CH 24: Endocrine Function Flashcards
effects of aging on endocrine function
Thyroid gland atrophies and activity decreases lower basic metabolic rate, reduced radioactive iodine uptake, and less secretion/release of thyrotropin
Adrenocorticotropic hormone (ACTH) secretion decreases reduces secretory activity of adrenal gland reduces secretion of estrogen, progesterone, androgen, 17-ketosteroids, and glucocorticoids
Pituitary volume decreases reduced serum somatotrophic growth hormone
Insufficient release of insulin and reduced tissue sensitivity to circulating insulin
Reduced ability to metabolize glucose
Overall, there is a decrease in the endocrine system’s ability to regulate the body.
prevalence of DM in older adults
6th leading cause of death among older adults
Glucose intolerance is a common occurrence in older adults
Diagnosis of DM in older adults
ADA recommends screening with the use of a fasting blood glucose every 3 years for people over the age of 45 years old
For adults over the age of 65 who are asymptomatic, they can be screened using a fasting blood glucose and/or HbA1c.
Renal threshold for glucose increases with age, older adults can be hyperglycemic without glycosuria***
The glucose tolerance test is most effective
results of glucose testing for diagnosis of DM
changes through aging - individualized
Symptoms of diabetes and a random blood glucose concentration ≥200 gm/dL.
Glycosylated hemoglobin (HbA1c) ≥6.5%.
Fasting blood glucose concentration ≥126 mg/dL (8hour fast).
Blood glucose concentration 2 hours after an oral glucose intake ≥200 mg/dL during an oral glucose tolerance test.
**results are confirmed on a different day
DM- patient education
Should be comprehensive and individualized
Establish a teaching plan focusing on definition/description of diabetes, nutrition, activity and exercise, medications, monitoring, recognizing hypo/hyperglycemia, and prevention of complications
Provide reassurance, support, and information to decrease learning barriers
first line of treatment; beneficial for the older adult; less risk of hypoglycemia; give with meals to prevent GI effects; inexpensive; avoid use in patients with kidney disease with reduced GFR
metformin
glyburide carries severe hypoglycemia risk, especially in dementia; glipizide and gliclazide are preferred in older adults but are no longer available in the US. Glimepiride, the latest generation is more selective but is on Beers Criteria along with glyburide; inexpensive
sulfonylureas
reduces post-prandial hyperglycemia and is safe for older adults; be mindful of GI disturbance
acarbose
reduced risk of hypoglycemia for older adults; can be used alone on in combination with other medications; can precipitate cardiac failure; caution in liver disease
rosiglitazone and pioglitazone
congruency with cognition, motor skills, function, and level of sensory impairment; basal insulin is safe; requirements are individualized; sliding scale is not used for long-term therapy; be aware of peak, onset, duration, and timing
insulins (p.374)
self-care and monitoring for DM
Infrared method for glucose testing
Continuous Glucose Monitoring (CGM)
Hemoglobin A1c Test
Healthy older adults with few chronic illnesses, intact cognition, optimum functional status without ADL impairment should have HbA1c of <7.5%
Older adults with severe impairment and complex medical illnesses can have HbA1c of <8.5%
Monitor triglycerides with the link to metabolic syndrome
Weight
Exercise and nutrition for DM
Regular exercise & physical activity improve insulin response
Type of exercise program with permission from provider
Maintain a consistent daily food intake
Be aware of barriers such as finances, energy, social limitations
Use nutritional supplements
Increased fiber and complex carbs to control release of glucose can reduce insulin requirements
greater threat than ketoacidosis; quick identification can reduce mortality and morbidity
hypoglycemia
S/S of hypoglycemia in older adults
Classic symptoms & warning signs aren’t evident in older adults, but their S/S could include behavior disorders
confusion**
somnolence
convulsions
disorientation
poor sleep patterns
nocturnal headaches
slurred speech
unconsciousness
increases the risk of hypoglycemia
Hepatic and renal functions altering drug metabolism and excretion
Impairments in the autonomic nervous system
Meds (Beta-Blockers, warfarin, salicylates, sulfonamides, tricyclic antidepressants, alcohol) increase the risk of hypoglycemia in older adults
PVD & neuropathies: poorer circulation with increased age; important to teach proper foot care
Retinopathy: leading to blindness
Cognitive impairment
CAD & cerebral arteriosclerosis
