Week 8: Endocrine Flashcards
\What is diabetes?
multi system disease related to abnormal insulin production, impaired insulin utilization or both
What complications is diabetes the leading cause of?
End stage renal
Adult blindness
Lower limb amputations
Heart disease/stroke
What causes diabetes?
Genetics factors, viral infections and obesity/lifestyle./diet
What is type 1 diabetes?
Insufficient production of insulin
Body’s immune system attacks and destroys insulin producing beta cells in the pancreas
How much is the reduction of beta cells before the symptoms even appear?
80-90%
What is the onset for type 1 diabetes?
Before the age of 20
What is pre diabetes?
Impaired glucose tolerance or impaired fasting glucose
Fasting glucose levels are high but not high enough to be classified as diabetes
What are the normal fasting glucose levels, and what are pre diabetics ranges?
Normal is less than 6.1 mmol/L
Prediabetic is 6.1-6.9 mol/L
What is crucial for pre diabetics?
Changing diet, more exercising and closely monitoring blood sugar levels
What is type 2 diabetes?
Insulin resistent, the body does not respond to the action of insulin
Where are insulin receptors, and what happens to them in type 2 diabetes?
Located in skeletal muscle, fat, and liver cells
Receptors are unresponsive and have less of them in type 2
What happens when glucose is unable to enter the cells?
Leads to high blood sugar levels (hyperglycaemia)
In type 2, what happens to pancreatic insulin production
The ability decreases and beta cells become fatigue
In type 2, how does the liver produce glucose?
It releases glucose irregularly disregarding the body’s needs and adds to increased blood sugar
How are the hormones altered in type 2 diabetes?
Adiponectin is decreased
Leptin is increased
Results in altered glucose metabolism
When is type 2 usually diagnosed?
Usually 55 years old or older
Recently happening in children
What is metabolic syndrome?
Insulin resistent
Cluster of abnormalities that increase the risk of cardiovascular disease
What characterizes metabolic syndrome?
Apple shaped body, hypertension, dyslipidemia and insulin resistance
Pts with metabolic syndrome are at a high risk for what conditions?
Diabetes and cardiovascular disease
How is gestational diabetes diagnosed?
By an oral glucose tolerance test
What is secondary diabetes?
Develops as a result of neurological conditions like cushings and tumors or meds
What med can cause secondary diabetes, and how?
Prednisone is a medication that causes the adrenals to release glucocorticoids, leading to hyperglycaemia
What does physical activity do for blood glucose?
Lowers blood glucose and facilitates a normal and stable glucose range
What hormones work against the release of insulin?
Glucagon, Epinephrine, Growth hormone, cortisol
What is diabetic ketoacidosis?
Life threatening condition resulting in hyperglycaemia
Sugars are 30-50 mmol/L
What else does DKA cause?
An osmotic shift leading to dehydration
What is the type 1 diabetes honeymoon phase?
Happens in newly diagnosed pts
The pt requires little to no injected insulin because the remaining beta cells are sufficient for glucose control
What do you need to monitor for during the honeymoon phase of type 1 diabetes?
Hypoglycaemia
What are the 3 classic symptoms of diabetes?
Polyuria: excessive urination
Polydipsia: Excessive thirst
Polyphagia: Excessive hunger
What are other S&S of diabetes?
Weight loss (type 1)
Weight gain (type 2 )
Visual changes
Recurrent infections
Weakness/fatigue
What is Hyperosmolar Non ketotic Coma (HNK)
Severe metabolic complication characterized by hyperglycaemia, dehydration and altered consciousness
What population does HNK occur in?
Older adults
How is the insult production in HNK?
Still produces some insulin, prevents DKA but not enough to effectively transport sugar into the cells
How is HNK treated?
Rapid administration of IV saline solution and insulin
What happens if HNK goes untreated?
Seizures, coma or even death
What is the HbA1C test?
Diagnostic test for diabetes
Glucose binds to hemoglobin, reflecting blood sugar control over the past 3 months based on the 120 day lifespan of an RBC
What is the test fasting glucose?
Another diagnostic test for diabetes
Random blood sugar test of 11mmol/L or higher may prompt further testing
What is insulin therapy used for in each type of diabetes?
Is necessary for type 1
Helps stabilize blood sugar in type 2
rapid acting insulin
Lispro and Aspart
Inject 15 mins before meals, onset is 15 mins
Short acting insulin
Regular insulin
Inject 30 - 45 mins before meals
Half life is 30-60 mins
Can be administered IV
Immediate acting insulin
NPH
Half life is 6-8 hours
Long acting insulin
No peak
Given at bedtime, preventing hypoglycaemia at night
Cannot be mixed with other insulins
What is important to remember regarding rapid acting insulin?
Patient should have food right beside them because they might get hypoglycaemic
How should insulin be stored?
Refrigerate but don’t freeze, avoid heat and direct sunlight
Where is the fastest absorption site for insulin?
in the abdomen
What is important in regards to insulin injection sites?
Rotate sites to prevent lipodystrophy (abnormal fat disruption)
Avoid injecting into exercise used sites
What syringe is typically used for insulin injections?
U-100 syringe for accuracy
What are complications of insulin therapy?
Hypoglycaemia
Allergic reactions to insulin
Somogyi effect (hormonal response, glucose spikes)
Dawn phenomenon (low morning blood sugar due to overnight fasting)
How is meal planning in diabetes management?
Tailored to individual lifestyle and preferences
What is the plate method in diabetes management?
Half non starchy veggies, 1/4 lean protein and 1/4 complex starch
How is alcohol considered in diabetes management?
It can inhibit gluconeogenesis and cause hypoglycaemia
(should be done under guidance)
How much moderate intensity aerobic exercise is recommended?
150 minutes/week
For type 2 how much resistance training is recommended?
3 times a week
What should a diabetic do when doing a prolonged exercise?
Consumes carbohydrate snacks every 30 mins to prevent hypoglycaemia
If a diabetic is getting surgery how long should their metformin be held for prior?
48 hours
What should diabetics wear to prevent ulcers on their feet?
leather shoes and diabetic socks
How should you treat DKA?
Assess ABCs, Iv fluids, potassium replacement and IV insulin
How should you treat HNK?
Gentle fluid resuscitation, insulin, and electrolyte monitoring
What are insulin pumps?
Contiunous insulin flow to mimic regulatory control
Allow for bolus injections to cover meals.
How do you manage hypoglycaemia?
Administer D50 IV or oral glucose tablets if the patient is conscious.
Once blood glucose reaches 14-15, switch to D5W to prevent hypoglycemia
Nurses should observe diabetic patients for what?
Weight loss
Excessive thirst
Increased hunger
Poor wound healing
Kussmaul respirations
What is important about hypoglycaemia and symptoms?
Not all patients will show any signs of hypoglycaemia
If they do it mimic alcohol intoxication
What are the thyroid hormones?
T3 AND T4 which regulate energy metabolism, growth, and development
What is the prevalence of hyperthyroidism?
More common in women, with highest frequency between 20 and 40 years.
what is the most common form of hyperthyroidism?
Graves’ disease
What is Graves’ disease?
An autoimmune disorder characterized by diffuse thyroid enlargement and excessive thyroid hormone secretion.
No known cause
What can Graves disease lead to?q
hypothyroidism due to thyroid destruction.
What happens in regards to hormones in Graves disease?
Antibodies bind to TSH receptors, stimulating the thyroid gland to release excessive T3 and T4.
How can you treat graves disease?
Radiation or iodine treatment
But it can eradicate the entire thyroid gland, leading to hypothyroidism.
What is thyroid cancer?
common cancer, particularly among females, but has a high survival rate.
The primary sign is a painless, palpable nodule in an enlarged thyroid gland.
How can you diagnose thyroid cancer?
Decreased TSH levels.
Elevated T3 and T4 levels.
Radioactive iodine uptake test to differentiate from thyroiditis.
Imaging: CT, MRI, ultrasound-guided aspiration.
What is the treatment for thyroid cancer?
Surgical removal (lobectomy or bilateral lobectomy)
Or radiation therapy
What needs to be monitored post op for thyroid cancer?
Assess for hemorrhage or tracheal compression every 2 hours for 24 hours.
Monitor for irregular breathing, neck swelling, and excessive swallowing.
What is the indications for surgery for thyroid disorders?
Large goiter causing tracheal compression.
Failure of anti-thyroid therapy.
Thyroid cancer
Unsuitability for radioactive iodine uptake.
What types of surgeries are performed for thyroid disorders?
Unilateral lobectomy: Removal of one lobe.
Bilateral lobectomy: Removal of both lobes and the isthmus.
Subtotal thyroidectomy: Removal of a significant portion, leaving some functional tissue.
What are the advantages of thyroidectomy?
More rapid reduction in T3 and T4 levels compared to radioactive iodine.
What is thyroid storm (Thyrotoxic Crisis)
an acute, life-threatening condition characterized by an intensification of hyperthyroid manifestations
What are the clinical manifestations for thyroid storm?
Tachycardia.
Heart failure.
Hyperthermia.
Agitation.
Shock.
What is treatment for thyroid storm?
Manage respiratory distress.
Reduce fever
Provide fluids
Eliminate stressors.
What is Thyroiditis?
Inflammation of the thyroid gland, often caused by viral, bacterial, or fungal infections. It can be acute or chronic
What is Hashimoto’s Thyroiditis? What is the major sign?
Chronic autoimmune disease leading to hypothyroidism
Painful thyroid gland
What are diagnostic tests done for thyroid disorders?
TSH, T3, AND T4 level tests
Ultrasound, CT, MRI
Ophthalmic Examination, Checks for fat pads behind the eyes
Radioactive Iodine Uptake, can also kill thyroid tissue
What is Primary Hypothyroidism?
Related to thyroid tissue destruction or defective hormone synthesis
Secondary Hypothyroidism
Related to pituitary gland disorders
