C9-Endocrine System Pt1 Flashcards by Amelia Heusuk

Endocrine system

Pancreas
Thyroid
Adrenal gland
Pituitary gland

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Pancreas Produces:

Insulin
Glucagon

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Thyroid gland produces

Thyroid hormones
T3
T4

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Adrenal Gland produces:

Corticosteroids
from the cortex

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Pituitary Gland Produces:

Anterior pituitary
TSH
ACTH

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Pancreas Alpha cells create:

Glucagon (hyperglycemia)

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Pancreas Beta Cells produce:

Insulin
(hypoglycemia)

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Diabetes Mellitus (DM) is deficient in

Carbohydrate metabolism
(can’t metabolize)

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What are the 3 POLYS discussed with DM?

Polyuria (excessive urine)
Polydipsia (extreme thirst)
Polyphagia (excessive hunger)

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Type 1 Diabetes

Destruction of pancreatic beta cells
Juvenile onset
Produce no insulin

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Type 2 diabetes

Non insulin dependent
Mature onset diabetes of the young (MODY)
Adult onset
Insulin resistant

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Gestational diabetes

Increased hormone levels during pregnancy can inhibit insulin usage

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Secondary Diabetes

Result of other medications
steroids
diuretics

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Insulin administration

Given subcutaneous or IV
not effective orally

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Insulin Naturally occurring from the

Pancreas (beta cells)

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Insulin absorption rates vary, what is the fastest absorption site?

Abdominal

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Insulin absorption rates vary, what is the slowest absorption site?

Thigh

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Insulin absorption varies according to what?

Injection site
Blood supply
Degree of tissue hypertrophy at injection site

Exercise increases absorption

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Insulin therapeutics (what does it help?)

Diabetes
Type 1 or (2 not common unless necessary)
Hyperkalemia
increased influx of K+
Emergency
DKA
diabetic ketoacidosis

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Insulin Action

Moves glucose into ell
used for Krebs cycle
changes ADP into ATP
Lowers blood glucose
glucose can be stored as glycogen
can be converted into fat for storage
Lowers level of K+

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Insulin is classified by concentration, what are the different dosages? Which is most common?

U100 (most common) 100 units/mL
U200
U500
*USE APPROPRIATE SYRINGE!
(different colors for different doses)

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Rapid Acting Insulin Name:

Aspart Lispro (Humulog Novolog)

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Short Acting insulin name

Regular (Humulin R)

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Intermediate acting insulin name

NPH= Isophane
(Humulin N)

** CLOUDY **

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Constant acting Insulin name

Lantus (glargine) Detemir

Rapid acting insulin ONSET

15 mins

Rapid acting insulin PEAK

1-3 HOURS

Rapid acting insulin DURATION

3-5 HOURS

Short acting insulin ONSET

0.5-1 HOUR

Short acting insulin PEAK

2-4 HOURS

Short acting insulin DURATION

6-8 HOURS

Intermediate acting Insulin ONSET

1-2 hours

Intermediate acting Insulin PEAK

6-12 HOURS

Intermediate acting Insulin DURATION

18-24 HOURS

Constant insulin ONSET

Irrelevant because constant overlaps

Constant insulin PEAK

NONE

Constant insulin DURATION

>24 HOURS

When mixing insulin, what is the rhyme to help you know which order to draw up first?

Draw up the CLEAR (fast-acting) Before the CLOUDY (long-acting)

Adjust client’s dosage of insulin on a sliding scale, increase it with:

Increased calories Infection Stress Growth spurts 2nd and 3rd trimester

Adjust client’s dosage of insulin on a sliding scale, decrease it with:

NPO/ fasting Exercise 1st trimester

Give mixed insulin within ___ mins of mixing:

15 mins

Before administering insulin check the clients ______________

Blood glucose

Insulin complications: Hypoglycemia results from (list situations)

Reduced intake of food Vomiting/diarrhea Intensive exercise Childbirth

Insulin complications: Lipodystrophy results from

Lipoatrophy Lipohypertrophy *ROTATE INJECTION SITES*

Insulin complications- Hypokalemia causes

Arrhythmias

Drug interactions: Hypoglycemic agents

Sulfonylureas Glinides Beta Blockers hide signs & symptoms of low blood sugars Alcohol

Drug interactions (insulin): Hyperglycemic agents

Thiazide/Loop diuretics Glucocorticoids (inc. Blood glucose) Sypathomimetic drugs

Hypoglycemia definition:

Insulin shock Very low blood glucose

Hypoglycemia treatment: (conscious)

15:15 rule 15g oral sugar (fast acting) Recheck glucose in 15 mins Repeat as needed

Hypoglycemia treatment: (unconscious)

Dextrose Glucose IV 10%-50% Glucagon

Hyperglycemia: (DKA)

Diabetic ketoacidosis more common in type 1 300-500 blood glucose level

Hyperglycemia: HHNC

Hyperosmolar hyperglycemic nonketotic coma (more common in type 2) 800-1000 blood glucose level

Bicarbonate reverses ________

Acidosis

Hypoglycemia: Signs and symptoms

Sweating (Diaphoreis) Trembling/shaking Anxiety Tachycardia Hunger/ overactive abdominal sounds Nause/vomiting Dizziness Confusion Headache

Hyperglycemia: Signs and symptoms

Warm/dry skin Dehydration Acetone breath (DKA) Confusion Comatose Polyuria

Blood Sugar rhyme: (15:15 Rule)

Hot & Dry = Sugar High Cold & Clammy = Need some candy

Hypoglycemic Treatment : (2) drugs

Glucagon Dextrose in water

Glucagon comes from

Pancreatic alpha cells

Glucagon increases blood sugar by

Stimulating glycogen breakdown

Glucagon Routes of administration

Sub Q IM IV

Dextrose in water different concentrations

5% 10% 50%

Oral anti-diabetics treat which type?

Type 2 only

Oral Anti-Diabetics: action

Increase insulin release Or Reduce insulin resistance

Oral Anti-Diabetics therapeutic goal

Lower blood sugar moderate rise after meals

Oral Anti-Diabetics medications

Metformin Glipizide/glyburide Acarbose Sitagliptn

Oral Anti-Diabetics: Sulfonylureas (medication)

Glipizide Glyburide

Oral Anti-Diabetics: Sulfonylureas (nursing)

Give daily with first meal Use caution with sulfa allergies

Oral Anti-Diabetics: Sulfonylureas (action)

Stimulate pancreas to release insulin Increases sensitivity of insulin receptors

Oral Anti-Diabetics: Sulfonylureas (side effects)

Hypoglycemia Pregnancy cat. C/lactation

Oral Anti-Diabetics: Sulfonylureas (interactions)

Sulfonamides Insulin Thiazide/loop diuretics Alcohol

Mixed insulin

Humulin 70/30