Week 4 - Endocrine Emergencies (Diabetes and hypoglycaemia, Addison's and thyroid) Flashcards
What is Diabetes mellitus?
Group of metabolic disorders causing hyperglycaemia due to a decrease or total lack of insulin or reduced effectiveness of circulating insulin.
How many people in the UK are diagnosed with diabetes?
almost 3.7 million people.
How many people in the UK are at an increased risk of diabetes in the UK?
12.3 million, almost 20% of the population.
Approximately how many people in the UK are living with diabetes (diagnosed/not diagnosed)
4.6 million
What are the types of diabetes?
▪ Type 1 / Type 2
▪ Gestational / Secondary
▪ (from another disease/cause)
What does the Pancreas produce that regulates blood sugar in the body?
Glucagon: increases blood sugar levels; produced from alpha cells, works on liver and fat cells.
Insulin: reduces blood sugar levels; produced from beta cells, works on most cells throughout the body.
Diabetes type 1?
- dysfunction of insulin
- endocrine area of pancreas is destroyed so cant produce enough insulin and blood sugar levels rise.
- autoimmune disease - genetic predisposition, started by environmental cause.
- younger onset, usually juvenile.
In type 1 diabetes: glucose isn’t removed from the blood and given to cells, this causes the body to think it hasn’t got any glucose. As a result, the liver releases stored glucose back into the bloodstream.
This leads to:
- Tiredness (body tries to save glucose for vital organs such as brain.
- Excessive urination: kidneys can’t absorb excess glucose so it is expelled into the urine.
- excessive thirst: dehydration caused by excessive urination.
Diabetes Type 1 information?
- ketosis
- Rapid weight loss
- age of onset <50 years usually
- BMI below 25kg/m2
- personal and/or family history of autoimmune disease.
Advice for adults with type 1 diabetes?
- a fasting plasma glucose level of 5-7mmol/litre on waking and a plasma glucose level of 4-7mmol/litre before meals at other times of the day.
- advise adults of test after meals to aim for a plasma glucose level of 5-9mmol/litre at least 90 minutes after eating.
Diabetes type 2?
- most common form of diabetes.
- insulin resistance - cells become desensitized to inulin.
- insulin still produced -> cells don’t respond correctly so the glucose remains in the blood.
- Pancreas may initially compensate by over producing insulin, over time pancreas can not keep up with demand, as a result blood glucose levels rise.
Causes of Type 2 diabetes?
- genetics
- age (usually occurs in older adults)
- hypertension
- obesity
Risk factors for Diabetes type 2?
- pre-diabetes
- obesity
- waist size
- gestational diabetes
- old age
- ethnicity
- inactive lifestyle
- family Hx
What is Gestational Diabetes?
- diabetes that occurs during pregnancy.
- usually diagnosed in weeks 24-28 of pregnancy (due to routine blood testing)
- normally resolves itself post pregnancy.
- if diagnosed in 1st trimester (first 3 months/12-14 weeks), mother is likely to have pre-existing diabetes.
- Pregnancy hormones can affect how the body uses insulin.
- Insulin resistance increases within the 2nd trimester (13/14-28 weeks of pregnancy/ 3- 6 months) . Increase in insulin resistance leads to rise in blood glucose levels.
- some women cannot produce enough insulin to manage the demand causing hyperglycemia (typical with diabetes type 2)
Symptoms of Hypoglycaemia (low)?
- increased HEART/PULSE RATE.
- full (heavy) PULSE VOLUME.
- shallow or normal RESPIRATION.
- decreased TEMPERATURE.
- normal or slightly increased BLOOD PRESSURE.
- clammy and/or sweaty SKIN (APPEARANCE).
- moist TONGUE.
- no Acetone (chemical smell) in breath.
- brisk REFLEXES.
Symptoms of Hyperglycaemia (high)?
- increased HEART/PULSE RATE.
- weak PULSE VOLUME.
- may be a decrease in TEMPERATURE.
- rapid and deep RESPIRATION’S.
- decreased BLOOD PRESSURE.
- dry SKIN.
- dry TONGUE.
- acetone (chemical smell) may be present in the BREATH.
- diminished REFLEXES.
Hypoglycaemia?
- low blood glucose.
- blood glucose levels under 4.0
- more common in patients prescribed insulin.
- causes: missed meal, alcohol, insulin error, increased activity and overdose.
- abnormal neuro signs may be present.
- consider Hypoglycaemia as a cause/factor in Road Traffic Collisions (RTC’s):
it is a legal requirement to inform the DVSA if prescribed insulin.
Ways someone suffering from diabetes can regulate their blood sugar?
1) oral carbohydrates
2) glucagen
3) IV glucose
Drugs used to regulate blood sugar levels in patients suffering with Diabetes?
- insulin
- Metaformin
What is Addison’s disease?
AKA = Primary adrenal insufficiency
- rare disorder of the adrenal glands that reduces or stops function.
- Correct, regular daily medication aids a normal lifespan.
- patients may be prescribed an ‘emergency injection kit’
- approximately 8,400 people affected.
- roughly 300-350 new diagnosis every year.
- more likely in women
- usually presents at 30-50 years.
Adrenal glands?
- small yellow, lobular glands.
- Superomedial to the kidneys, behind (posterior) the Peritoneum.
- Inner Medulla: Epinephrine and Norepinephrine are secreted from the Suprarenal Medulla.
- Outer cortex: Mineralocorticoids, Glucocorticoids, and Androgens are secreted from Suprarenal Cortex.
What are Mineralocorticoids?
A class of Corticosteroids, a class of Steroids hormones.
Mineralocorticoids are SYNTHETIC VERSIONS of the hormones produced by the ADRENAL CORTEX that regulate inflammation and metabolism.
- Secreted by Glomerulosa Cells.
- Affect the Kidneys, increasing blood pressure and blood volume.
- regulate the Sodium, Pottasium and Hydrogen Ion levels.
An example of a Mineralocorticoid = Aldosterone
common on ambulance = Hydrocortisone -> used for adrenal crisis and bad COPD.
Reduces number of inflamatory compounds in the lung called eosinophils.
What are Glucocorticoids?
Steroid hormones that are essential for the body to function.
Glucocorticoids are HORMONES PRODUCED BY THE BODY that regulate inflammation and metabolism.
- secreted by Zona Fasciculata cells
- affect most tissues, increasing blood glucose levels by controlling Carbohydrate metabolism.
-normal levels also help with stress resistance.
-high levels have anti-inflammatory and anti-immune effects.
Causes of Addison’s disease?
1) Immune system affected
2) Adrenal cortex attacked and damaged.
3) Aldosterone and cortisol production reduced.
What are common illnesses that can affect the immune system and subsequently lead to Addison’s disease?
- tuberculosis (TB)
- infections
- haemorrhage; into the adrenal glands, e.g: meningitis/severe sepsis.
- Cancer (if it has spread into adrenal glands).
- Amyloidosis (amyloid damages your adrenal glands) -> disease where abnormal proteins called amyloid build up in the body.
- Adrenalectomy (surgical procedure to remove one or both adrenal glands).
- Adrenoleukodystrophy (ALD) -> rare genetic disease that prevents the body from breaking down certain fats.
- Cushing’s syndrome treatments -> many treatments involve suppressing the adrenal glands, which can result in them not producing enough cortisol.
