Week 4 - Endocrine Health Flashcards
What is Diabetes?
- Chronic, metabolic, multisystem disease
- Cause: genetic, viral, autoimmune, lifestyle
-abnormal insulin production
-impaired insulin utilization
-problems with both insulin production & utilization
Why is there and Increasing incidence of Type 2 diabetes?
Due to:
- sedentary lifestyle
-obesity
- aging population
- migration of high-risk population
How is Blood Glucose Regulated
- Insulin is produced in β cells of
pancreas - Insulin transports glucose into cells for energy
- Continually released = BASAL RATE
- Increased release when eating= BOLUS
What is a stable glucose level?
4-6 mmol/L
What are Counter-Regulatory Hormones?
ex. Glucagon, epinephrine, growth hormone, cortisol
- Work to do the oppose the effects of insulin
- Increase blood glucose levels by stimulating glucose production & output by the liver & by decreasing movement of glucose into the
cells
If someone with diabetes becomes ill or requires surgery, how will their glucose levels be impacted?
- Counter regulatory hormones cause increased release of glucose;
- Blood glucose level increases
What actually happens when there is an insulin deficiency?
- Every organ (except for the brain) will use proteins and fat to compensate for not having enough sugar
Type 1 diabetes
- Absolute deficiency of insulin
Treatment: insulin must be given
Type 2 Diabetes
- Resistance to action of insulin
Treatment: Can be controlled via exercise and diet
Gestational Diabetes
- Develops during pregnancy and resolves
○ Increases risk of Type 2 within 5-10 years
○ Health teaching: diet and exercise to prevent type 2
Secondary Diabetes
- Results of another treatment/health condition
- Medications can interfere with glucose metabolism (immunosuppressives, corticosteroids)
- May resolve when the underlying condition is treated or the medication is stopped
Type 1 VS. Type 2 Diabetes
Type 1
- Common young
- Abrupt onset
- less prevalent
- thin, normal, obese
- ketosis is prone at onset or lack of insulin
- insulin is required
- Symptoms: polyuria, polydipsia, polyphagia, fatigue, weight loss
Type 2
- usually >35
- insidious onset (starts slowly and does not have obvious symptoms at first)
- more prevalent
- obese, normal
- insulin required for some
- Symptoms: frequently none, fatigue, recurrent infections
Clinical Manifestations of Diabetes
Central
- Polydipsia
- Polyphagia
- Lethargy
- Stupor
Eyes
- Blurred Vision
Breath
- Smell of acetone
Systemic
- weight loss
- glucose > 11.1 mmol/L
Respiratory
- Kussmaul breathing (hyper ventilation)
Gastric
- Nausea
- Vomiting
- Abdominal Pain
Urinary
- Polyuria
-Glycosuria
3 Ways to Diagnose Diabetes
1) Fasting Blood Glucose Test - 2 results of > 7mmol/L
- no caloric intake for 8 hours and hold diabetes medications prior to test
2) Glucose Tolerance Test - 11/1 mmol/L
- 75mg of glucose given, 2 hour test or 100g glucose given
3) Glycosylated Hemoglobin (HbA 1c) - > 6.5%
- highest accuracy and precision
Treatment Goals for Diabetes
- Reduce symptoms, prevent acute complications of hyperglycemia & hypoglycemia
- Delay the onset & progression of long-term complications
- Maintain glucose levels as close to normal as possible
- Aim for A1C% < 6.5- reduce risk of kidney disease, retinopathy
- A1C >7.0 for most adults with Type 1 or 2 diabetes
Diet Treatment for Diabetes
- Consistent carb consumption (ex. Same # of carbs for breakfast each day)
- 3 meals per day at regular times; no more than 6 hours apart
- Limit sugars and sweets
○ Anything with a lot of sugar is hard for the body to absorb and process - Limit amount ig high fat food
- Eat more high-fibre foods (whole-grail breads and cereals, lentils, dried beans and peas, brown rice, fruits, vegetables)
- Drink water if thirsty as drink of choice
- Glycemic index 9GI) - rise in blood glucose levels after consuming carbohydrate containing food
- Foods with high GI (ie. Potatoes, white bread) cause a sharp rise in blood glucose
- Foods with low GI (brow rice) steadily increase blood glucose over a longer period
- Plate method (ex. 1/2 veg, 1/4 starch, 1/4 protein)
- Alcohol inhibits glucose production in liver lower BG, mimics S & S of hypoglycemia
○ Hypoglycemia can make people appear drunk; ie. Slurred speech
Exercise Diet Treatment for Diabetes
- At least 150 minutes/week of moderate-intensity aerobic activity
- Exercise increases insulin sensitivity to help decrease blood glucose
- May help reduce triglycerides, low-density lipoprotein (LDL), cholesterol levels, reduce blood pressure, & improve circulation
- If taking insulin or oral hyperglycemic meds risk of hypoglycemia with exercise
- Exercise 1 hour after a meal or have a 10-to 15-g carbohydrate snack before
exercising. - Keep fast-acting carb available at all times
Blood Glucose Monitoring
- Promotes self-management decisions regarding diet, exercise, &
medication - Helps detect episodic hyperglycemia & hypoglycemia
- Capillary BG (finger pick), continuous (sensor inserted, 5 minute updates), flash glucose monitoring (sensor with reader/cell phone)
- Capillary BG lower than venous BG so lab-to-meter correlation required annually orA1C different from self-monitored readings
- Type 1- monitor BG 3 times/day pre & post meal
- Type 2 with once daily insulin or oral hypoglycemic agents- monitor at least 1 time/day
- Assess BG if hypoglycemia is suspected
- If ill, assess BG q4h
○ They can go into diabetic ketoacidosis very quickly
How Insulin is used?
Insulin- stimulates glucose uptake by cells
Uses
- replacement therapy for type 1 diabetes
- type 2 if lifestyle & oral hypoglycemic meds not effective
Side effects
- hypoglycemia
- lipodystrophy, pain at injection site
-allergic reactions
- Basal-bolus regime mimics body’s insulin secretion
- Bolus with short acting insulin before meals
- Administer intermediate or long acting 1-2 times/day (basal)
- Requires multiple injections daily or insulin pump continuous infusion
- Goal: maintain BG as close as possible to 4-7 mmol/L to prevent complications
Types of Insulin
1) Aspart - Rapid
- fast onset; food must be available very quickly
2) Novolin - Regular
- Has a peak period
- Can become very hypoglycemic
- Don’t use this if we do not have to - bc it has a big peak (causes hypoglycemia)
- Only type of insulin that can be mixed with anything
3) Glargine - Long-Acting
- slow onset
- very long duration
- no peak
Can the body better handle high or low glucose levels?
- People can tolerate high glucose levels a lot better than low glucose levels
○ Bc the brain can not function without having glucose
What is the Symogi Effect?
- rebound morning
hyperglycemia - blood sugar drops too low overnight
- the body reacts by releasing counter-regulatory hormones that rase blood sugar too much
- by morning, blood sugar is too high bec body was overcompensating for low blood sugar in the night
Treatment and Prevention:
* Bedtime snacks
* Reduction in insulin dose
What is the Dawn Phenomenon?
- hyperglycemia on awakening
- Due to increased secretion of
cortisol & growth hormone
throughout night
Treatment and prevention:
* Increase insulin dose
* Adjust administration timing
Oral Hypoglycemics?
Mechanism of action:
*Increase insulin production or release
* Increase insulin sensitivity
* Decrease hepatic glucose production
* Decrease glucagon production
* Block enzymes that break down complex carbohydrates
2 Types of Oral Hypoglycemics?
1) METFORMIN
- 1st line med
* Decrease hepatic glucose production
* Reduces insulin resistance
* Side effects: nausea, vomiting, abdominal discomfort, metallic taste,
diarrhea, headache, dizziness, anorexia, fatigue
2) Glyburide
* Stimulate release of insulin from β cells
* Side effects: hypoglycemia, nausea, feeling of fullness
Complications of Diabetes
What is Hypoglycemia?
Cause: too much insulin in proportion to glucose in blood
- Blood glucose less than 4 mmol/L Life-threatening
- Body’s response: Suppression of insulin secretion, production of
glucagon & epinephrine - Epinephrine release causes diaphoresis, tremors, hunger,
nervousness, anxiety, pallor, palpitations - Lack of glucose for brain = neuroglycopenic signs of irritability, visual
disturbances, difficulty speaking, stupor, confusion, coma
Neurogenic VS. Neuroglycopenic Symptoms
Neurogenic (autonomic): Caused by the activation of ANS in response to low blood sugar
- tremors
- palpitations
- sweating
- anxiety
- hunger
- nausea
- tingling
FULL BODY RESPONSE
Neuroglycopenic: Caused by insufficient glucose supply to the brain.
- difficulty concentrating
- confusion
- drowsiness
- weakness
- vision changes
- difficulty speaking
- headaches
- dizziness
BRAIN CHANGES
How to treat Mild-Moderate Hypoglycemia.
- Blood glucose: < 4mmol/L
- Able to self-treat
- Oral ingestion of 15g carbohydrate (best way to do this is by drinking juice bec juice has a lot of naturally occurring sugars that absorbs quickly)
- Glucose or sucrose tablets/solution (preferable) OR ∼ 175 mL juice
- Retest BG in 15 minutes, monitor for symptoms
- Re-treat with another 15 g carbohydrate if BG remains less than 4.0 mmol/L
How to treat Severe Hypoglycemia (Conscious)?
- Glucose: 2.8 mmol/L
- Oral ingestion of 20g carbohydrate
- Glucose or sucrose tablets/solution (preferable) OR ∼ 250 mL juice
- Retest BG in 15 minutes, monitor for symptoms
- Re-treat with another 20 g carbohydrate if BG remains less than 4.0 mmol/L
How to treat Severe Hypoglycemia (Unconscious)?
If IV access available:
- IV push 20-50 mL Dextrose 50% in water (D50W) over 1-3 minutes
If no IV access
- SC/IM Glucagon 1 mg or Glucagon 3 mg intranasal
- Retest BG in 10 minutes
- Administer another 1 mg Glucagon if still unconscious & BG low
Nursing Care of Client with Diabetes
- Cut toenails straight across
- Avoid extreme hot/cold
- Wear footwear (no bare feet)
- Change socks daily
- Proper fitting shoes
(buy in late afternoon
as feet swell slightly by then) - Seek professional help for blisters, ingrown nails
- Wash, dry inspect for skin
breakdown daily
What to if Feeling Unwell?
- Take meds as prescribed
Hold Metformin if unable to
maintain hydration - Monitor BG q4h urine for ketones if BG above 14 mmol/L
- Consume liquids q 30-60
minutes if vomiting or
diarrhea occur - If regular diet not tolerated,
eat soft foods 6-8 times/day
or carb-containing liquids
(juice)
Notify HCP if
- Vomiting, diarrhea or fever
persist
- BG increases above 13.9
mmol/L
- Unable to eat or drink for 4
hours
- llness last longer than 2
days
