Wk 3 Flashcards
what is up regulation
When there are low hormone levels, there is an increase in number of receptors
what is the pituitary gland
Regulates the operation of all the other glands
Regulates growth and development through secretion of somatotropin
Secretes vasopressin, which regulates re-absorption of fluid in the kidneys
posterior: oxytocin, antidiuretic
anterior: thyroid stimulating hormone, growth hormone, adrenocorticotropic, follicle stimulating hormone
describe the insulin glucose metabolism
- Cell membranes impermeable to glucose
o Insulin binds to insulin receptor on cell surface
o Generation on intracellular signal
o Glucose transporter moves from inactive site to cell wall
o Glucose transported across cell wall
what is diabetes
- Inability of the body to produce or to use insulin, resulting in a lack of ability to use of metabolize glucose
- Type 1 v type 2
o Nearly 90% of people with DM have type 2 - Cause is unknown; some factors include
o Genetic disposition
o Smoking
o Obesity
o Lack of activity
o High levels of stress/anxiety
describe type 1 diabetes
- Absolute insulin deficiency
o The body cannot produce insulin - Destruction of the Islet Beta cells
o Genetic predisposition and autoimmune response
o Body forms autoantibodies that destroy the insulin- producing beta cells - Dependent on exogenous insulin to prevent ketosis and for survival
describe type 2 diabetes
- Relative lack of insulin- hyperglycaemia despite presence of insulin
- Positive family history increases chances two to four times of acquiring type 2 DM
- Obesity and physical inactivity
- Resistance to insulin
- Causes a rise in the level of glucose in the blood Hyperglycaemia
- Beta cells increase production of insulin to try to maintain a normal blood glucose level
- Beta cells fail, lose ability to secrete insulin
gestational diabetes
- Glucose intolerance detected during pregnancy
- Risk factors
o Family history of diabetes
o History of stillbirth, foetal abnormalities, large baby - Management
o Risk assessment during pregnancy
o Insulin therapy if necessary
o Mother may develop diabetes later in life
S&S of type 1 diabetes
- Frequent Urination (“diabetes” means “frequent urination”)
- Extreme hunger and thirst
- Fatigue
- Hyperglycaemia
- Glycosuria
- Blurred vision
- Dry, itchy skin
- Poor wound healing
- Impotency in men due to vascular problems
- Numbness and tingling in upper and lower extremities
S&S type 2 diabetes
- Obesity and lack of physical activity
- Family history
- Over 55
- Polycystic ovary disease
- Gestational diabetes
- Borderline glucose tolerance test results
- Heart attack, heart disease, high BP
- Polydipsia
- Polyphagia
- Smell of acetone
- Kussmaul breathing (hyperventilation
treatment for type 1 and type 2 diabetes
t1: Insulin Pancreas/kidney and islet cell transplant • Nutrition • Exercise • Oral medication • Insulin therapy • Monitoring • Education • Optimal medical management
t2: Lifestyle Modification
Oral Hypoglycaemics
Insulin
- Nutrition
- Exercise
- Oral medication
- Insulin therapy
- Monitoring
- Education
- Optimal medical management
what is diabetic ketoacidosis
Due to an absolute insulin deficiency
usually in Type I but possible in Type 2
Hyperglycaemia develops due to reduced peripheral utilisation of glucose (as no insulin available)
• also gluconeogenesis (glycogen from fatty acids)
• increased glycogenolysis (glycogen to glucose in the liver)
Acidosis develops due to fat breakdown (fatty acids)
Cause: Infection 50%, Non-compliance 25%, newly diagnosed 10-30%, stress, alterations in insulin regime and drug
S&S of DKA
- polyuria
- polydipsia
- weight loss
- nausea
- vomiting
- shortness of breath
- abdo pains (kids)
- increased resp rate/ Kussmaul’s breathing
- ketotic breath (acetone; fruity smell)
- postural hypotension
- hypothermia
- hypovolaemia
- acidosis
- shock
nursing considerations and complications of DKA
- Fluid replacement: lots!
- Insulin therapy: sliding scale
- Potassium replacement
- Treatment of precipitant
Consideration for Intensive Care Unit
• haemodynamic instability, severe acidosis, impaired conscious level, precipitating illness
what is hyperosmolar hyperglycemic state (HHS)
Relative insulin deficiency seen in type 2 DM
• sufficient insulin to prevent gluconeogenesis and therefore ketoacidosis
• but not enough to prevent hyperglycaemia
• dehydration arising from osmotic diuresis from hyperglycaemia
S&S of HHS
- Insidious onset
- Confusion
- Profound dehydration (up to 9- 10L deficit)
- Coma
- Fitting: especially with very high osmolality
- Deep Vein Thromboses and CerebroVascular Accidents (Stroke) may occur
