Endocrine and Metabolic Disorders

normal glucose control

the result of nutrients, neural and hormonal regulation

metabolic hormones are released by ?

islets of Langerhans in the pancreas

insulin

allows uptake of glucose from the blood-stream; suppresses hepatic glucose production, lowering plasma glucose levels. secreted by the beta cells

glucagon

stimulates hepatic glucose production to raise glucose levels, especially in fasting state. secreted by the alpha cells

amylin

modulates rate of nutrient delivery (gastric emptying); suppresses release of glucagon. secreted by beta cells

somatostatin

acts locally to depress secretion of both insulin and glycogen; decreases motility of stomach, duodenum, and gallbladder; decreases secretion and absorption of GI tract. secreted by delta cells

what is the metabolic syndrome?

(syndrome x)

cluster of risk factors that increase the likelihood of developing heart disease, stroke, and type 2 diabetes

criteria for dx of metabolic syndrome

3 or more of the following:

a. abdominal obesity (M: 45 in; F: 35 in)

b. cholesterol

-- elevated triglycerides (150 mg/dL)

-- low HDL (M: less than 40; F: less than50)

-- on cholesterol meds

c. high BP (> 135/85)

high blood sugar (100 mg/dL)

characteristics of diabetes mellitus

complex disorder of carbohydrate, fate, and protein metabolism caused by deficiency or absence of insulin secretion by the beta cells of the pancreas or by defects of the insulin receptors. causes an abnormally high level of sugar or glucose in the blood

type 1 DM

insulin dependent

juvenile-onset

characteristics of type 1 DM

- dec in number of islet cells = def in insulin secretion

- onset = puberty

- requires insulin delivery by injection, pump, or inhalation

- prone to ketoacidosis

type 2 CM

insulin resistance

characteristics of type 2 DM

gradual onset

not insulin dependent

not prone to ketoacidosis

progressive disease

risk factors of type 2 DM

obesity and older adults

family hx of diabetes

unhealthy eating patterns

lack of physical activity

secondary diabetes

associated with other conditions, endocrine disease, drugs, and chemical agents

gestational diabetes mellitus (GDM)

glucose intolerance (high blood sugar) associated with pregnancy; most likely in 3rd trimester. affects approximately 4% of pregnancies

classic signs and symptoms of DM

elevated blood sugar

elevated sugar in urine

excessive excretion of urine

excessive thirst

excessive hunger

unexplained weight loss

fatigue

blurred vision

microvascular complications of DM

retinopathy

renal disease

polyneuropathy

macrovascular complications of DM

dyslipidemia (accelerated atherosclerosis)

- CVA

- MI

- PAD

integumentary complications of DM

*degenerative connective tissue changes

*slow healing

*anhidrosis (inability to sweat adequately)

*increased risk of ulcers/infection

musculoskeletal complications of DM

- joint stiffness and increased risk of contractions

- increased risk of adhesive capsulitis of shoulder, tenosynovitis, plantar fasciitis

- increased risk of osteoporosis

neuromuscular complications of DM

diabetic polyneuropathy

diabetic autonomic neuropathy

mononeuropathies

entrapment neuropathies

diabetic polyneuropathy

- symmetrical numbness and tingling of the hands and feet (stocking and glove distribution)

- distal (long nerves first) progressing to proximal

- altered sensations; paresthesias, shooting pain; loss of protective sensations

- motor weakness: foot/ankle weakness initially with balance and gait impairments

diagnostic criteria for DM

1. sx of diabetes plus glucose concentration >200

2. fasting plasma glucose ?126

3. 2 hr postload glucose > 200 during an oral glucose tolerance test

outcomes of regular exercise in DM patients

improved glucose tolerance

increased insulin sensitivity

decreased glycosylated hemoglobin

decreased insulin requirements

exercise intensity recommendations for DM patients

50-80% of max oxygen uptake or HRR

3-7 days/week

20-60 min

_______ is the most common problem for patients with diabetes who exercise

hypoglycemia

do not exercise is blood glucose is __________

less than 70 mg/dL

or fasting glucose greater than 300

signs and symptoms of hypoglycemia

Early:

-pallor

-shakiness/trembling

-sweating

-excessive hunger

-tachycardia and palpitations

-fainting or feeling faint

-dizziness

-fatigue and weakness

-poor coordination and unsteady gait

Late:

- nervousness and irritability

- headache

- blurred or double vision

- slurred speech

- drowsiness

- inability to concentrate

- LOC

signs of hyperglycemia

weakness

increased thirst

dry mouth

frequent urination

dec appetite

dulled senses

flushed

deep respirations

rapid and weak pulse

fruity odor

BMI

weight (kg) / height (m^2)

overweight BMI

25-29.9

obesity BMI

30 or greater

morbid obesity BMI

over 40

health risks associated with obesity

hypertension

hyperlipidemia

type 2 DM

CV disease

stroke

glucose intolerance

gallbladder disease

menstrual irregularities & infertility

endometrium, breast, prostate, and colon CA

______ obesity is an independent predictor of morbidity and mortality

abdominal

diet recommendations for obesity prevention and management

reduced caloric intake

fat intake of <30%

emphasis of fruits, veggies, whole grains, and lean protein

exercise prescription (ACSM guidelines) for obesity

gradual progression to prevent injury

5-7 days/week

30-60 minutes

aerobic physical activities (circuit training)

hypothyroidism

decreased activity of the thyroid gland with deficient thyroid secretion

- metabolic processes are SLOWED

sx of hypothyroidism

weight gain

mental and physical lethargy

dry skin and hair

low BP

constipation

intolerance to cold

goiter

Myxedema

if hypothyroidism is left untreated, what can occur

myxedema (severe hypothyroidism) with sx of swelling of hands, feet and face

red flags for hypothyroidism

can result in exercise intolerance, weakness, apathy; exercise induced myalgia; reduced CO

hyperthyroidism

hyperactivity of the thyroid gland

grave's disease

hyperthyroidism

symptoms of hyperthryoidism

nervousness, hyperreflexia, tremor, hunger, weight loss, fatigue, heat intolerance, palpitations, tachycardia, goiter, diarrhea

addison's disease

primary adrenal insufficiency

- partial or complete failure of adrenocortical function: results in dec production of cortisol and aldosterone

signs and symptoms of addison's disease

increased bronze pigmentation of skin

weakness, dec endurance

anorexia, dehydration, weight loss, GI issues

anxiety, depression

decreased tolerance to cold

intolerance to stress

Cushing's syndrome

metabolic disorder resulting from chronic and excessive production of cortisol by adrenal cortex

cause of cushing's

pituitary tumor with increased secretion of ACTH

signs and symptoms of cushing's

decreased glucose tolerance

round "moon" face

obesity - buffalo hump

decreased testosterone or decreased menstrual period

muscular atrophy

edema

hypokalemia

emotional changes