Endocrine Refresh VOCABULARY Flashcards

Page 1

• Endocrine Refresh
• NR325

Page 2

• Endocrine System components listed
  • Parathyroid Gland
  • Adrenal Gland
  • Kidney
  • Stomach
  • Brain
  • Thyroid Gland
  • Skin
  • Hypothalamus
  • Testicle
  • Liver
  • Pineal Gland
  • Pituitary Gland
  • Thymus
  • Uterus
  • Ovary
  • Pancreas

Page 3

• Pituitary Gland Hormones (Anterior Pituitary Gland)
  • Adrenocorticotropic hormone (ACTH)
  • Follicle-stimulating hormone (FSH)
  • Luteinizing hormone (LH)
  • Growth hormone (GH), or somatotropin
  • Melanocyte-stimulating hormone (MSH)
  • Thyroid-stimulating hormone (TSH), or thyrotropin
• Target Tissues & Functions
  • ACTH → Adrenal cortex
  • FSH & LH (Gonadotropic hormones) → Reproductive organs
  • GH → All body cells
  • MSH → Melanocytes in the skin
  • TSH → Thyroid gland
• Specific Functions
  • Growth of the adrenal cortex; corticosteroid secretion
  • Secretion of sex hormones resulting in reproductive organ growth; reproductive processes
  • Promotes growth and tissue repair
  • Increases melanin production in melanocytes making skin darker
  • Stimulates milk production in lactating women; increases response of follicles to LH and FSH; stimulates synthesis and release of thyroid hormones
• Posterior Pituitary Gland Hormones
  • Antidiuretic hormone (ADH)
  • Oxytocin
  • Target tissues/functions
  • ADH → Renal tubules; promotes water reabsorption from renal tubules; vascular smooth muscle effects
  • Oxytocin → Uterus; Mammary glands; stimulates uterine contractions and milk secretion

Page 4

• Thyroid Gland & Parathyroid Gland Hormones
• Hormones
  • Calcitonin (thyroid) → Bone tissue; regulates serum calcium and phosphorus (lowers serum Ca)
  • Thyroxine (T4) (thyroid) → All body tissues; precursor to T3
  • Triiodothyronine (T3) (thyroid) → All body tissues; regulates metabolic rate
  • Parathyroid hormone (PTH), or parathormone (parathyroid) → Bone; intestines; kidneys; regulates cell growth and tissue differentiation; increases serum Ca; promotes bone demineralization; increases intestinal absorption of Ca
• Note on relationship: Calcitonin lowers serum Ca; PTH raises serum Ca

Page 5

• Adrenal Gland Hormones and Tumors
• Hormones
  • Epinephrine (adrenaline)
  • Norepinephrine (noradrenaline)
  • Androgens and estradiol
  • Corticosteroids
  • Mineralocorticoids
  • Adrenal Gland Tumors (catecholamine-secreting or steroid-secreting tumors)
• Target Tissues & Functions (summary interpretation)
  • Epinephrine → Reproductive organs (generalized SNS effect when stressed)
  • Norepinephrine → All body tissues (SNS support)
  • Androgens and estradiol → Kidney (androgenic effects) and secondary sexual characteristics (context from content)
  • Corticosteroids (glucocorticoids) → Adrenal cortex functions: promote growth during adolescence; anti-inflammatory properties; regulate metabolism; respond to stress
  • Mineralocorticoids (e.g., aldosterone) → Regulate sodium and potassium balance and water balance; influence blood volume and pressure
• Adrenal Gland Tumors
  • Can cause excess catecholamines or steroids depending on tumor type
• General emphasis from the page
  • Catecholamines increase in response to stress and enhance/prolong SNS effects
  • Adrenal cortex hormones (corticosteroids) support stress, metabolism, growth, and immune modulation; mineralocorticoids regulate electrolyte/water balance

Page 6

• Pancreatic Hormones and their targets/functions
• Amylin (from beta cells) → Pancreas; targets Liver and Stomach
  • Function: decreases gastric motility; decreases glucagon secretion; decreases endogenous glucose release from the liver; increases satiety
• Glucagon (from alpha cells) → General
  • Function: stimulates glycogenolysis and gluconeogenesis
• Insulin (from beta cells) → General
  • Function: promotes glucose transport from the blood into the cells
• Pancreatic polypeptide (from F cells) → General
  • Function: influences regulation of pancreatic function and metabolism of absorbed nutrients
• Somatostatin (from delta cells) → Pancreas
  • Function: inhibits insulin and glucagon secretion
• Summary: Pancreas hormones regulate glucose and energy metabolism with insulin and glucagon as key regulators; amylin and pancreatic polypeptide modulate digestion and pancreatic function; somatostatin regulates the pancreatic endocrine/exocrine environment

Page 7

• Gonadal Hormones and Reproductive Characteristics
• Hormones
  • Estrogen
  • Progesterone
  • Testosterone
• Target Tissues
  • Estrogen & Progesterone → ovaries (and reproductive system, breast tissue)
  • Testosterone → testes (gonads)
• Functions
  • Estrogen: stimulates development of secondary sexual characteristics; maintains lining of the uterus for pregnancy
  • Progesterone: prepares uterus for fertilization and fetal development; maintains uterine lining
  • Testosterone: stimulates development of secondary sexual characteristics; spermatogenesis

Page 8

• Common Endocrine Disorders (overview)
• Hormones involved in disorders (examples)
  • Adrenocorticotropic hormone or adrenal corticosteroids
  • Growth hormone
  • Antidiuretic hormone
  • Thyroid-stimulating hormone
  • Parathyroid hormone
• Over-Secretion (examples)
  • Hypercortisolism (Cushing's disease)
  • Acromegaly
  • Syndrome of inappropriate antidiuretic hormone (SIADH)
  • Hyperthyroidism
  • Hyperparathyroidism
• Under-Secretion (examples)
  • Adrenal insufficiency (Addison's disease)
  • Dwarfism
  • Diabetes insipidus
  • Hypothyroidism
  • Hypoparathyroidism

Page 9

• Antidiuretic Hormone Problems
  • SIADH and Diabetes Insipidus (DI)
• Pathophysiology (summary)
  • SIADH: excessive ADH → water retention, hyponatremia
  • Central DI and nephrogenic DI: ADH deficiency or resistance → polyuria, hypernatremia
• Etiology (examples)
  • Lung cancer, head trauma, some drugs (for SIADH/central DI)
  • Head injury or nephrogenic causes for DI
• Symptoms/Diagnostic tests (summary)
  • SIADH: hypervolemia, hyponatremia, low serum osmolality; urine osmolality high; low urine output
  • DI: hypovolemia, hypernatremia, high serum osmolality; urine output high; urine specific gravity low

Page 10

• ADH imbalance: Nursing care and treatments
• SIADH treatment considerations
  • Strict intake and output (I&O)
  • Cardiovascular monitoring
  • Daily weights
  • Seizure precautions
• Diabetes Insipidus treatments
  • Treat underlying cause
  • Fluid restriction (for SIADH) vs hypertonic saline in severe hyponatremia (not for DI)
  • Desmopressin (DDAVP) for DI
  • Low sodium diet
• Diagnostic tests mentioned
  • Water deprivation test
• General nursing notes
  • Monitor electrolytes, fluid status, neuro status

Page 11

• Thyroid Problems (introductory header)

Page 12

• Thyroid Problems: Diagnostic Tests and Normal Values
• Tests and normal ranges (summarized)
  • TSH: 0.3–4.2
  • T4 (Total): 4.5–11.7; T4 (Free): 0.8–2.8
  • T3: 80–200
  • Calcitonin: Male < 14.3; Female < 7.6
• Anticipated findings by condition (summary)
  • Abnormal TSH and T4/T3 indicate hypo- or hyperthyroidism
  • Calcitonin is a tumor marker for medullary thyroid carcinoma

Page 13

• Thyroid Problems: Common Symptoms by Condition
• Hypothyroidism
  • Dry hair; constipation; weight gain; cold intolerance; goiter; slow heart rate; fatigue; hair and skin changes
• Hyperthyroidism
  • Hair loss; heat intolerance; goiter; weight loss; tachycardia; rapid heartbeat; diarrhea; infertility risks
• Menstrual changes
  • Irregular cycles; possible infertility

Page 14

• Hyperthyroidism Causes & Feedback
• Graves' disease highlighted as a cause
• Mechanism concepts
  • Primary hyperthyroidism (thyroid origin)
  • Secondary hyperthyroidism (outside thyroid, e.g., pituitary)
  • Hormonal feedback loops and potential heredity factors
• Other contributing factors listed: injury to thyroid gland, nerve shocks, infections, medications, thyroid dysfunction, etc.

Page 15

• Graves' Disease Symptoms (key features)
  • Sweating; exophthalmos; goiter; weight loss; nervousness; tremor; tachycardia; nausea/diarrhea; irritability; menstrual changes; muscle weakness; headaches

Page 16

• Hyperthyroidism Manifestations by System
• Nervous system: hyperreflexia, anxiety, rapid speech, irritability, tremors, insomnia, sleep pattern changes
• Reproductive system: decreased libido; menstrual irregularities; infertility
• Cardiovascular: hypertension, tachycardia, bounding pulses, systolic murmurs; angina
• GI: increased hunger/thirst, diarrhea, hyperactive bowel sounds
• Integumentary: warm moist skin; hair/nail changes; diaphoresis; skin fragility
• Other: heat intolerance; exercise intolerance; risk for falls; osteoporosis; thyroid storm; impaired thermoregulation
• Respiratory: tachypnea
• Skin integrity and overall risk considerations

Page 17

• More Hyperthyroidism Systemic Effects
• Nervous, reproductive, respiratory, integumentary systems effects continue
• Other effects: impaired skin integrity, risk for ineffective thermoregulation, thyroid storm (acute) and possible delirium

Page 18

• Acute Thyrotoxicosis: Thyroid Storm
• Treatment principles
  • Antithyroid medications
  • Rest, fluid/electrolyte replacement
  • Oxygenation management
  • Cardiac dysrhythmia management
  • Cooling
  • Pain/anxiety relief
  • ABCs (Airway, Breathing, Circulation) monitoring

Page 19

• Hyperthyroidism: Treatments listed
• Antithyroid medications: Propylthiouracil and methimazole
• Iodine therapy
• Beta-adrenergic blockers
• Radioactive iodine therapy
• Surgical therapy
• Nutritional therapy: high-calorie, high-protein, high-carbohydrate diet; vitamins/minerals; low-fiber; avoid caffeine

Page 20

• Hyperthyroidism: Nursing Care
• Environment: Calm, quiet room; frequent linen changes due to diaphoresis
• Emotional support for anxiety/irritability
• Calorie/protein intake increase
• Do not palpate thyroid (stimulates hormone release)
• Exophthalmos care: sodium restriction; raise HOB; artificial tears; sunglasses

Page 21

• Post-Op Care: Thyroidectomy
• Preop: Antithyroid meds, iodine, beta-blockers as indicated
• Postop monitoring: risk of hypothyroidism, hypoparathyroidism, hypocalcemia, hemorrhage, infection, thyrotoxicosis, airway patency
• Positioning: Semi-Fowler's; support head/neck with pillows; avoid neck flexion; pain control

Page 22

• Hypothyroidism: Pathways & Causes
• Pituitary dysfunction vs Thyroid dysfunction
• Negative feedback loop: ↓ T4/T3 reduces TSH (depending on origin)
• Causes of hypothyroidism
  • Iodine deficiency; thyroid inflammation/injury; drug therapies that suppress thyroid function; partial/complete thyroid gland destruction; use of radioactive iodine; congenital anomalies; environmental factors
• Primary vs Secondary hypothyroidism definitions
  • Primary: thyroid-origin (TSH elevation with low T4/T3)
  • Secondary: pituitary/hypothalamic origin (low TSH or inappropriate TSH response with low T4/T3)

Page 23

• Hashimoto's Thyroiditis (autoimmune)
  • Symptoms: dry/thinning hair; enlarged/inflamed thyroid; joint/muscle pain; heavy/irregular menstrual periods; feeling cold; autoantibodies present

Page 24

• Hypothyroidism: Body System Manifestations (Summary)
• Cardiovascular: hypotension, bradycardia; decreased cardiac output; cholesterol elevation
• GI: decreased appetite, constipation; hypoactive bowel sounds
• Musculoskeletal: fatigue, muscle aches; joint pain; slow movements
• Nervous: slowed mental processes; hyporeflexia; depression; memory issues; hoarseness
• Complications: cardiac hypertrophy, heart failure, anemia, atherosclerosis; weight gain; risk for falls
• Nursing Diagnoses (examples): risk for unstable blood pressure; ineffective peripheral tissue perfusion; dysmotility; nutrition imbalance; fall risk; immune/skin concerns

Page 25

• Hypothyroidism: Reproductive, Respiratory, Integumentary, and Other System Effects
• Reproductive: menstrual irregularities, infertility
• Respiratory: bradypnea; reduced breathing capacity; dyspnea with exertion
• Integumentary: dry, thick, cold skin; dry hair; poor turgor; generalized edema; dry mucosa
• Other: decreased sweating; goiter; cold intolerance; infection risk; hearing changes; constipation; myxedema coma risk; thermoregulation issues

Page 26

• Causes of Goiters and Thyroiditis
• Drugs: Amiodarone, Lithium
• Foods: cruciferous vegetables (broccoli, Brussels sprouts, cabbage, cauliflower, kale, mustard greens, turnips), peanuts, strawberries; salicylates; sulfonamides

Page 27

• Myxedema Coma
  • Medical emergency! Often due to infection, medications (opioids, barbiturates), cold exposure, trauma
  • Manifestations: subnormal temperatures, extreme hypotension, hypothermia, severe bradycardia, hypoventilation
  • Nursing care: aspiration precautions, airway support, measures to prevent cardiovascular collapse

Page 28

• Levothyroxine Review
• Dosage: start low, titrate every 4–5 weeks based on TSH
• Full effect up to ~8 weeks
• Avoid abrupt cessation
• Watch for hyperthyroid signs (overmedication)
• Interactions: ↑ effect with anticoagulants; ↓ effect with digoxin
• Diabetics may need more insulin while on levothyroxine
• Administration: take on an empty stomach 30–60 minutes before breakfast

Page 29

• Hypothyroidism: Nursing Care
• Safety: fall prevention; DVT prophylaxis; warm environment
• Diet: low-calorie, high-fiber, low-fat, low-cholesterol; stool softeners as needed
• Medication administration cautions: slowed metabolism/excretion; monitor for interactions

Page 30

• Adrenal Disorders (Introductory heading)

Page 31

• Cushing's Disease/Syndrome
• Symptoms of Cushing's syndrome
  • Red, round face; CNS irritability; emotional disturbances; hypertension; obesity (central); cardiac hypertrophy; hyperplasia/tumor; purple striae; osteoporosis; muscle wasting; skin ulcers
  • In females: amenorrhea, hirsutism; in males: erectile dysfunction

Page 32

• Cushing's: Glucocorticoid Excess – Clinical Manifestations
• Insulin resistance; glycosuria; hypercalciuria; muscle wasting; osteoporosis; thin skin; purplish abdominal striae; immunosuppression; dyslipidemia; labile emotions; weight gain (truncal obesity, moon face, buffalo hump)
• Complications: hyperglycemia, renal stones, risk for falls, osteoporosis, poor wound healing, cardiovascular disease, depression/anxiety
• Nursing Diagnoses: risk for infection, overweight, disturbed body image, impaired tissue integrity, risk for injury

Page 33

• Cushing's: Mineralocorticoid Excess
• Clinical manifestations and complications: hypokalemia; fluid/sodium retention; hypertension; peripheral edema; hypernatremia
• Nursing diagnoses: risk for electrolyte imbalance, risk for imbalanced fluid volume

Page 34

• Cushing's: Androgen Excess
• Clinical manifestations (females): menstrual irregularities, infertility, hirsutism; (males): erectile dysfunction, reduced self-esteem; acne; gynecomastia
• Nursing Diagnoses: risk for chronic low self-esteem, disturbed body image, risk for infertility

Page 35

• Cushing’s Disease: Diagnostic Testing
• Salivary cortisol levels
• Dexamethasone suppression test
• Urinary cortisol level
• Adrenocorticotropic hormone (ACTH)

Page 36

• Cushing's Disease: Treatment (three main steps)
• Treat the underlying cause
• Drug therapy
• Taper long-term steroids when appropriate

Page 37

• Cushing’s Disease: Nursing Care
• Monitor vital signs, daily weights, glucose, infection risk, thromboembolic risk, emotional support, corticosteroid education

Page 38

• Addison’s Disease: Acute Adrenal Insufficiency
• Life-threatening; triggers include stress, abrupt withdrawal of corticosteroids, adrenal surgery, sudden pituitary destruction
• Treatment: corticosteroids

Page 39

• Diabetes Mellitus (Introductory page for DM section)

Page 40

• Pancreas Hormones (revisited with targets)
• Amylin (from beta cells) → Pancreas; Liver; Stomach
  • Decreases gastric motility; decreases glucagon secretion; decreases endogenous glucose release from the liver; increases satiety
• Glucagon (from alpha cells) → General
  • Stimulates glycogenolysis and gluconeogenesis
• Insulin (from beta cells) → General
  • Promotes glucose transport from the blood into the cells
• Pancreatic polypeptide (from F cells) → General
  • Influences regulation of pancreatic function and metabolism of absorbed nutrients
• Somatostatin (from delta cells) → Pancreas
  • Inhibits insulin and glucagon secretion

Page 41

• Metabolic pathways: Gluconeogenesis, Glycogenolysis, Lipolysis, and Ketogenesis (diagrammatic outline)
• Key components:
  • Gluconeogenesis from lactate, alanine, glycerol, etc.
  • Glycogenolysis and glycogenesis in liver
  • Lipolysis in adipose tissue yielding NEFAs and glycerol
  • Utilization of glucose in tissues; interplay with liver and adipose tissue
  • Pyruvate, alanine, glutamine as amino-acid sources feeding gluconeogenesis
• Note: This page provides a schematic view of how glucose is generated and utilized

Page 42

• Insulin Effects: When food is consumed
• Process: Food is converted to glucose; pancreas produces insulin; glucose is stored as glycogen in liver; insulin helps glucose uptake by muscles and other tissues; muscle tissue uses glucose for energy during activity
• Summary: Insulin shuttles glucose from blood into cells and promotes storage as glycogen; maintains euglycemia after meals

Page 43

• Regulation of Blood Glucose: Insulin and Glucagon interplay
• Insulin pathway (high blood glucose):
  • Insulin triggers glucose uptake by cells; Liver stores glucose as glycogen (glycogenesis)
  • Pancreas releases insulin; Glucose is stored; Blood glucose level drops toward normal
• Glucagon pathway (low blood glucose):
  • Glucagon stimulates glycogenolysis and gluconeogenesis in liver; Blood glucose rises
• Visual mnemonic: High BG → insulin; Low BG → glucagon

Page 44

• Diabetes Mellitus: Diagnostic Testing – Key Values and Ranges (Overview)
• Glycosylated hemoglobin (A1C)
  • Reference: < 5.6% (nondiabetic); 5.7–6.4% (prediabetes); ≥ 6.5% (diabetes)
• Fasting blood glucose (FBG)
  • Reference: < 110 mg/dL (nondiabetic) [some sources vary here]
• 2-hour postprandial glucose (2-hour PPG) after 75 g load
  • < 140 mg/dL (nondiabetic); 126 mg/dL or higher diagnostic for diabetes
• 1-hour postprandial and casual glucose values and thresholds provided
• Glucose tolerance test (GTT)
• Additional notes on testing timing (fasting 8 hours) and testing conditions

Page 45

• Diabetes Mellitus: Diagnostic Testing (Detailed Lab Values)
• Hemoglobin A1C: 4%-5.9% (normal); 6.5% or higher (diabetes)
• Fasting blood glucose (FBG): < 110 mg/dL (nondiabetic); 126 mg/dL or higher (diabetes)
• 2-hour postprandial plasma glucose (2-hour PPG): < 140 mg/dL (nondiabetic); 200 mg/dL or higher (diabetes)
• Random plasma glucose: < 200 mg/dL (nondiabetic); 200 mg/dL or higher with symptoms
• Special notes: 2-hour PPG values are age-dependent in some guidelines

Page 46

• Types of Diabetes Mellitus (DM)
• DM Type I (DM I): Autoimmune destruction of beta cells; produce no insulin; require insulin injections; more common in children
• DM Type II (DM II): Insulin resistance with some insulin production; may require oral agents; more common in adults
• Gestational Diabetes: Occurs during pregnancy; usually resolves after pregnancy but increases future DM II risk

Page 47

• Monitoring Blood Glucose
• Frequency depends on goals, type, meds, access to supplies, etc.
• Patients on insulin often check 4–8 times daily (before meals and at bedtime)
• Check BG if symptoms of hypoglycemia occur
• Practical note: skill video on Checking Blood Glucose

Page 48

• Complications of Diabetes Mellitus
• EYES: Retinopathy, Glaucoma
• BRAIN: Stroke
• NERVES: Diabetic neuropathy
• KIDNEYS: Diabetic nephropathy
• HEART: Diabetic cardiomyopathy
• TEETH: Periodontal disease
• Circulatory system: Reduced blood flow
• SKIN: Diabetic foot

Page 49

• Diabetes Mellitus: Nutrition
• Carbohydrates: Healthy forms (whole grains, fruits, vegetables, low-fat dairy); Complex carbs promote stable glucose; avoid processed sugars
• Dietary fats: Limit saturated fat, cholesterol, and trans fats; promote healthy fats (plants, olives, nuts, avocados)
• Protein: Lean sources; essential for function
• Alcohol: Can inhibit gluconeogenesis; risk of hypoglycemia; moderate intake with carbohydrate planning

Page 50

• Glycemic Index (GI) Examples (selected list)
• High GI range (~70–100): white bread, donuts, white rice, potatoes, some fruits
• Medium GI (~50–70): rye/wholegrain bread, muesli, brown rice, pasta, lentils, yams, popcorn
• Low GI (~0–50): barley bread, apples, berries, citrus, milk, yogurt, oats, beans, leafy vegetables
• Practical use: choose lower GI foods to improve glycemic control

Page 51

• Symptoms of Hyperglycemia (polyuria, polydipsia, polyphagia, weight loss) and other signs
• Polyuria: Excessive urine production
• Polydipsia: Excessive thirst
• Polyphagia: Excessive hunger
• Weight loss with hyperglycemia
• Fatigue, blurry vision, nausea/vomiting

Page 52

• Types of Insulin: Onset, Peak, Duration (summary)
• Rapid-acting: Lispro, Aspart, Glulisine
  • Onset: ~10–30 min; Peak: ~0.5–3 hours; Duration: ~3–5 hours
• Short-acting (Regular): Onset ~0.5–1 hour; Peak ~2–5 hours; Duration ~5–8 hours
• Intermediate-acting (NPH): Onset ~1.5–4 hours; Peak ~4–12 hours; Duration ~12–18 hours
• Long-acting (Glargine, Detemir, Degludec): Onset ~1–4 hours; Peak: less defined or no peak; Duration ~16–24 hours (Degludec can be longer)
• Important notes
  • Rapid-acting must be given with meals; risk of hypoglycemia high
  • Short-acting should be given 30 min before meals
  • NPH is cloudy; mix by rolling (not shaking)
  • Glargine/Detemir should not be mixed with other insulins

Page 53

• Insulin Types: Quick reference by class
• Rapid-acting: peaks 30 minutes to 3 hours
• Short-acting: peak 2–5 hours
• Intermediate-acting: peak 4–12 hours
• Long-acting: peak less defined or none

Page 54

• Insulin Regimens: Basal-Bolus vs Combination/Hybrid
• Basal-Bolus structure shown with meals and bedtime injections
• Glucose control pattern across 24 hours

Page 55

• Insulin Effect Schedule (example)
• 6 AM: Basal (long-acting) and/or fast-acting with breakfast
• Breakfast/Lunch/Dinner/Bedtime: corresponding rapid-acting or short-acting with meals
• Total insulin effect and stacking concepts

Page 56

• Insulin Storage & Administration Guidelines
• Unopened vials: refrigerate until use; opened vials: room temp up to 4 weeks
• Administration: subcutaneous (SQ) at 45–90 degree angle or IV in some cases
• Tools: insulin syringe, pen, or pump
• Pump/infusion set: change every 2–3 days
• Site rotation; insulin should be clear (except NPH), roll to mix (do not shake)
• Home hygiene: wash with soap and water

Page 57

• Somogyi Effect vs. Dawn Phenomenon
• Somogyi effect: nocturnal hypoglycemia triggers counterregulatory hormones → morning hyperglycemia
  • Symptoms: headaches, night sweats, nightmares
  • Management: bedtime snack, reduce evening insulin dose, test 2–4 AM to differentiate
• Dawn phenomenon: early morning hyperglycemia due to increased counterregulatory hormones (growth hormone, cortisol)
  • Management: adjust insulin dose/time; consider earlier supper or bedtime snack adjustments
• Monitoring strategy: test between 2–4 AM to differentiate causes; if predawn levels elevated, increase insulin; if low, decrease dose

Page 58

• Hypoglycemia: Emergency treatment
• If conscious: 15 g fast-acting carbohydrate (e.g., 4 oz juice, 8 oz milk) or glucose gel/tabs
• Recheck in 15 minutes; repeat if needed; follow with protein and complex carbohydrate
• If unconscious: 25–50% Dextrose IV; or Glucagon 1 mg IM

Page 59

• Hypoglycemia vs Hyperglycemia Symptoms (quick reference)
• Hypoglycemia: sweating, pallor, dry mouth, confusion, shakiness, irritability, tremor, paleness, hunger
• Hyperglycemia: thirst, polyuria, fatigue, dry mouth, blurred vision, weight loss, nausea

Page 60

• Diabetes Patient Education & Self-care
• Regular exercise; hypoglycemia possible after exercise
• If BG < 100 mg/dL before exercise, eat a 15–30 g carbohydrate snack
• Vaccines: annual flu and COVID-19 recommended
• Report to provider if BG > 250 mg/dL on two consecutive days or if moderate ketonuria
• Regular dental/foot care; wear medical alert bracelet; follow sick-day rules

Page 61

• Sick Day Rules (S-I-C-K mnemonic)
• Sugar: Check blood glucose every 4 hours (2–3 hours ideal)
• Insulin: Always take; do not skip; could lead to DKA
• Carbohydrates: Drink fluids with carbohydrates if BG high; drink sugar-free fluids if BG low
• Ketones: Check urine or blood ketones every 4 hours if BG > 240 mg/dL; take rapid-acting insulin if ketones present

Page 62

• Diabetic Ketoacidosis (DKA)
• What is DKA?
  • Insulin deficiency → cells cannot use glucose; fat/protein breakdown → metabolic acidosis, weight loss, fatigue
  • Blood glucose > 200 ext{ mg/dL}; ketones present; glycosuria; ketonuria
  • Signs: dehydration, dry mucous membranes, tachycardia, orthostatic hypotension; Kussmaul respirations; fruity breath
• Risk factors: Type 1 DM, illness, infection, poor insulin dosing; inadequate self-care

Page 63

• DKA Treatment Protocol
• IV fluids: start with 0.9% saline; aim for adequate BP and urine output (~30 mL/hr)
• When glucose approaches ~250 ext{ mg/dL}, add 5% dextrose to prevent hypoglycemia
• Insulin: Regular insulin IV infusion at 0.1 ext{ U/kg/hr} until metabolic goals reached
• Potassium: monitor and replace as needed (often follows insulin therapy and fluid resuscitation)
• Monitoring: continuous cardiac monitoring in ICU; hourly I&O and BG; monitor electrolytes

Page 64

• DM Type II: Pharmacologic Treatments (Class, Example, Mechanism, Special Considerations)
• Alpha-glucosidase inhibitors: Acarbose, Miglitol
  • Delay GI carbohydrate absorption; take with first bite; monitor 2-hour postprandial glucose
• Biguanides: Metformin (most common)
  • Increase insulin sensitivity; decrease hepatic glucose production; improve tissue glucose use; may cause weight loss; hold 48 hours before/after IV contrast to reduce lactic acidosis risk
• DPP-4 inhibitors: Alogliptin, Sitagliptin
  • Prolong incretin effect; generally weight-neutral; potential pancreatitis risk
• Meglitinides: Nateglinide
  • Stimulate pancreatic insulin release
• SGLT2 inhibitors: Canagliflozin
  • Increase urinary glucose excretion by lowering renal glucose reabsorption
• Sulfonylureas: Glipizide, Glyburide
  • Increase insulin secretion; take up to 30 minutes before meals; hypoglycemia risk; avoid if meals skipped
• Thiazolidinediones: Pioglitazone
  • Increase insulin sensitivity; may not be used in sulfa allergy; risk of fluid retention and cardiovascular events

Page 65

• DM Type II: Non-insulin Injectables
  • GLP-1 receptor agonists (e.g., albiglutide, exenatide): increase insulin synthesis/release, inhibit glucagon, slow gastric emptying, increase satiety; some weekly dosing; pancreatitis risk; avoid absorption interactions; take oral meds at least 1 hour before GLP-1 agonists when given concomitantly
  • Amylin analogs (pramlintide): slows gastric emptying, reduces glucagon, increases satiety; used with insulin; cannot be mixed in the same syringe; may cause hypoglycemia; meals should be at least ~250 calories; carry fast-acting carbohydrate

Page 66

• Hyperosmolar Hyperglycemic Syndrome (HHS)

• Life-threatening complication of DM Type II

• Similar to DKA but with some insulin presence; absent or low ketones

• Symptoms: somnolence, seizures, hemiparesis, aphasia

• Treatment: Regular insulin IV; initial 0.9% saline, then switch to dextrose-containing solution when BG < 250 mg/dL; monitor electrolytes; continuous cardiopulmonary monitoring in ICU

• Monitoring: hourly I&O and BG; monitor mental status; close electrolyte management (especially potassium)

• End of transcript notes