chronic - module 4 (diabetes mellitus)

what are the messengers of the endocrine system?

hormones

what are the structures of the endocrine system?

hypothalamus, pituitary gland (anterior/posterior), gonads, adrenal glands (cortex/medulla), thyroid, parathyroid, pancreas (islets of langerhans), & thymus

what is the thyroid?

metabolism

what is the parathyroid?

calcium regulation

what is the thymus?

immune function

what is the phrase for hormone-receptor binding?

"lock & key"

what kind of feedback system is the endocrine system?

negative

what are the laboratory tests done in the endocrine system?

provocative/suppression tests, assays, urine tests, glucose tests, radiographic examinations, & others

what are provocative/suppression tests used for?

stimulating organs

what do assays determine?

amount of a hormone circulating

what happens to ADH as age progresses?

decreases

what happens to ovarian as age progresses?

decreases

what happens to glucose as age progresses?

decreases

what happens to general metabolism as age progresses?

decreases

what is the word that goes along with DM?

hyperglycemia

what is hypoglycemia?

the undertreatment of hyperglycemia

what are the 3 cells of the pancreas?

beta cells (insulin), alpha cells (glucagon), & delta cells (somatostatin)

what are the 3 p's of DM?

polyphagia, polydipsia, & polyuria

what is the pancreas known as?

insulin machine

what is DM type I?

absence of insulin

what builds up in type I?

ketones & lactic acid

type I causes metabolic what?

acidosis

what is the compensatory for metabolic acidosis?

respiratory alkalosis

what respirations are used for ketoacidosis?

kussmaul respirations

what does type I DM do to potassium levels?

alters them; hypokalemia or hyperkalemia

what is DM type II?

insulin resistance/deficit

what are the causes of type II?

insulin resistance at the cellular level & insulin secretion deficit (decreased insuline production)

what are the risk factors for type II?

age (over 30), family history, & lifestyle (obese/sedentary)

what assessments are done for DM?

history, blood tests (FBS, oral glucose test), HgbA1C, urine tests, & tests for renal function

what is FBS?

a snapshot; fasting blood glucose; 2 tests >126mg/dL

what is the oral glucose tolerance test?

blood glucose >200mg/dL at 120 minutes

what is HgbA1C?

glycosylated hemoglobin assays; 4-6% is considered good

what is looked for in urine tests?

ketones

what are the signs/symptoms for hyperglycemia?

polydipsia, polyuria, polyphagia, blurred vision, dry skin, & nausea

what are 3 acute complications of DM?

DKA (diabetic ketoacidosis) for type I, HHS (hyperglycemic-hyperosmolar nonketoic state) for type II, and hypoglycemia

what are the 2 categories of chronic complications?

macrovascular & microvascular

what are the macrovascular complications?

cardiovascular disease, cerebrovascular disease, peripheral vascular disease, & reduced immunity

what is the leading cause of death for daibetics?

myocardial infarction (MI) or heart attack

what are the microvascular complications?

nephropathy, retinopathy, neuropathy, autonomic neuropathy, & peripheral neuropathy

what is involved in autonomic neuropathy?

tachycardia, GI, GU, & sexual dysfuntion

what is involved in peripheral neuropathy?

maintenance of blood glucose levels, anticonvulsants (gabapentin), & antidepressants

what does neuropathic pain feel like?

burning

what are foot care practices for diabetics?

cleanse/inspect feet daily, test bath water with thermometer, wear properly fitting shoes, avoid walking barefoot, trim toenails properly, & report nonhealing breaks

what are nursing interventions for diabetic patients with nephropathy?

control of blood glucose levels, control of blood pressure, yearly evaluation of kidney function, avoidance of nephrotoxic drugs, & prompt treatment of UTIs

what is treatment for DM type II?

weight loss, exercise (decrease insulin resistance), diet control of calories vs. available insulin, & meds (PO, insulin)

what can alcohol cause in diabetics?

alcohol-induced hypoglycemia

what is true, in general, about drug therapy with DM type II?

take before or with meals

what can pancreatic stimulators cause?

hypoglycemia

what are the less common signs & symptoms of drug therapy with DM type II?

n & v

what is the initial drug therapy for type II DM?

metformin (aka glucophage); monitor renal function

what are alternate drug therapies for "think pancreas"?

sulfonylureas & meglitinides

what are the 2 sulfonylureas?

glipizide & glyburide

what do sulfonylureas do?

increase insulin production & increase insulin sensitivity

what is a meglitinide?

repaglinide

what do meglitinides do?

increse insuline production

what are alternate drug therapies for "think liver"?

biguanides & thiazolidinedones

what is a biguanide?

metformin

what do biguanides do?

decrease glycogenolysis (creation of sugar) & increase insulin sensitivty

what are the 2 thiazolidinediones?

rosiglitazone & pioglitazone

what do thiazolidinediones do?

decrease glycogenesis & increase insulin sensitivity

what are alternate drug therapies for "think intestines"?

alpha-glucosidase inhibitors, DPP-4 inhibitors, & GLP-1 agonists

what is an alpha-glucosidse inhibitor?

acarbose

what do alpha-glucosidase inhibitors do?

decrease starch digestion & decrease glucose absorption

what is a DPP-4 inhibitor?

sitagliptin

what do DPP-4 inhibitors do?

decrease glucagon/glycogenesis & decrease gastric emptying

what are 2 GLP-1 agonists?

dulaglutide & semaglutide

what do GLP-1 agonists do?

decrease glucagon/glycogenesis & decrease gastric emptying

what are alternate drug therapies for "think kidneys"?

SGLT2 inhibitors

what is a SGLT2 inhibitor?

empagliflozin

what do SGLT2 inhibitors do?

decrease renal glucose absorption

what is the drug therapy for DM type I & type II?

insulin

what are the 2 main types of insulin?

short acting & long acting

what are 2 insulin administration considerations?

injection site & time of injection

what is client education for insulin?

storage/dose preparation, syringes, blood glucose monitoring, interpretation of results, frequency of testing, & blood glucose therapy goals

what are complications of insulin therapy?

hypoglycemia, lipoatrophy, lipohypertrophy, dawn phenomenon, & somagyi's phenomenon

what is the saying for hyperglycemia?

hot & dry

what is the saying for hypoglycemia?

cold & clammy

what are the signs/symptoms for hypoglycemia?

shaking, tachycardia, sweating, dizziness, hunger, & impaired vision

what is the mild/moderate indication of hypoglycemia?

what is the treatment for mild/moderate hypoglycemia?

glucose tabs, candy, juice/soda (4oz), & skim milk (8oz)

what is the severe indication of hypoglycemia?

what is the treatment for severe hypoglycemia?

glucagon (SQ, IM) or dextrose (IV)

what is the treatment for skin problems related to DM?

rotate sites

what is the treatment for lack of insulin related to DM?

give adequate

what is the dawn phenom?

high blood glucose at 6am due to release of GH (growth hormone)

what is the somogyi phenom?

high blood glucose in am due to pm hypoglycemia (rebound effect, adjust pm insulin)