NURS 1020, LECTURE NOTES; Week #3

Metabolism and Its Role in Diabetes

  • Initial Thoughts on Metabolism

    • Common associations with the term "metabolism":

    • Digestion

    • Energy processing

    • Related problems

  • Pathophysiology of Diabetes

    • Examination of physical assessment findings in diabetic patients.

    • Understanding signs and symptoms of diabetes.

    • Nursing responsibilities:

    • Importance of patient teaching related to self-management and understanding their condition.

Importance of Teaching in Nursing

  • Teaching Responsibilities

    • Critical for every medical diagnosis.

    • Continuous patient education, often unrecognized by the nurse.

  • Sensation Component

    • Mentioned as a broader concept addressed in multiple classes relating to hormonal effects and regulation.

Hormonal Regulation:

  • Endocrine Glands and Hormones

    • Endocrine glands secrete hormones directly into the bloodstream or tissues.

    • Hormones: Natural chemicals that exert effects on specific tissues.

    • Focus on regulating hormonal balances, identifying imbalances, and interventions required to restore balance.

  • Production and Secretion Issues

    • Problems of hormone deficiency or excess often rooted in:

    • Production issues.

    • Secretion issues.

    • Regulatory mechanism dysfunctions.

Overview of Endocrine System

  • Hypothalamus

    • Connects the nervous and endocrine systems, directing other glands.

  • Pituitary Gland

    • Referred to as the master gland; regulates other endocrine glands (e.g., anterior pituitary releases Thyroid Stimulating Hormone (TSH)).

  • Other Glands

    • Adrenal Glands: Release hydrocortisone and aldosterone, influencing water and salt balance.

    • Pancreas: Serves dual roles as both an endocrine and digestive gland.

    • Produces digestive enzymes and hormones like insulin and glucagon.

    • Other Endocrine Glands: Include hypothalamus, pituitary, thyroid, ovaries, and testes.

Hormonal Feedback Loops

  • Negative Feedback Loop

    • Hormonal secretion is responsive to physiological needs (e.g., insulin secretion is based on glucose levels).

  • Positive Feedback Loop

    • Increase in hormone levels leads to further elevation (e.g., menstrual cycle with estradiol stimulating further hormone release).

Circadian Rhythms and Stress Response

  • Circadian Rhythm

    • A 24-hour cycle influencing hormone secretion, such as cortisol.

  • Fight or Flight Response

    • Activation of the sympathetic nervous system during stress affects endocrine functions and may lead to hormonal imbalances.

Diabetes Focus

  • Pancreas and Hormone Regulation

    • The pancreas's role in metabolism, secreting insulin from beta cells in response to glucose levels.

    • Alpha cells produce glucagon for low glucose levels.

  • Islets of Langerhans

    • Structures in the pancreas with three cell types:

    • Alpha Cells: Produce glucagon.

    • Beta Cells: Produce insulin.

    • Delta Cells: Produce somatostatin.

Types of Diabetes

  • Type 1 Diabetes

    • Previously referred to as insulin-dependent diabetes.

    • Characterized by autoimmune destruction of beta cells.

    • No insulin production.

  • Type 2 Diabetes

    • Previously referred to as non-insulin-dependent.

    • Some insulin production but with insulin resistance.

    • More common in older adults.

  • Gestational Diabetes

    • Develops during pregnancy, affecting around 7% of women.

  • Impaired Glucose Tolerance

    • Prediabetic range: Fasting glucose between 100-125 mg/dL or 140-199 mg/dL for a 2-hour glucose tolerance test.

Risk Factors for Diabetes

  • Risk Factors:

    • Abnormal levels of cholesterol and triglycerides increase risk of type 2 diabetes.

    • History of gestational diabetes increases risk.

Hyperglycemia Mechanism

  • Effects of Hyperglycemia

    • Causes serum osmolality changes, drawing water from cells into circulation.

    • Results in increased blood volume and renal blood flow.

    • Acts as an osmotic diuretic, leading to polyuria and polydipsia.

Laboratory Indicators

  • BUN (Blood Urea Nitrogen)

    • Elevated BUN can indicate dehydration.

  • Creatinine

    • Indicator of kidney function.

  • Hemoglobin A1c

    • Measure of long-term glucose control.

    • > 6.5% is considered elevated.

  • Urinalysis

    • Checks for glucose and ketone levels, though less accurate than serum tests.

Management of Diabetes

  • Hypoglycemia Management

    • Mild hypoglycemia: Administer 15 grams of rapid-acting sugar if the patient is alert.

    • If unresponsive and with IV access, administer dextrose intravenously.

  • Sliding Scale Insulin Doses

    • Based on current blood glucose levels, e.g., for levels from 141 to 200.

  • Understanding Patient Symptoms

    • Monitor the range of symptoms for hypoglycemia from consciousness changes to diabetic reactions.

Key Takeaways

  • Diabetes is a complex disorder necessitating a nuanced understanding of glucose regulation, hormonal interplay, and proper patient management strategies.

  • Continuous assessment through lab work plays a critical role in evaluating and adjusting treatment plans for diabetic patients, emphasizing the interconnectedness of various bodily systems in maintaining metabolic health.