ATI alterations in Endocrine Function [HYPERGLYCEMIA+ HYPOGLYCEMIA]

What is the pancreas and where is it located?

It is an endocrine gland, approximately six inches long, lying transverse across the upper abdomen, behind the stomach.

What are the two ends of the pancreas called, and where are they located?

Head: Wider end on the lower right side, connected to the duodenum by the pancreatic duct.

Tail: Thinner end on the left side, extending toward the spleen.

What are the two main functions of the pancreas?

Endocrine function: Secretes insulin (from beta cells) and glucagon to regulate blood glucose.

Exocrine function: Secretes digestive enzymes such as amylase and lipase.

what is released in response to blood glucose levels to prevent hypoglycemia?

glucagon

what is the key hormone that unlocks the cell to allow the absorption of glucose?

insulin

what is the main source of fuel for the body and brain and requires insulin to move across cell membranes into cell?

glucose

Insulin is an essential hormone that is produced in the beta cells of the pancreas. True or false?

true

What is hyperglycemia?

A fasting blood glucose concentration greater than 126 mg/dL.

Where is insulin produced in the pancreas?

In the islets of Langerhans from beta cells.

What conditions are characterized by hyperglycemia?

Type 1 diabetes mellitus (DMT1)

Type 2 diabetes mellitus (DMT2)

What is insulin resistance?

A failure of insulin receptors on target cell membranes to accept insulin.

What CAUSES insulin resistance?

Cell receptors becoming resistant to insulin.

Pancreas gradually losing the ability to produce enough insulin.

why do cells require glucose?

For energy production.

What happens when cells cannot absorb glucose due to a lack of insulin?

The liver releases glucagon stores and stimulates hepatic glucose production.

What are the two processes through which the liver produces glucose?

Gluconeogenesis – Generates glucose from non-carbohydrate sources (proteins, lipids, pyruvate, lactate).

Glycogenolysis – Breaks down glycogen into glucose.

Where does glycogenolysis mainly occur?

In the hepatocytes of the liver and the myocytes of the muscles.

What hormones are released if hyperglycemia continues despite glucagon regulation?

Cortisol, catecholamines, and growth hormone.

What metabolic processes occur when these hormones are released?

Lipolysis (breakdown of fats)

Proteolysis (breakdown of proteins)

Both processes generate glucose, further increasing blood glucose levels.

What happens when blood glucose levels become excessively high?

Glucose enters the renal tubules of the kidneys, leading to:

Increased urination (polyuria)

Excretion of water, sodium, and potassium, which can contribute to dehydration and electrolyte imbalances.

What hormones are released when hyperglycemia persists despite glucagon regulation?

Cortisol, catecholamines, and growth hormone.

What metabolic processes contribute to further glucose production in persistent hyperglycemia?

Lipolysis (fat breakdown)

Proteolysis (protein breakdown)

How does excessive blood glucose affect the kidneys?

Glucose enters the renal tubules, leading to:

Increased urination (polyuria)

Excretion of water, sodium, and potassium

Potential dehydration and electrolyte imbalances

What is the primary function of insulin in glucose regulation?

Promotes glucose uptake into cells for energy.

What happens when insulin is lacking or ineffective?

Blood glucose levels rise, leading to hyperglycemia.

What are two main causes of hyperglycemia related to insulin?

Lack of insulin production

Insulin resistance (cells not responding to insulin)

hyperglycemic hypersmolar state

A metabolic complication of hyperglycemia or type 2 diabetes mellitus with severe hyperglycemia, extreme dehydration, hyperosmolar plasma, altered consciousness, and no ketones

What is the most severe metabolic complication of hyperglycemia in Type 2 Diabetes Mellitus (DMT2)?

Hyperglycemic Hyperosmolar State (HHS).

What are the key diagnostic criteria for Hypergylcemic hypersmolar state?

Plasma glucose > 600 mg/dL

Plasma osmolarity > 320 mOsm/L

Severe dehydration

Absence of ketosis

Hypotension and altered mentation

the nurse anticipates that a client who has hyperglycemia may have which of the following complications as the liver begins compensating?

gluconeogenesis

What are some non-modifiable risk factors for hyperglycemia?

Genetic or familial predisposition

Metabolic disorders (diabetes mellitus, metabolic syndrome)

What are some common causes of hyperglycemia related to diabetes management?

Missing or insufficient dosages

of insulin or oral medications

Improper insulin administration technique

Using expired insulin

Non-adherence to diet or exercise plan

What are some secondary causes of hyperglycemia?

Total parenteral nutrition (TPN)

Dextrose infusions

Medications such as glucocorticoids, phenytoin, and estrogens

What are modifiable risk factors for hyperglycemia?

Body weight ≥120% of

expected weight

Diet high in simple carbohydrates

Sedentary lifestyle

Smoking

Excess stress

What factors have contributed to the increase in hyperglycemia over the last 20 years?

Higher rates of obesity

Decreased physical activity

Increasing population of older adults

Which populations have a higher incidence of hyperglycemia in the U.S.?

Clients from low- or medium-income households

Members of historically marginalized ethnic or racial groups

What are some common comorbidities associated with hyperglycemia?

Autoimmune disorders

Hyperlipidemia

Hypertension

Gestational diabetes

Polycystic ovary syndrome (PCOS)

Metabolic syndrome

Cushing's syndrome

Acromegaly

Pheochromocytoma

What can untreated hyperglycemia lead to?

Metabolic syndrome (precursor to DMT2)

Coma and death if blood glucose levels become extremely high and persist

What are some complications of untreated hyperglycemia?

Coronary artery disease

Cerebrovascular disease

Peripheral vascular disease

Retinopathy

Nephropathy

Poor wound healing

Depression

What happens when glycogen stores are released by the liver during hyperglycemia?

It further increases hyperglycemia and impairs glucose utilization by peripheral tissues.

What complications can polyuria in hyperglycemia lead to?

Fluid imbalance

Loss of sodium and potassium

Hypovolemic hypotension

What are some indications of the effects of hyperglycemia?

Polyphagia (excessive hunger)

Polydipsia (excessive thirst)

polyuria (excessive pee)

What are the manifestations of advanced hyperglycemia like diabetic ketoacidosis (DKA)?

Fruity odor to the breath

Deep, rapid Kussmaul

respirations (to compensate by blowing off acid)

Nausea

Vomiting

Abdominal pain

How does elevated blood glucose at night affect sleep?

Excessively elevated blood glucose levels can negatively affect sleep quality and patterns.

What impact does poor sleep have on blood glucose levels?

Decreased sleep can cause glucose levels to rise and lead to insulin resistance.

What are some sleep disturbances that can be associated with higher glucose levels or glucose intolerance?

Disordered breathing

Obstructive sleep apnea

Other sleep-breathing issues

What are the circulatory effects of hyperglycemia?

Blood vessel damage

Cardiovascular disease

Poor wound healing

What are the respiratory effects of hyperglycemia?

kussmaul respirations

What are the digestive effects of hyperglycemia?

Nausea

Vomiting

Pain

What are the nervous system effects of hyperglycemia?

Vision problems

Neuropathy

Depression

Insomnia

Stress

what is a potential consequence of chronic hyperglycemia, and the inflammatory process triggered by excess glucose?

damage to to major organs

What does chronic, uncontrolled hyperglycemia cause in the vascular system?

Damage and inflammation to the vascular walls

Increases atherosclerosis

Inhibits circulation, especially in older adults

Increases the risk of peripheral artery disease, leading to potential loss of toes or limbs

What conditions can chronic hyperglycemia lead to in older adults?

Carotid artery disease, increasing the risk of strokes and heart attacks

Damage to peripheral nerves, causing tingling, numbness, and neuropathic pain

Damage to the optic nerve, leading to blindness

What are the effects of chronic, uncontrolled hyperglycemia on blood vessels?

Causes damage and inflammation to vascular walls

Increases atherosclerosis

Impairs circulation, especially in older adults

How can chronic hyperglycemia affect circulation and lead to complications?

Leads to peripheral artery disease with poor circulation

Increases the risk of limb loss, particularly toes

What cardiovascular risks are associated with chronic hyperglycemia?

Carotid artery disease

Increased risk of strokes and heart attacks

How does chronic hyperglycemia affect the nervous system in older adults?

Causes damage to peripheral nerves, leading to tingling, numbness, and neuropathic pain

May damage the optic nerve, potentially causing blindness

What are some common physical assessment findings in clients with SEVERE hyperglycemia?

Increased urine output

Increased thirst

Weight loss

Dry mucous membranes

due to dehydration

What vital sign changes may occur in clients with SEVERE hyperglycemia?

Low blood pressure

Fast heart rate

How might cognition be affected in clients with severe hyperglycemia?

Confusion

Lethargy

Coma

What gastrointestinal manifestations are common in clients with diabetic ketoacidosis (DKA)?

Abdominal pain

Nausea

Vomiting

What changes in breathing and breath odor are seen in diabetic ketoacidosis (DKA)?

Fast and shallow breathing

Fruity odor to breath

a client who presents to the emergenct department is confused and combative and has fruity breath. Which of the following is the priority

check a fingerstick blood glucose level

How is hyperglycemia diagnosed through blood glucose testing?

Fasting blood glucose level > 125 mg/dL

Blood glucose level 1-2 hours AFTER EATING > 180 mg/dL

What does Hemoglobin A1C (HbA1c) measure?

The average blood glucose level over the previous 2-3 months

What does an HbA1c of 7% indicate?

An estimated average blood glucose level of 154 mg/dL over the previous 2-3 months

How does HbA1c percentage relate to blood glucose levels?

As HbA1c percentage increases, the estimated average blood glucose level increases

As HbA1c percentage decreases, the estimated average blood glucose level decreases

What is the estimated average glucose level for an HbA1c of 6%?

126 mg/dL

What is the estimated average glucose level for an HbA1c of 8%?

183 mg/dl

What is the estimated average glucose level for an HbA1c of 9%?

212 mg/dL

what is the estimated average glucose level for an HbA1c of 10%

240 mg/dL

What laboratory tests can be performed to monitor hyperglycemia?

Capillary blood sampling (using a portable glucose monitoring device)

Venous blood sampling (sent to the lab for analysis)

What should be done if point-of-care test results for hyperglycemia are inconclusive?

Venous blood should be obtained and sent to the lab for analysis.

What areas of nursing care may be involved when providing care to a client with hyperglycemia?

Monitoring

Medication administration

Teaching

How do environmental factors impact the management of hyperglycemia?

Environmental factors, including social determinants of health (SDOH), can impact a client's ability to safely manage chronic conditions like hyperglycemia

What are safety considerations related to hyperglycemia and lancet use?

Lancets should be disposed of appropriately and not be reused or shared to minimize infection risk.

Why should clients with recurring hyperglycemia obtain a medical ID?

Clients with recurring hyperglycemia should obtain a medical ID,

such as a bracelet or necklace, to provide key medical information in case they are unable to communicate.

What is the focus of initial client education for hyperglycemia?

Initial education focuses on how frequently to monitor for hyperglycemia, how to use a blood glucose monitor, and possibly a target blood glucose goal.

Why is proper storage of blood glucose monitoring equipment important?

Test strips should be stored properly, away from extreme temperatures or moisture, to ensure accurate results.

What should the nurse teach the client about checking for ketones?

The nurse will teach when to check urine for the presence of ketones.

Why is exercise not recommended when ketones are present in the urine?

Exercise is not recommended when ketones are present because it could cause blood glucose levels to rise even higher.

Why is sliding-scale insulin discouraged in the acute care setting?

Sliding-scale insulin is reactive, treating hyperglycemia after it occurs, whereas proactive approaches prevent hyperglycemia from happening.

What is the preferred method of blood glucose management for NPO or poorly nourished hospitalized clients?

The preferred method is basal or basal plus bolus treatment for blood glucose management in clients who are NPO or have poor nutritional intake.

What approach is recommended for hospitalized clients with good nutritional intake?

A BASAL

PRANDIAL

and CORRECTIVE APPROACH is preferred for clients with good intake to manage blood glucose.

What interventions related to lifestyle changes can the nurse implement?

The nurse may coach clients on diet and physical activity and provide referrals to a nutritionist and diabetic educator.

What should the treatment plan for hyperglycemia include?

The treatment plan includes lifestyle modifications (diet and exercise), possibly oral hypoglycemic medications (e.g., metformin), and for some clients, insulin therapy

How should clients approach weight management to help manage hyperglycemia?

Clients should receive instructions on appropriate methods for weight loss or weight maintenance, including changes in portion size and caloric intake.

What role does exercise play in managing hyperglycemia?

A regular exercise routine, such as daily walking or aerobic workouts two to three times per week, is essential in managing hyperglycemia.

When is collaboration with an endocrinologist necessary in the management of hyperglycemia?

Collaboration with an endocrinologist is often necessary for clients who have chronic hyperglycemia.

What is the action of sulfonylureas like GLYBURIDE, GLIPIZIDE, and GLIMEPIRIDE?

They decrease blood glucose by increasing insulin secretion from beta cells in the pancreas.

What are common adverse effects of GLYPURIDE, GLIPIZIDE, and GLIMEPIRIDE?

Hypoglycemia, weight gain, nausea, diarrhea, dizziness, and headache.

When should clients take sulfonylureas?

Take 30 minutes before meals or with the first meal of the day.

What should clients monitor for when taking sulfonylureas?

Monitor for signs of hypoglycemia, such as shakiness, sweating, confusion, or dizziness.

What is the action of thiazolidinediones like PIOGLITAZONE and ROSIGLITAZONE?

They decrease resistance to insulin, helping the body use insulin more effectively.

What are common adverse effects of pioglitazone and rosiglitazone?

Liver toxicity, weight gain, and edema.

How should clients take thiazolidinediones?

They may be taken with or without food.

What monitoring is required for clients taking pioglitazone or rosiglitazone?

Monitor liver function and report signs of liver toxicity, such as appetite changes, jaundice, abdominal pain, or dark urine.

Monitor for hypoglycemia.

What is the action of metformin (Glucophage)?

It decreases the amount of glucose produced by the liver and reduces glucose absorption from food.

What are common adverse effects of metformin?

Indigestion, bloating, abdominal pain, constipation, headache, and a METALLIC TASTE.

How should metformin be taken?

Take 30 minutes before meals or with the first meal of the day.

What are important precautions for metformin use?

Do not take if NPO.

Hold before procedures requiring contrast dye.

Monitor for hypoglycemia.