How does the body manage high glucose levels?
Islet of Langerhans secrete insulin to increase cell membrane permeability and mediates transport of glucose across membranes into cells. Glucose is converted into energy via glycolysis.
How does the body manage low glucose levels?
Alpha cells in islets of Langerhans releases glucagon. Glucagon raised the blood sugar and brings the body’s energy back to normal stimulating the liver to convert stored glycogen to glucose through glycogenolysis.
What is metabolized when glycogen levels are depleted?
Fats, proteins, and other noncarbonate sources
Alpha cells in islets of Langerhans
Beta cells in islets of Langerhans
Delta cells in islets of Langerhans
Major effects of hypothyroidism
Cardiovascular : slow pulse, reduces CO
Metabolic : decreased metabolism, cold skin, weight gain
Neuromuscular : weakness, sluggish reflexes
Mental, emotional : sluggish, personality placid
GI : constipated
General somatic : cold, dry skin
Major effects of hyperthyroidism
Cardiovascular : rapid pulse, increased CO
Metabolic : increased metabolism; skin hot and flushed, weight loss
Neuromuscular : tremor, hyperactive reflexes
Mental, emotional : restlessness, irritability, emotional lability
GI : diarrhea
General somatic : warm, moist skin
s/s thyroid storm
s/s of hyperthyroidism including fever, severe tachycardia, n/v, AMS, and possibly heart failure
Caused my excessive levels of circulating thyroid hormone called thyrotoxicosis.
3 p’s of DM
polyphagia - increased appetite
polydipsia - increased thirst
polyuria - excessive urination
What is microangiopathy?
Microscopic deterioration of the vessel walls. It causes swelling of the basement membrane cells restricting blood flow to organs and tissues causing ischemia.
Why can’t insulin be ingested orally?
The digestive process with render it inactive.
Normal, prediabetic, and type 2 A1c levels.
Normal - less than 5.7%
Prediabetes - 5.7% to 6.4%
DMII - greater than 6.4%
Risk factors of prediabetes and DMII
Older than 45
African American, Hispanic/Latino, American Indian, Pacific Islander, and some Asian American
Gestational diabetes or given birth to baby over 9 lbs
Physically active fewer than 3x/week
Two hormones produced by the placenta, ____ and ____, results in insulin resistance.
Progesterone and estrogen
Management of gestational diabetes.
Diet modification, exercise, and blood glucose testing.
Gestational diabetes is usually diagnosed at ____ weeks of gestation and peaks in ____ trimester.
Which nervous system depends entirely on glucose for energy?
Central nervous system
What is the body’s first line of defense again hypoglycemia?
Insulin production is reduced in the pancreas and glucagon is increased by alpha cells.
When cells are deprived of glucose where does the stress signal go to and what happens?
Sympathetic nervous system.
Causes a release of catecholamines - epi and norepi - by adrenal gland.
What is the body’s second line of defense against hypoglycemia?
Cortisol is released to increase blood glucose levels to interact insulin’s action.
Two actions of type 2 dm medications.
Stimulate body’s ability to secrete insulin.
Improve insulin’s actions.
Hypoglycemia is caused by :
Elevated level of exogenous insulin Inaccurate dosing Intentional OD Mismatch w/ carb and insulin Increased use of glucose
Most common signs of hypoglycemia :
BS less than 70 Hunger Agitation, irritability, combative AMS or confusion Nausea Weakness, dizziness, or fainting Tachycardia Cool, clammy skin Headache Incoordination Slurred speech Dilated pupils Seizures or coma
AKA diabetic coma
State of unresponsiveness resulting from problems including DKA, hyperglycemia, and dehydration.
Hyperglycemia can be caused by :
Excessive food intake Insufficient insulin dosages Infection or illness Injury Surgery Emotional stress
Hyperosmolar hyperglycemic syndrome (HHS)
blood glucose level greater than 600
s/s of simple hyperglycemia
blurred vision polyuria polydipsia polyphagia orthostatic syncope frequent infections skin ulcerations
Treatment of simple hyperglyemia
Supportive care and transport
The body loses excessive amounts of ___, ____, and ___, in the urine during hyperglycemia resulting in dehydration and metabolic acidosis.
Sodium, potassium and phosphates
s/s advanced hyperglycemia
3 p's n/v tachycardia Kussmaul respirations Warm, dry skin and dry mucous membranes Fruity odor on breath Abd pain Orthostatic hypotension Supine hypotension Fatigue AMS Weight loss Hypocapnia
Onset : rapid Skin : pale, moist Breathing : normal or rapid BP : low Pulse : rapid, weak LOC : irritability, confusion, seizure, coma Response to treatment : immediately after administration Intense hunger
Skin : warm and dry Breathing : tachypneic Odor of breath : none BP : hypotensive Pulse : rapid, weak LOC : restless to coma Response to treatment : gradual ; 6-12 hours
HHS/HONK typically characterized by
hyperglycemia, hyperosmolarity, and absence of substantial ketosis
Difference between HHS/HONK and DKA
HHS/HONK : > 600. Usually secondary illness resulting in reduced fluid intake. Lack ketoacidosis. Takes weeks to develop.
DKA : > 250. Metabolic ketoacidosis present. Occurs in a few hours.
Pertinent additional SAMPLE questions for DM emergencies.
Last meal and insulin dose
Visual changes, headaches, dizziness, or bleeding
Changes in bowel or eating habits
Tingling, numbness, or swelling in extremities
What should be the main focus in the secondary assessment for DM emergencies?
Mental status - GCS
Ability to swallow
Protect the airway
Dosage of IV dextrose for adults, peds, neonates/infants.
Adults : 12.5 to 25 mg of D50 (or local protocol)
Children > 1 : 0/5 to 1 g/kg per dose of D25 or D10 slow IV push.
Neonates/infants : 200 to 500 mg/kg of D10 via IV push. (D50 2 mL into syringe and 8 mL of normal saline)
Dosage of Glucagon.
Adult : 1MG IM. May be repeated in 7-10 minutes.
Pediatric : 0.5 mg or 20 to 30 mcg/kg IM who weigh less than 20 kg.
Management of hyperglycemia and DKA
Maintain airway and administer oxygen Prepare for vomiting Consider ALS IV access Administer 20-mL/kg bolus of isotonic crystalloid solution for sign of dehydration or hypotension
What is the prehospital treatment goal for hyperglycemia and DKA?
Goals are to rehydrate and correct electrolytes and acid-base abnormalities.
Management of HHS/HONK
Consider c-spine w. possible mechanism of high-energy injury
Obtain blood glucose level
500 mL bolus of 0.9% normal saline
(Give fluid sparingly w/ hx of heart failure or renal insufficiency)
Bone marrow is found in:
long bones, pelvis, skull, and vertebrae.
Potential complications of sickle cell disease:
CVA Gallstones Jaundice Osteonecrosis Splenic infections Osteomyelitis Opiate tolerance Leg ulcers Chronic pain Pulmonary hypertension Chronic renal failure
Blood flow to an organ is restricted causing pain, ischemia, and organ damage.
Acute chest syndrome
vaso-occlusive crisis associated with pneumonia
Worsening of baseline anemia causing tachycardia, pallor, and fatigue
Acute accelerated drop in Hgb. Caused by RBCs breaking down faster than a normal rate.
Splenic sequestration crisis
Painful, acute enlargements of the pain causing the abdomen to become hard and bloated.
Suspicion of leukopenia
Infection and fever
Suspicion of low platelet count
Cutaneous bleeding (petechiae) and bleeding from mucous membranes.