugar high
Symptoms of hyperglycemia
headache, polyphasic, polyuria, sweet urine, weakness/fatigue, hot/dry skin, blurry vision, abdominal cramps
Symptoms of hypoglycaemia
vision changes, cool, clammy, shaky dizzy, emotional outburst, headache, hunger/nausea, tachycardia, slurred speech, unsteady gate, numbness, seizure, unresponsive
Subjectives questions to ask diabetic patients
-last insulin, last glucose, symptoms of three P’s, symptoms of hyperglycaemia?
Kussmauls
Kussmaul breathing is an abnormal breathing pattern characterized by rapid, deep breathing at a consistent pace.
Assessment for Diabetic patient
CVS (tachycardia, hypertension, hypokalemia), Resp (Kuddmauls), CNS (confusion, may see change in LOC)
Things to do as nursing interventions for a diabetic patient
Oxygen, IV fluid (Salin 500 mL/h x 4), monitor ins and outs, Serum and Urine labs, ECG/cardiac monitor, Electrolyte replacement, Insulin 0.1 unit/kg/hour, monitor BGM, treat symptoms such as nausea
Insulin is not to be given to treat
Hyperglycaemia
Insulin is given to reverse
ketosis
Serum lights in a hyperglycemic pateint will appear
high
ABG metablic acid results for a Hyperglycemic patient
-pH lower because of increased acid
-CO2 lower because the body is trying to compensate by blowing off acid in the form of CO2
-H+ lower because the base has been lost from the GI tract with the vomitting
Sick day plan
-Which diabetes meds to continue which to stop, insulin adjustment, advice to contact the healthcare provider or go to the ER
Hypersmolar hyperglycaemic state
Lifethreatening with sever CNS symptom, severe dehydration
Can type 2 pateint produce enough insulin to prevent severe hyperglycaemia
NOPE
What is serum glucose in severe hyperglycaemia
24 mmol/L
Hyperosmolar
Elevated serum glucose, Fluid loss, Electrolyte loss
DKA and HHS are
Medical emergencies
Macrovascular complications
Vicoud blood, hypercoagulabilty, vessel damage, increased stroke, MI, Amputation, delayed healing
Microvacular complications
Thickening of vessel membrane, thickening of capillaries/arterioles. Retinopathy, nephropathy, neuropathy, dermopahty (glucose, bp, lipids)
Client foot teaching
wash feet daily, with mild soap and warm water, pat feet dry gently especially toes, visually inspect
Why do diabetic patients have to get amputations
Nerve damage or diabetic peripheral neuropathy is one of the long-term complication of diabetes. If left untreated, the damage caused by neuropathy can potentially lead to infection and limb amputation.
