2.3 NFB, endocrine Flashcards
(44 cards)
DIABETES MELLITUS TYPE I
TYPE I auto-immune process abrupt onset often triggered by illness/stress insulin dependence childhood onset
DIABETES MELLITUS TYPE II
TYPE II
decreased insulin release
insulin resistance in liver, peripheral tissues
Classic signs and symptoms are related to hyperglycemia
Polyuria Polydipsia Polyphagia (hunger) Weight loss Fatigue Increased frequency of infections Rapid onset Insulin dependent Early onset
Polyuria
Increased intravascular fluid causes increased urine output- electrolyte imbalances.
Blood Glucose >180 glucose is excreted in urine “glucosuria”.
Polydipsia
Mouth becomes dry and thirst sensors activated
Increase urine output causes dehydration
Polyphagia
Energy production decreases - stimulates hunger- in hopes of providing body with energy -glucose still can’t enter cell to provide energy - body breaks down fats and proteins to restore energy -person loses weight.
Type II deabetes
Sedentary lifestyle Familial tendency Average age, 50 History of high BP Fatigue Reduced energy Recurrent infections
Hypoglycemia s/s
Rapid onset: 1-3 hr Anxious Sweaty Hungry Ha Blurred vision Shaky
Hypoglycemia in Elderly
What does an insulin reaction look like in an older patient?
Speech Disorder
Slurring
Confusion
Disorientation
Not the typical diaphoresis and clammy skin
Diabetic Ketoacidosis
A state of absolute or relative insulin deficiency resulting in hyperglycemia and an accumulation of ketones in the blood with subsequent metabolic acidosis
Ketosis Acidosis pH<7.30 Bicarb<15 mmol/L Hyperglycemia Ketones in urine/blood BS: >250 Lethargy Coma Kussmaul's resp Hypotension
Occurs in Type 1 DM
Diabetic ketoacidosis s/s
Lack of insulin
Hx:
GI upset, febrile illness
Slow onset: 4-10 hr
Fruity breath Tachycardia Hypotension Acidosis High blood sugar Hyperkalemia
NEED:
hydration
insulin
electrolyte replacement
Somogyi phenomenon
Rebound hyperglycemia due to hypoglycemia during the night
Caused by too much insulin
Hyperglycemia- more insulinhypoglycemia- secretion of contra insulin hormones- hyperglycemia- more insulin- cycle repeats
Treat by slowly reducing insulin
Tx:
decrease evening insulin or adjust timing to prevent hypoglycemia
Dawn phenomenon
Normal morning effect increases growth hormones and decrease insulin levels
Tx:
increase basal insulin or adjust timing for better control
Complications of DM
Macrovascular
Hyperglycemia from impaired glucose & insulin resistance invokes an inflammatory process in vascular endothelial lining causing complications:
Macrovascular:
Manifested thru atherosclerosis results in HTN, CAD, PVD, Cerebral & Carotid artery damage
Complications of DM
Microvascular
Hyperglycemia from impaired glucose & insulin resistance invokes an inflammatory process in vascular endothelial lining causing complications:
Microvascular:
Basement membrane of smaller blood vessels & capillaries thickens eventually leading to decreased tissue perfusion.
Complications of DM
Retinopathy
Retinopathy- micro-vascular damage & hemorrhage lead to scarring of retina. Leading cause of blindness in DM.
Complications of DM
Nephropathy
Nephropathy: thickening of basement membrane of glomeruli impairing renal function.
Complications of DM
Neuropathy
Neuropathy- thickening of blood vessels that supply nerve endings. Causes change in sensation (numbness/tingling), pain (ache, burn, shooting, cold) Teach importance of visually inspecting feet/legs daily to look for injury
DIABETIC FOOT CARE
DIABETIC FOOT CARE Daily inspection avoid crossing legs Always wear shoes, Bathe feet--test water temp do not self-treat foot problems avoid dry skin, cracks, infections Podiatrist evaluation
Sick day rules
Monitor blood sugar more often Do not stop taking insulin Check urine for ketones Careful with OTC Have game plan Force liquids Call provider if unable to eat >24 hr, vomiting/diarrhea >6 hr, urine ketones
Insulin
know types
oral
know meds
Insulin Administration
Preferred site is Abdomen- allows most rapid absorption.
Do not give in legs prior to exercise- increases absorption rate and chance of hypoglycemic event.
If mixing insulin must draw up “clear before cloudy” (regular then NPH). Avoids contamination of NPH into regular insulin vial.
Do not massage site
Teach pt that exercise lowers insulin requirements; seek consultation prior to exercise program.
Metformin (Biguanides):
Reduces FBG & postprandial hyperglycemia.
Often suspended during hospitalization r/t risk of lactic acidosis
Stopped prior to and 48 h after use of contrast media & surgery r/t risk of renal failure.
Low risk of hypoglycemic events
