Unit 7: Meds for Endocrine System

Nutritional Evaluation for Diabetes

Balanced intake of carbohydrates, proteins, and fats is essential

• Monitor: carb intake and glycemic index

• Nurs Considerations: Educate patients on meal planning and healthy food choices

Important Lab Values for Diabetes

• HbA1c (hemoglobin): indicates how well you manage blood sugar by measuring average blood glucose over 3 months

• Fasting Blood Glucose: blood sugar after not eating for 8 hr; normal range (70-100 mg/dL)

• Postprandial Blood Glucose: Blood sugar levels after eating (within 2 hr)

• Nurs Considerations: Regular monitoring and timely intervention based on lab results

Activity + Exercise for Diabetes

Helps regulate blood glucose and improve overall health; body uses extra glucose during exercise

• Monitoring: Check blood glucose before and after exercise

• Nurs Considerations: Educate patients on safe exercise practices + monitoring

Psychological Considerations for Diabetes

can negatively impact mental health; must be able to identify depression/anxiety in pt

• Nurs Considerations: Regular mental health assessments and referrals (as needed).

Hypoglycemia

Blood glucose level below normal range

• Common Symptoms: Shakiness, sweating, confusion, irritability

• Severe Symptoms: Seizures, loss of consciousness

• Nursing Considerations: Immediate treatment with glucose or glucagon; monitor pt

Hyperglycemia

Elevated blood glucose levels

• Common Symptoms: Increased thirst, frequent urination, fatigue

• Severe Symptoms: Ketoacidosis, coma

• Nursing Considerations: Adjust treatment and monitor glucose levels.

Rapid-Acting Insulin

known as “mealtime” insulin to control postprandial glucose spikes; don’t administer unless pt has eaten meal

• onset: 10-30 min

• duration: 3-5 hr

• nurs considerations: monitor for hypoglycemia; educate pt on timing of dosages

Long-Acting Insulin

basal insulin used to maintain steady blood glucose levels;doses are usually larger

• onset: 1-2 hr

• duration: up to 24 hr

• nurs considerations: educate pt on consistent daily dosing and monitoring

Insulin

lowers blood glucose levels

• types: rapid-acting, short-acting, intermediate-acting, long-acting

• nurs considerations: educate pt on proper administration + storage

Oral Hypoglycemic Agents

oral meds exclusively used to help reduce blood sugar exclusively in type 2 diabetes by stimulating insulin secretion

• types: sulfonylureas, thiazolidinediones, DPP-4 inhibitors, SGLT2 inhibitors

• Nurs Considerations: Monitor side effects, ensure adherence

Sulfonylureas

• MOA: stimulate insulin release from pancreas

• Clinical use: type 2 diabetes management

• Ex: glipizide, glyburide

• Nurs Considerations: monitor for hypoglycemia, educate on proper dosing

Biguanides

• MOA: reduce glucose production by the liver and increases insulin sensitivity

• Clinical use: type 2 diabetes management

• Ex: metformin

• Nurs Considerations: monitor for GI effects (nausea, vomiting, diaherra, discomfort), educate on gradual dose escalation

• off label used for PCOS

Thiazolidinediones

also known as glitazones

• MOA: increases insulin sensitivity in muscle and adipose tissue

• Clinical use: type 2 diabetes management

• Ex: pioglitazone, rosiglitazone

• Nurs Considerations: monitor for fluid retention, liver function, bone health and heart failure symptoms; not for use in kidney or heart failure pt

Education Needs for Pt w/ Complications from Diabetes

• complications: neuropathy, nephropathy, retinopathy, cardiovascular disease

• education: regular monitoring, med adherence, lifestyle modifications

• support: provide resources for managing complications

• nurs considerations: tailor education to patient needs

Mineral corticosteroids

Regulate electrolyte and water balance

• MOA: increases sodium reabsorption, increases potassium excretion

• Clinical use: type 2 diabetes management

• Ex: aldosterone

• Nurs Considerations: monitor for electrolyte levels, BP, fluid retention, heart failure

Glucocorticoids

helps regulate metabolism, immune and stress response

• MOA: increases glucose production, suppresses immune system, reduced inflammation

• Ex: cortisol

• Nurs Considerations: monitor blood glucose, signs of infection, high BP, Cushing’s syndrome, osteoporosis, GI (increased peptic ulcer risk)

Baseline Assessments for Corticosteroids

• medical history: asses for conditions that can be affected (diabetes, hypertension)

• physical exam: signs of infection, weight and BP

• lab tests: blood glucose, electrolytes, CBC

• nurs considerations: establish baseline to monitor changes during therapy

Corticosteroids

class of steroid hormones produced by the adrenal cortex or synthesized as meds

• types: glucocorticoids, mineralocorticoids

Clinical Use of Corticosteroids

• Clinical use: inflammatory conditions (lupus, rheumatoid arthritis), allergic reactions (asthma, allergic rhinitis), autoimmune disease (multiple sclerosis, IBD)

• Nurs Considerations: monitor for therapeutic effect, adjust dose as needed

Adverse Effects of Corticosteroids

• short-term: increased appetite, weight gain, mood changes

• long-term: osteoporosis, hypertension, diabetes, increased risk of infection

• nurs considerations: educate pt on side effects and preventative measures

Managing Adverse Effects of Corticosteroids

• osteoporosis: calcium + vitamin D supplementation, weight-bearing exercises

• hypertension: monitor BP, dietary modifications

• diabetes: monitor blood glucose, adjust antidiabetic meds

• nurs considerations: implement strategies to minimize adverse effects

Drug Interactions w/ Corticosteroids

NSAIDS, anticoagulants, vaccines

• effect: increased risk of GI bleeding (peptic ulcers), altered immune response

• nurs considerations: monitor for signs of interactions, adjust treatment as needed

Complications of Corticosteroid Therapy

Adrenal insufficiency, Cushing’s syndrome

• Nurs considerations: educate pt on recognizing signs of complications and seeking medical attention