Endocrine/ Insulin - Exam 3

Hormones

The endocrine system deals with

Homeostasis

Steady state among all body systems (Blood glucose, PH, Temperature, Etc)

Type 2 Diabetes

Insulin resistance and/or inadequate insulin secretion

Type 1 diabetes

Auto immune destruction of the beta cells in the pancreas so they are not able to produce insulin

Hyperglycemia

Chronic damage to blood vessels

Fasting BG

80-100 mg/dl

126 & above

BG of someone who is diabetic

100-125 mg/dl

BG of a pre diabetic

200 mg/dl

An individual is just getting their blood glucose checked. What number would concern and show signs of diabetes, regardless of what they ate?

5.6%

Hemoglobin A1c Target number should be…

5.7- 6.4%

Pre-diabetes hemoglobin levels will be…

Every hour

Regular insulin is administered as a IV, called an Insulin drip. How often should you check BG?

Lowers blood potassium

What happens to potassium as a result of insulin

3.5-5.2

Normal potassium levels

NPH (intermediate) and short acting

What insulins can you mix?

Sliding scale

A flawed hospital system for managing glycemic levels of pt’s. Used with short acting insulins.

3-4 hours

Pt’s with Type 1 carrying an insulin pump need to check their BG how often?

Every 2 to 3 days

How often do you need to refill the insulin reservoir and an insulin pump?

Renal (kidneys)

Diabetics are at risk for what kind of issue

Metformin

What drug do you add contrast dye to

Hypoglycemia

By having more insulin in your bloodstream, what are you at risk for?

Sign of liver disease or damage

What happens when these enzymes are elevated in the bloodstream? Aspartame aminotransferase and alanine aminotransferase

What BG level is Low?

70

What BG level is dangerous?

60

For a type one patient when their blood sugar gets dangerously high at BG levels above 300 what is it called?

Ketoacidosis

For a patient who blood sugar gets dangerously high, how do you treat this?

Short acting regular IV insulin drip

Insulin

Made in the pancreas when blood sugar is high. Helps pull sugar out of the bloodstream into the liver into muscle and fat cells.

Incretin

The release of this hormone increases insulin

Amylin

Secreted along with insulin from the pancreas. Slows down the release of glucose into the bloodstream

Rapid Actin Insulin

Insulin lispro, Insulin Aspart, and Insulin Glulisine

Insulin Lispro takes how long to reach peak effect

1 hour

Insulin Glulisine takes how many minutes to work

Approximately 15 minutes

Regular insulin takes how many minutes to work and reach peak effect

Around 30 minutes to work and 1 hour until peak effect

NPH Insulin is what type of insulin

Intermediate Duration

NPH Insulin takes how long to work

60 minutes

How long does NPH Insulin take to reach peak effect?

6 hours

Long Duration Insulin

Insulin Glargine, Insulin Detemir, Basal Insulin

Overnight to maintain steady state

When do you administer long duration Insulin

Can you freeze insulin?

No

Metformin [Biguanide] MOA

Does not allow glucose to be made in the liver. Pulls glucose out of the blood and into the fat and skeletal muscle target tissues. 

Metformin [Biguanide] Side effects

Side effects: G.I Issues, B12 Deficiency causing fatigue. (*Lactic Acidosis* Causes buildup of lactic acid. Greater risk for patients with Renal issues (Kidneys)

Symptoms of LA is Tachycardia, RR increase, vomiting)

Sulfonylureas Drugs

Glipizide and Gluburide (Only work on type 2 diabetes pt’s)

Glipizide and Glyburide MOA

Promote release of insulin from the pancreas. Cannot use for Type 1 diabetes. Taken once a day and they last the entire day

Side effects: Hypoglycemia and weight gain.

Meglitinides Drugs

Repaglinide and Nateglinide

Repaglinide and Nateglinide MOA

Stimulate pancreatic B cells to release more insulin. Taken before each meal, no skipping meals 

Side effects: Weight gain

Thiazolidinediones Drugs

Rosiglitazone and Pioglitazone

Rosiglitazone and Pioglitazone MOA

Decrease insulin resistance

Side effects: It can Impact the kidneys to hold onto more fluid. An issue for heart failure patients   

Empagliflozin

SGLT-2 Drug

Empaglifozin MOA

Gets the sugar out of the urine, causes weight loss bc of excess water pushed out of system, and hyperkalemia (excess k+)

Empagliflozin SE

Side effects: Weight loss, urinary or genital complications. A risk of this drug is also gangrene

Sitagliptin MOA

Inhibits breakdown of DPP-4 and will lead to increased insulin release.

Sitagliptin SE

Side effects: Headache is main, joint pain, pancreatitis 

Semaglutide Drug class

GLP-1 Agonist

Semaglutide [GLP-1 Agonist] MOA

Weekly injection stimulating weight loss.

Side effects: GI main, pancreatitis. Black box warning: thyroid tumors. Ozempic, so weight loss.

• Aspartate Aminotransferase 

• Alanine Aminotransferase 

When these enzymes are elevated in the bloodstream, it may be a sign of liver disease or damage. 

When both these values are elevated in the bloodstream, it may indicate renal injury or failure.

• Blood Urea Nitrogen (BUN) 

• Creatinine 

Thyroid hormones

metabolism and cardiac function and growth/development 

T3 and T4

Thyroid Hormones

Iodine

Required to produce thyroid hormones

Graves Disease

Autoimmune condition which causes hyperthyroidism

Signs of hyperthyroidism

weight loss, diarrhea, heat intolerance, nervous/anxiety, sweating, tachycardia/palpitations, exophthalmos 

Methimazole (Tapazole)

treats hyperthyroidism by blocking the thyroid gland from making hormones 

Side effects: extreme hypothyroid signs, fever, rash, sore throat, jaundice, leukopenia due to agranulocytosis 

Agranulocytosis

low neutrophil count which means risk for infection, could also decrease RBC and platelets 

Hashimoto disease

This disease causes hypothyroidism

Signs of hypothyroidism

weight gain, constipation, hypothermia, depression, dry skin, fatigue, bradycardia, puffy face, impaired memory, weakness 

Synthetic form of T4

Levothyroxine

Levothyroxine

Side effects: hyperthyroidism, everything increase- HR, shakiness, nervousness, trouble sleeping)

• Need to report signs and symptoms that feel like MI 

Antidiuretic hormone (vasopressin, so increase BP)

stop you from losing too much water in urine 

Diabetes Insipidus

body doesn't make enough ADH and you lose too much water, due to damage to the pituitary gland. 

• If you have too little ADH then you can’t hold onto water so you make a lot of urine and become dehydrated and blood pressure may drop 

• Treatment can be DDAVP or hypertonic 3% sodium chloride 

Syndrome of inappropriate antidiuretic hormone

high ADH which means you will hold more fluid, and you urinate very little which means fluid-overload. Hyponatremia.

Desmopressin acetate

synthetic ADH, binds to receptors in the kidney to enhance water reabsorption at the end of the nephron. Helps the kidney hold onto water so less urine production and prevents dehydration. Treats DI 

• Used to treat diabetes insipidus, bedwetting 

• Administered SQ, IV, and nasal spray 

Side effects: water intoxication, hyponatremia, altered mental status, seizures.

Mineralocorticoid (aldosterone)

 promotes sodium reabsorption in exchange for potassium secretion 

Glucocorticoid (cortisol)

 increase availability of glucose. Also called stress hormone

Spironolactone (Aldactone)

blocks aldosterone receptors so you lose sodium and water through urine and keep potassium. 

• 50 or 100 mg for HTN or 200-400 mg for anti-androgen effect (blocks male hormones)

• Side effect: hyperkalemia

Addisons Disease

adrenal cortex doesn't make enough hormones (cortisol and aldosterone)

• GI disturbance, weight loss, hypoglycemia

Symptom support for addison's disease: treat hypoglycemia consider D5NS. treat for hypotension fluid will help 

Hydrocortisone

steroid that helps increase cortisol and aldosterone, teats addison disease 

Cushing Syndrome

Overproduction of hormones

How do you treat Cushing syndrome

 treat hyperglycemia like insulin or metformin. Treat fluid retention like diuretics. Treat for high bp, diuretic can help  

Steroids -(s)one

 suppress inflammatory genes that are turned on in chronic inflammation. Cause GI effects so take with food. Synthetic version of cortisol 

Side effects: altered mental status, hyperglycemia, increased appetite, fluid retention, weight gain

Anabolic steroids

synthetic version of testosterone. Builds muscle

Prednisone

corticosteroid, suppresses immune system and increase risk of infection

used for inflammation and allergies.

• Retinopathy

• Neuropathy

• Nephropathy

Hyperglycemia causes what problems?

Exercise

What can play a huge role in diabetic management?

Foods related to type 2 diabetes

Sugary foods, red meat, and processed foods

Alpha cells

Where is the hormone glucagon secreted from?

Conversion of glycogen to glucose and counteracts insulin.

Glucagon triggers what?

• Insulin Lispro

• Insulin Aspart

• Insulin Glulasine

Rapid acting insulin

• Regular insulin

Short acting insulin

• NPH Insulin

Intermediate acting insulin

• Insulin Glargine

• Insulin Detemir

Long-acting insulin

[Biguanide] Metformin

Most common type of med to treat type 2 diabetes without insulin.

Sodium Channel Blockers

Quinidine, Procaindamide, Lidocaine

Potassium Blocker

Amiodarone

Class 1 (Antiarrhythmic)

Which class is the largest group

Beta blockers

These drugs are used to slow down rhythm