CH 20 ENDOCRINE

• Endocrine disorders


  Caused by internal communication problem
• Things the brain needs to survive

  • O2
  • Glucose
• Glucose Metabolism


  1. Insulin is necessary for glucose to enter cells

  2. Pancreas produces glucagon and insulin

  3. Islets of Langerhans contain alpha and beta cells

  4. Alpha cells produce glucagon

  5. Beta cells produce insulin

  6. Insulin released when blood glucose is high, causes liver to convert excess glucose to glycogen

  7. Glucagon released when blood glucose is low, causes liver to break down glycogen to glucose
• Type 1 Diabetes


  Glucose cannot enter cell when there is not enough insulin, requires insulin injection
• Type 2 Diabetes


  Desensitized receptors, so much glucose, not enough insulin, requires lifestyle changes and possibly insulin
• Diabetes Mellitus


  Disease in which body's ability to produce or respond to insulin is impaired, resulting in abnormal metabolism of carbs and elevated levels of glucose and urine
• Without treatment, blood glucose levels become too high
• If not managed well, diabetes can cause blindness, cardiovascular disease, kidney failure, amputation of limbs and extremities, and impaired ability to heal
• Treatment for diabetes


  Medications and injectable hormones that lower blood glucose level
• Low blood glucose level (hypoglycemia)


  Can be life threatening if unrecognized and untreated
• High blood glucose level (hyperglycemia)


  Can be life threatening if unrecognized and untreated
• Gestational Diabetes


  Pregnancy Induced Diabetes, goes away after delivery
• Diabetes Insipidus


  Uncommon disorder that causes imbalance of fluids in the body due to insufficient antidiuretic hormone (ADH) from the pituitary gland, resulting in frequent urination
• Diabetes Mellitus Type 1


  Autoimmune disorder where the immune system produces antibodies against the pancreatic beta cells, resulting in little to no insulin production, requires external insulin source
• New onset symptoms of Type 1 Diabetes

  • Polyuria (frequent urination)
  • Polydipsia (increase in fluid consumption)
  • Polyphagia (severe hunger and increased food intake)
  • Weight Loss
  • Overall Fatigue
• Pathophysiology of Type 1 Diabetes

  1. Insulin is unavailable to allow glucose into cells, body turns to burning fat for energy, producing acidic waste (ketones)

  2. Kidneys become saturated with glucose and ketones and cannot maintain acid-base balance

  3. Patient breathes faster and deeper as the body attempts to reduce the acid level, resulting in Kussmaul respirations

  4. If fat metabolism and ketone production continue, DKA (Diabetic Ketoacidosis) may develop
• DKA (Diabetic Ketoacidosis)


  Acute, mostly associated with Type 1 Diabetes, presents as generalized illness with abdominal pain, body aches, nausea and vomiting, altered level of consciousness or unconsciousness
• Type 2 Diabetes


  Caused by resistance to the effects of insulin at the cellular level, usually occurs later in life, can be improved by exercise and dietary modification, associated with obesity, treated with oral medications and possibly injectable medications or insulin
• Symptomatic Hyperglycemia


  Occurs when blood glucose levels are high, leads to altered mental status, dehydration, and other symptoms
• HHNS (Hyperosmolar Hyperglycemic Nonketotic Syndrome)


  Fluid imbalance, type 2 diabetes, excretion of glucose in urine, patient may be unconscious or have seizure activity due to severe dehydration
• Chronic Hyperglycemia


  High levels of blood sugar over time, leads to peripheral neuropathy, chronic kidney disease, heart disease
• Symptomatic Hypoglycemia


  Acute emergency when sugar drops suddenly, glucose levels fall while insulin levels remain high, causing insufficient glucose to the brain
• Normal blood glucose levels

  • Nonfasting adult: 80-120 mg/dL
  • Neonates: above 70 mg/dL
• Signs of Hypoglycemia


  • Respiratory rate normal to rapid
  • Pulse weak and rapid
  • Skin pale and clammy
  • Low blood pressure
• Signs of Hyperglycemia


  • Kussmaul respirations
• Patient Assessment and Interventions

  1. Reassess patient with diabetes frequently

  2. If unable to test blood glucose, perform assessment, contact medical control

  3. Giving oral glucose: call medical control, follow 9-rights and D-DICE, gel or chewable tablets between cheek and tongue, reassess frequently

  4. Contraindications: inability to swallow, unconsciousness, altered level of consciousness, wear gloves