Endocrine & Metabolic 3

Question 1

what is hypoglycemia characterized by

Answer 1

• shaky, hungry, weak, headache, dizziness, pallor, sweating, tachycardia
• difficulty concentrating, seizure, loss of consciousness

Question 2

if hypoglycemic, blood is

Answer 2

• glucose <70 mg/dL
• ketones negative
• pH normal

Question 3

if hypoglycemic, urine is

Answer 3

• glucose negative
• acetone negative
• normal output

Question 4

if hypoglycemic what do you give

Answer 4

*15 grams of rapid acting glucose

Question 5

examples of 15 g rapid acting glucose

Answer 5

• 1/2 cup orange juice or sugar sweetened carbonated beverage
• 1 small box raisins
• 3 or 4 glucose tablets
• **if unconscious… GLUCAGON

Question 6

what is hypergylcemia characterized by

Answer 6

-thirsty, weak, flushed, abdominal pain, blurred vision, irritable, N/V, dehydration, kussmaul resp, fruity breath, decreased LOC

Question 7

if hyperglycemic, blood is

Answer 7

• glucose 200 mg/dL or higher
• ketones high, large
• low pH

Question 8

if hyperglycemic, urine is

Answer 8

• high glucose
• high acetone
• increased output

Question 9

describe type 2

Answer 9

• associated with insulin resistance
• risk factors: obesity, low levels of physical activity, diet high in fat and family hx of diabetes
• several genes on chromosomes have been associated with predisposition for development of type 2

Question 10

etiology and incidence of type 2

Answer 10

• family hx
• insulin resistance, glucose toxicity and eventual inadequate insulin secretion
• usually in teens over 12 (overweight) and adults >45 yrs
• gradual onset without ketosis

Question 11

type 2 clinical manifestations

Answer 11

• obese, little to no wt loss
• Acanthosis nigricans
• Polyuria, polydipsia, may be mild or absent
• Glycosuria without ketonuria in 1/3 of cases on initial presentation
• Ketoacidosis may be present
• Fatigue

Question 12

type 2 diagnostic tests

Answer 12

• Blood glucose levels of 200 mg/dL or greater without fasting
• Fasting glucose level of 126 mg/dL or greater

Question 13

clinical therapy of type 2

Answer 13

• Normalizing blood glucose and Hemoglobin A1C
• Decrease weight
• Increase exercise
• Normalize lipid profile and blood pressure
• Prevent complications

Question 14

describe the initial med treatment for type 2

Answer 14

• When the child or adolescent presents with severe hyperglycemia or diabetic ketoacidosis, insulin is usually required to gain the initial glycemic control
• Then once metabolic control has been achieved metformin is initiated and the child is weaned off insulin

Question 15

describe metformin

Answer 15

• Metformin has been used when diet and exercise efforts are inadequate
• Metformin helps control hyperglycemia
• Metformin improves the sensitivity of target cells to insulin, slows the gastrointestinal absorption of glucose, and reduces hepatic and renal glucose production.
• So used when there is normal liver and kidney functioning and no ketosis

Question 16

An autosomal recessive inherited disorder of amino acid metabolism the impacts the body’s use of protein

Answer 16

Phenylketonuria (PKU)

Question 17

if left untreated what can PKU lead to

Answer 17

leads to irreversible brain damage and severe intellectual disability

Question 18

what is the PKU screening

Answer 18

Newborn screening for PKU is required in all 50 states

Question 19

PKU treatment

Answer 19

• Phenylketonuria is treated with special formulas and diet low in phenylalanine
• A low-phenylalanine diet is rigid and strict, families must be educated about sources of phenylalanine and a registered dietician can help with meal planning