Week 4: Endocrine Balance Flashcards
Islets of Langerhans
where insulin is produced in the pancreas
blood glucose homeostasis
Normal Eating > secrete insulin > glucose moves from blood into cells (muscle, liver adipose)
Normal Fasting > basal insulin release AND/OR when BG low glucagon is released > liver secretes glucose
what is diabetes?
insulin excretion/use is disrupted, glucose isn’t broken down into useable states
types of diabetes
type 1
type 2
gestational
diabetes associated with conditions and syndromes
pancreas issues or corticosteroids
Type 1 diabetes
complete lack of insulin
autoimmune condition or genetics
S&S of Type 1 diabetes prior to diagnosis
Polyuria, polydipsia, polyphagia & weight loss
complication in type 1 diabetes
hyperglycemia- Diabetic keto acidosis
hypoglycemia
Type 2 diabetes
insulin resistance
risks: Metabolic Syndrome (hypertension, obesity, hyperglycemia, high LDLs and low HDLs)
medications for diabetes
type 1: insulin dependent for life
type 2: oral antihyperglycemic agents or insulin
symptoms of diabetes
Result of: hyperglycemia, glucose excreted by kidneys, fluid/protein follow by osmosis = fluid volume deficit
neuro-cognitive (dizziness, confusion), weight, polydipsia, hungry, polyuria
complications of diabetes
Atherosclerosis (glucose damages blood vessels)
Poor perfusion
Damage to many body systems (ocular, cardiac, renal, integumentary, vascular, immune)
ocular complications
damage to micro-vessels in eye = blindness, blurred vision
cardiac complications
atherosclerosis = increased risk or MI, coronary artery disease, stroke, hypertension
renal complications
Damage to nephrons =increased risk of CKD
Neuropathy in bladder
=neurogenic bladder, UTI
50% of people with kidney disorders have a diabetes diagnosis – the kidneys are exposed to increased glucose
Neurogenic bladder – the nervous system that tells you to urinate can become unresponsive
vascular complications
Peripheral Vascular Disease
Peripheral Neuropathy =poor wound healing, numbness in feet/hands, falls risk, mobility
**foot ulcers
immune system complication
Impaired perfusion limits ability for immune cells to reach sites of
infection
High blood glucose is a breeding ground for infection
Decreased neutrophil synthesis
Risk for septic shock (compensatory = normal BP, tachycardia,
tachypnea, pale skin)
integumentary complications
impaired wound healing
impaired immunity
HBA1C
Hemoglobin A1c
Amount of glucose attached to Hb (glycated hemoglobin)
Reflects the average serum glucose level over the previous 2 to 3 months
higher the HBA1C = poorer control of diabetes
Causes of hypoglycemia
Too much insulin or oral antihyperglycemic agents
Inadequate food intake
Excessive physical activity
Hypoglycemia
Development of autonomic & neuroglycopenic symptoms
Low plasma glucose (< 4.0 mmol/L)
Symptoms that respond to CHO administration
S&S hypoglycemia (most common)
Autonomic (neurogenic): Trembling
Sweating
Anxiety
Nausea
Neuroglycopenic:
Poor concentration
Confusion (ofen first sign in older adults)
hypoglycemia - mild
autonomic symptoms, able to self-treat
hypoglycemia - moderate
autonomic & neuroglycopenic, able to self-treat
hypoglycemia - severe
autonomic & neuroglycopenic, BG under 2.8, requires support,
unconsciousness may occur
hypoglycemia treatment - mild/moderate
Treat and then notify provider
Mild – Moderate:
Oral ingestion of 15 g carbohydrate
Glucose or sucrose tablets/solution (preferable) OR juice (~ 175 mL)
Retest BG in 15 minutes and monitor closely
Re-treat with another 15 g carbohydrate if the BG level remains <4.0 mmol/L, according to protocol
hypoglycemia treatment: severe conscious
Severe (Conscious):
Oral ingestion of 20 g carbohydrate
Glucose or sucrose tablets/solution (preferable) OR juice (~ 250 mL)
Retest BG in 15 minutes and monitor closely
Re-treat with if the BG level remains <4.0 mmol/L, according to protocol
hypoglycemia treatment: severe unconscious
Severe (Unconscious):
IV Access
IV Push 20–50 mL of D50W over 1 – 3 minutes
No IV Access
SC/IM Glugagon 1 mg
**If the patient is not permitted to eat anything – going to go the IV access route
hypoglycemia recovery
BG rises above 4.0
Monitor closely (maintaining proper BG levels)
When in hypoglycemia, the body releases adrenaline, which
causes the rapid uptake of K into cells
Eat usual meal/additional snack
Find the underlying factor
hypoglycemia electrolytes
Hypoglycemia has close relationship with hypokalemia: when in hypo body releases adrenaline, adrenaline causes rapid uptake of K into cells
causes of Hyperglycemia
T1D - not enough insulin
T2D - lack of effective stimulation (insulin resistance)
diabetic hyperglycemia emergency
type 1 - BG greater (>) than 13.9 mmol/ L = diabetic keto acidosis
type 2 - BG greater (>) than 33 mmol/L = hyperglycemis hyperosmolar syndrome
S&S Hyperglycemia
Early Signs: tiredness, polurea, dehydration, polydipsia
health teachings for diabetes
- T1D – insulin administration
- T2D – diet
Diabetic diet
Avoid low simple sugar (pop, juice, candy, white bread, white rice, pasta, French fries)
Include healthy fats (peanut butter, whole milk), high fiber CHOs (beans, brown bread, whole grains), eat a bedtime snack
- Medication regimen
- BG monitoring
- Adjusting regimen
- Sick day management
pharmacological treatments
- insulin, insulin subcut, insulin pump, oral meds
- rapid (aspart, lispro, humalog), short acting (toronto, novolin), intermediate, long acting, imsulin pump, oral meds
Type 2 starts with oral medications – if doesn’t work then they will supplement with insulin
Type 2 diabetics cells are resistant to insulin – so their doses will be far different because they need more insulin to try and get a response
Insulin basics: administration
Check BG prior to administration
BG < 4.0 then give CHO
Administer based on Sliding Scale
Food should be given during the peak of the insulin
Do not mix long acting and other types of insulin
Draw up Regular insulin (clear) first and then NPH insulin (cloudy)
S/C Injections
Rapid (Aspart, Lispro, Humalog)
Onset: 15 minutes, peak = 30-90 minutes
Duration: 3-4 hours
Indication: rapid BG decrease (postprandial, hyperglycemia)
Short acting (Regular) (Toronto, Novolin R)
only insulin that can be given through IV*
Onset: 2-3 hours
Duration: 4-6 hours
Indication: 20-30 minutes before meal
Intermediate (NPH, Humulin N, Novolin N)
Peak: 4-12 hours
Duration: 16-20 hours
Indication: post meal
Long acting (Detemir, Glargine (Lantis)
Peak: NO PEAK
Duration: Over 24 hours
Indication: basal dose (do not mix)
Insulin Pump
Insulin is delivered continuously and in customized doses of rapid-acting insulin 24 hours a day
Oral medications (antihyperglycemics)
ONLY for T2D
Try diet and exercise first
AVOID: Iron, Ca and things that contain Ca, like antacids and dietary sources high in Ca. impaired absorption
Metformin
Pharmacologic class: Biquanides
Action: treat hyperglycemia, lower BG
Side effects: stomach pain, GI upset, gas, bloating, NVD, constipation
(may subside within a few weeks)
Nursing considerations:
Monitor BG (risk of hypoglycemia)
Potentially hepatotoxic
Do not give in eGFR under 30 (poor kidney function, cleared by
the kidneys)
Hold before contrast dye
Glyburide
Action: treat hyperglycemia, lower BG
Side effects: GI upset, skin reactions (use sunscreen), weight gain
Cautions: for heart failure/MI history
Nursing considerations:
Monitor BG (hypoglycemia)
Avoid alcohol (increases risk of hypoglycemia)
Rosiglitazone (Avandia), Pioglitazone
Action: treat hyperglycemia, lower BG
Side effects: weight gain, edema, macular edema, heart failure
Caution: for heart failure/MI history
Nursing considerations:
Monitor BG (HIGH risk of hypoglycemia)
Hepatotoxic (monitor ALT and AST)
Associated with increased risk of bladder cancer of genetic origin
Acarbose
Action: treat hyperglycemia, lower BG
Side effects: gas, diarrhea, bloating, stomach pain, GI upset, NV
Caution: for heart failure/MI history
Nursing considerations:
Monitor BG (risk of hypoglycemia)
Avoid in clients with GI issues (ie. IBS, Chrohn’s)
Sliding Scale
Combine insulins of different durations e.g. short + long acting
Goal: mimic the normal insulin secretion pattern
i.e. increases with food
Sliding Scales:
- Approximate dailyinsulinrequirements
- Progressive increase in AC meal or HSinsulindose
- Based on predefined blood glucose ranges
- Client administered dose based on
BG level
RISK = HYPOglycemia
Key points for Subcutaneous Insulin Administration
Check BG prior to administration
Under 4.0 = give CHO
Administer based on sliding scale
Food should be given during the
peak of insulin
Do not mix long acting and other types of insulin (do not have a peak)
Draw up regular insulin (clear) first, and then NPH insulin (cloudy)
Hypothyroidism
too little hormone
LOW & SLOW
o Cold intolerance
o Decreased sweating
o Weight gain
o Constipation
o Depression and irritability o Irregular and heavy periods o Slow heart rate
o Brittle nail
o Muscle/jointpain
o Puffyface
Hyperthyroidism
too much hormone
HIGH & HOT
o Weight loss or gain
o Short and light periods
o Increased sweating
o Nail thickening and flaking o Puffy/bulging eyes
o Heatintolerance
o Nervousness and anxiety o Racing heart
o Muscle weakness
o Diarrhea
Levothyroxine (Synthroid)
Hypothyroidism medication
Side effects: fever/hot flashes, sweating, nervousness, irritability, NVD, headache,
insomnia
o Nursing considerations:
Monitor toxicity
Risk of hyperthyroidism
Tachycardia, chest pain, palpations
Take in morning without food
Avoid calcium and iron – impacts absorption
Avoid fluctuations in thyroid levels
Iodine
Hyperthyroidism medication
acts to destroy thyroid hormone in the body
