Endocrine System

• The endocrine system is made up of glands that regulate numerous processes throughout the body by secreting chemical messengers called hormones

• Hormones: A secretion released by an endocrine gland into the circulatory system that has a specific regulatory effect on organs and other tissues. They regulate a wide variety of bodily processes, including metabolism, growth and development, sexual reproduction, the sleep-wake cycle, and hunger

Diabetes

What is Diabetes?

A chronic metabolic disorder that affects the body’s ability to produce and use insulin, a hormone that regulates the cellular reuptake of glucose (sugar). The disease is characterized by high blood glucose due to insufficient levels of insulin produced by the pancreas.

How diabetes affects the body and endocrine system?

1. Insulin is essential for regulating blood glucose levels. In diabetes, the lack of insulin or its reduced effectiveness results in elevated blood glucose levels (hyperglycemia). Chronically high blood glucose levels can damage various organs and tissues over time.

2. Diabetes can also affect the production and action of other hormones in the endocrine system. For example, elevated blood glucose levels can lead to increased secretion of counter-regulatory hormones such as glucagon, cortisol, and adrenaline, which further contribute to hyperglycemia

3. Over time, chronic hyperglycemia in diabetes can lead to various complications affecting multiple organ systems, including the eyes (diabetic retinopathy), kidneys (diabetic nephropathy), nerves (diabetic neuropathy), and blood vessels (increased risk of cardiovascular diseases)

4. The endocrine system is interconnected, and distubrances in one gland’s function can affect other glands. For instance, diabetes and its complications can influence the function of the hypothalamus, pituitary gland, and adrenal glands, leading to a broader impact on hormonal regulation in the body

Type 1 vs type 2

Type 1 diabetes, the immune system mistakenly attacks and destroys the insulin-producing beta cells in the pancreas. This leads to a severe deficiency of insulin, disrupting the endocrine system’s normal function.

It is an autoimmune condition. The immune system mistakenly attacks and destroys insulin-producing beta cells in the pancreas. As a result, the pancreas produces little to no insulin. The exact cause of the immune system’s attack is not fully understood, but genetic and environmental factors are believed to play a role.

It often develops in childhood or early adulthood, but it can occur at any age. Makes up 5-10% of diabetic cases.

People with type 1 diabates are dependent on insulin for survival. They need to take insulin via injections or insulin pump to regulate blood glucose levels effectively.

Family history of the disease, genetic predisposition, and exposure to certain environmental triggers are among the risk factors.

Type 2 diabetes, the pancreas may produce insulin, but the body’s cells become resistant to its effects, leading to insufficient glucose uptake and utilization.

It is primarily a metabolic disorder characterized by insulin resistance, where the body’s cells do not respond effectively to insulin, and insulin production may be insufficient. Initially, the pancreas may produce extra insulin to compensate for the resistance, but over time, the pancreas may not keep up with the demand, leading to relative insulin deficiency.

It typically occurs in adulthood, but due to the rising prevalence of obesity and sedentary lifestyles, type 2 diabetes is increasingly being diagnosed in children and adolescents. Makes up 80-90% of diabetic cases.

Initially, people with type 2 diabetes may manage their condition through lifestyle changes, oral medications, or non-insulin injectables. In some cases, insulin therapy may be required if other treatments are not sufficient to control blood sugar levels.

Risk factors include obesity, sedentary lifestyle, family history of the disease, age, and ethnicity

Gestational Diabetes

• Occurs during pregnancy due to insulin resistance caused by elevated hormone levels

• Onset in the 2nd and 3rd trimesters

• Treated with exercise, diet, and insulin

• Disappears usually after birth but 30-40% of patients will become more prone to develop diabetes later in life

Symptoms

• Frequent urination, often at night (nocturia)

• Increased thirst

• Sudden weight loss

• Hunger

• Blurred vision

• Numbness or tingling of hands or feet (neuropathy)

• Weakness

• Dry itchy skin

• Slow healing cuts or sores

• Prone to more infections than usual

Complications of Diabetes

• Heart disease

• Chronic kidney disease

• Nerve damage

• Loss of vision

• Diabetic foot ulcer

• Infections

• Heart attack

• Stroke

Diagnosing Diabetes

Blood tests are used to diagnose diabetes and pre-diabetes. Any one of the following tests can be used to diagnose diabetes:

• An A1C test: Glycosylated hemoglobin test, measures the amount of hemoglobin A1C in the blood as a means of determining the average blood sugar concentrations for the preceding 2-3 months. Used to determine how well your diabetes is being controlled.

• A fasting plasma glucose (FPG) test

• An oral glucose tolerance test (OGTT) also called a casual test

Diagnostic Lab Values

Treating Diabetes

• Lifestyle change (diet, exercise)

• Oral monotherapy

• Combination oral therapy

• Oral drug plus insulin

• Insulin only

Insulin

• Used for both Type I and II diabetes

• Only treatment for Type 1 diabetes

• Lowers blood sugar by helping move sugar from the bloodstream into your cells

• Rotate injection sites (abdomen, arms, legs, buttocks)

• Subcutaneous injection

• Refrigerated but can be stored at room temperature for up to 28 days

• Good for 28 days after first use

Types of Insulin

Treatment of Hypoglycemia

• Orange juice

• Milk

• Glucose tablet

• Glucagon injection

• Baqsimi (dry nasal spray) glucagon

Insulin Dosage Forms

1. Syringe and needle

2. Self-injector Pens; a device that contains the insulin and uses pen needles to pierce the skin to pump a dialed amount of the drug into the body; easy administration

3. Insulin Pump - delivers insulin through a tiny tube inserted just under the skin

American Diabetes Association Recommendations for Type II Diabetes

• Ace inhibitor (unless BP is under 130/80

  • Controls blood pressure

  • Prevents neuropathies

  • Protects kidneys

• Statin (unless LDL is less than 100 and HDL is greater than 40)

• Enteric coated aspirin

Thyroid Disorders

The thyroid is a butterfly-shaped gland in the lower front of the neck. It helps us use energy, stay warm, and keep the brain, heart, and muscles alert.

Hypothyroidism

Results from underactive thyroid gland and will require lifelong treatment. If untreated may lead to memory problems, depression, and weight gain.

Hashimoto’s Disease is an autoimmune disorder that leads to decreased thyroid production and death of the thyroid.

Symptoms of Hypothyroidism

• Tiredness

• Being sensitive to cold

• Weight gain

• Constipation

• Depression

• Slow movements and thoughts

• Muscle aches and weakness

• Muscle cramps

Hyperthyroidism

The thyroid is making too much thyroid hormone, Often referred to as “overactive thyroid”

Grave’s Disease can be caused by an autoimmune condition where the body makes too much thyroid.

Symptoms of Hyperthyroidism

• Increased sweating

• Increased heart rate

• Hand tremors

• Anxiety/nervousness

• Weight loss

• Hair loss

• Bulging of the eyes

• Enlarged thyroid gland

Menopause

• Decreased estrogen and progesterone production

• Irregular periods

• Vaginal dryness

• Hot flashes

• Chills

• Night sweats

• Sleep problems

• Mood changes

• Weight gain and slowed metabolism

Risks of Hormone Replacement Therapy for Menopause

• Breast cancer

• Stroke

• Myocardial infarction

• Use if risk factors do not outweigh potential benefit