Endocrine part 1

Diabetes Mellitus

Group of metabolic conditions involving blood glucose regulation, characterized by chronically high blood sugar

Type 1 diabetes

Autoimmune destruction of insulin-producing pancreatic beta cells (resulting in little/no insulin production)

Type 2 diabetes

Insulin resistance, cells do not properly respond to insulin, and pancreas cannot meet increased insulin demands

Gestational diabetes

Glucose intolerance first detected during pregnancy

Gestational diabetes risk factors

• Family history of diabetes

• 5+ pregnancies

• Previous large babies

• Older age

• Pregnancy complications

Polyuria

Excessive urination

Polydipsia

Excessive thirst

Polyphagia

Excessive hunger

Diagnostic fasting plasma glucose (FPG)

126 mg/dL or higher (indicates diabetes)

Normal fasting glucose

Less than 100 mg/dL

Diagnostic random glucose

200mg/dL

Diagnostic HbA1c

6.5% or higher (indicates diabetes)

HbA1c

Blood test that measures average blood glucose over the last 2-3 months

Catabolic disorder

The body breaks down fat, muscle, and glycogen into smaller molecules for energy, instead of building/storing them

Role of pancreas

Releases insulin and glucagon to regulate blood glucose

Alpha cells

Pancreatic cells that secrete glucagon, increasing blood glucose

Beta cells

Pancreatic cells that secrete insulin, promoting glucose uptake into cells

Metabolic syndrome

Cluster of metabolic abnormalities that increase the risk of heart disease, stroke, and type 2 diabetes

Characteristics of metabolic syndrome

• Obesity

• High triglycerides

• Low HDL

• Hyperlipemia

• HTN

DKA

Diabetic keto acidosis- serious condition caused by insufficient insulin, resulting in fat breakdown, ketone production, and metabolic acidosis

DKA blood glucose

Greater than 250mg/dL

Is DKA more common in type 1 or type 2 diabetes

Type 1

DKA pH

Less than 7.30

DKA S/s

• Ketones in ruine

• Fruity-scented breath

• Excessive thirst/urination

• Tachycardia

• SOB

• Confusion, extreme fatigue

DKA treatment

• IV fluids- Dextrose typically added once glucose drops sufficiently

• IV Insulin therapy

• Electrolyte replacement (K)

Hyperglycemia

Random blood glucose greater than 200mg/dL

Hyperglycemia S/s

• Increased thirst

• Polyuria

• Dehydration

• Weakness/fatigue

• Weight loss

• Sodium/potassium imbalance

Hypoglycemia

Blood glucose below 70mg/dL

Hypoglycemia S/s

• Neuropathy

• Coma

• Tachycardia

• Diaphoresis

• Difficulty concentration

• Headache

Hypoglycemia treatment

Give 15-20g of fast-acting oral glucose

Examples of fast-acting glucose

• Glucose tablets

• Orange juice

• Sugar cubes

• Honey

• Corn syrup

Severe hypoglycemia

Blood glucose below 50mg/dL

Severe hypoglycemia treatment

IV D50

How do beta blockers impact hypoglycemia

They may mask symptoms and interfere with glucose regulation

Diabetic retinopathy prevention

Strict glucose control, regular eye examinations

Diabetic nephropathy

kidney disease caused by type 1 or type 2 diabetes that damages the tiny blood vessels in the kidneys

Why is poor wound healing common in diabetes

It causes damaged blood vessels, impaired immune function, decreased collagen synthesis, and nerve damage

What happens to glucose and insulin after a meal

Glucose increases, insulin is secreted

Where is glycogen stored

The liver

What happens to glucose in between meals?

The liver releases glucose to maintain blood glucose levels

Where is extra glucose stored

fat

Liver’s role in glucose metabolism

Converts and stores glucose that exceeds metabolic needs

Type 1 diabetes cause

• Genetic predisposition

• Environmental triggers

What happens to pancreatic beta cells in Type 1 diabetes

The are destroyted

Insulin in Type 1 diabetes

Low/absent insulin secretion

Type 1 diabetes metabolic state

catabolic disorder

Type 1 diabetes treatment

Requires insulin injections to prevent a catabolic state

Type 1A diabetes

Auto-immune mediated destruction of insulin-producing beta cells

Type 1B diabetes

Beta-cell destruction/dysfunction without autoimmune antibodies

Type 2 diabetes cause/risk factors

• Strong link to obesity

• Genetics

• HTN

• Pancreatic disease

• Age

• Stress

• Unhealthy diet

Type 2 diabetes insulin

The pancreas continues to produce insulin, but it is not used effectively and the pancreas cannot keep up with the increased insulin demands

What is insulin

A hormone that moves glucose from the bloodstream into cells for energy

Primary function of insulin

To lower/regulate blood glucose

Insulin helps prevent…

Fat and glycogen breakdown

Insulin role in glucose storage

Facilitates the storage of excess glucose in the liver

True or false: Insulin increases protein synthesis

True

Aspart (Novo) and Lispro (Humalog)

Rapid-acting insulin

Rapid-acting insulin onset

5-15 minutes

Rapid-acting insulin peak

1-3 hours

Humulin R, Novolin R

Regular insulin (short acting-insulin)

Short acting insulin onset

30-60 minutes

Short acting insulin peak

2-4 hours

Intermediate-acting insulin

NPH (Humulin N, Novolin N)- cloudy appearance

NPH insulin onset

2-4 hours

Glargine (Lantus) and U-300 Toujeo

Long acting insulin

Long acting insulin duration

Approximately 24 hours

Insulin routes

• Syringe

• Pen

• Pump

• Injection

Insulin subcutaneous administration

Injected into the fatty layer beneath the skin and above the muscle

Mixing insulin

Draw up clear (short acting regular) before cloudy (NPH) (R before N)

Which Long-acting insulin can be mixed?

NPH

When is bolus insulin administered

With meals/snacks

Bolus insulin types

Rapid acting or short acting

Carb-to-insulin ratio

1 unit of insulin per 10g of carbohydrates

Carb/meal bolus

Covers the carbohydrates consumed in a meal

Correction bolus

Insulin administered to correct elevated blood glucose

Basal insulin

Background insulin providing a steady amount of insulin throughout the day and night (long acting)

True or false: Basal insulin needs to be coordinated with meals

False

How long are opened insulin vials good for, when stored at room temperature

30 days

ADH

Antidiuretic hormone- regulates fluid balance / water retention

ADH Production

Produced in the hypothalamus, released by the posterior pituitary

SIADH

Syndrome of inappropriate antidiuretic hormone (excessive ADH secretion)

Affects of SIADH on the body

• Decreased urine output

• Increased fluid retention

• Increased levels of ADH

• Decreased sodium

Causes of SIADH

• CNS disorders- Stroke, TBI

• Malignancies- Cancer

• Medications- SSRIs

• Pulmonary disorders- pneumonia, TB

SIADH treatment

• Fluid restriction

• Diuretics

• Electrolyte monitoring / replacement

Diabetes insipidus

Disorder of fluid regulation- kidneys excrete large amount of dilute urine

Diabetes insipidus effects on the body / S/s

• Increased urine output (very dilute urine)

• Decreased ADH

• Polydipsia

• Dehydration

• Increased sodium

Diabetes insipidus causes

• Damage to hypothalamus or pituitary gland

• Head injury / brain surgery

Diabetes insipidus treatment

• Replace fluids (IV)

• Desmopressin

Vasopressin (Pitressin)

Medication that treats diabetes insipidus by ADH replacement (increases water reabsorption, decreases urine output, may increase BP and cause vasoconstriction)

Desmopressin (DDAVP)

Synthetic ADH used to treat diabetes insipidus