final - endocrine Flashcards
(74 cards)
1
Q
Adrenal Insufficiency in Adults
A
- Deficiency of Cortisol
- 2 Types
- Acute vs Chronic
- Sounds simple but it can get complicated
2
Q
Acute Adrenal Insufficiency
A
- Symptoms: hypotension, nausea, vomiting, history of weight loss anorexia, unexplained hypoglycemia, fever of unknown origin, hyponatremia
- Acute- adrenal crisis should be considered in any patient who presents with peripheral vascular collapse (vasodilator shock- also known as Distributive shock)
- 3 types
- Septic shock (from a bacterial infection)
- Anaphylactic shock (from an allergic reaction or asthma attack)
- Neurogenic shock (spinal cord injury)
3
Q
Chronic Adrenal insufficiency
A
- Chronic Adrenal insufficiency is more difficult to diagnosis
- Symptoms are more insidious: fatigue, weight loss, GI complaints, psychiatric changes, musculoskeletal complaints.
- Primary vs Secondary/tertiary adrenal insufficiency
- Primary: Starts at the adrenal gland
- Secondary: Starts at the pituitary gland
4
Q
Primary Adrenal Insufficiency
A
- Addison Disease
- Caused by damage to the adrenal gland
- Immune response is triggered by a normal adrenal gland protein, typically a protein called 21-hydroxylase.
- This protein is responsible for the production of hormones from the adrenal gland such as : cortisol and aldosterone
- With a prolonged attack against this protein the adrenal cortex the outer layer of the adrenal gland gets destroyed thus preventing hormone production.
- .
5
Q
Primary Adrenal Insufficiency
A
- Rarely Addison disease can be caused by a non autoimmune processes including
- infections that damage the adrenal glands, such as
- Tuberculosis which use to be the most common cause of Addison Disease
- Tumors in the adrenal glands
6
Q
Secondary Adrenal Insufficiency
A
- A lack of the hormone ACTH (Adrenocorticotropic Hormone)
- Damage to either the Pituitary gland or the Hypothalamus
- Pituitary gland tumors
- Loss of blood flow to the pituitary gland
- Removal or the pituitary gland
- Radiation of the pituitary gland
- Removal of parts of the hypothalamus
- Can also be Caused by the chronic use of steroids (Decadron, Prednisone )
7
Q
Adrenal InsufficiencySymptoms
A
- Weakness
- Fatigue
- Dizziness
- Darkened skin on face, neck and back of hands (Addison DX only)
- Bluish black color around nipples, mouth, rectum, vagina ( Addison’s)
- Weight loss
- Dehydration
8
Q
Adrenal InsufficiencySymptoms
A
- Lack of appetite
- Craving salt
- Muscle aches
- Vomiting
- Diarrhea
- Low blood pressure
- Low blood sugar
- Irregular or no menstrual cycle
9
Q
Adrenal InsufficiencyDiagnoses
A
- Physical exam
- Blood, urine or saliva tests
- TB (was the most common cause of Adison DX )
- Imaging: x-rays , ultrasound, CT scan and MRI
10
Q
Adrenal InsufficiencyPhysical Exam
A
- Patients show evidence of dehydration, hypotension, and orthostatic. Female patients may show an absence of axillary and pubic hair and decreased body hair.
11
Q
Adrenal InsufficiencyLaboratory Testing and Findings
A
- CMP- complete metabolic panel
- Hyponatremia- NA level less then 135 meq/L
- Hypoglycemia- glucose less then 70 mg/dl
- Hypercalcemia occurs in adrenal insufficiency due to reduced calcium removal by the kidney andincreased calcium entry into the circulation
12
Q
Laboratory Testing and Findings
A
- CBC- complete blood count
- Affected individuals may also have a shortage of red blood cells (anemia ) andan increase in the number of white blood cells
- Mild anemia- Hemoglobin 10.0g/dl to lower limit of normal
- Lymphocytosis- level higher then 3,000 lymphocytes in mm3 of blood
13
Q
Cosyntropin Stimulation Test
A
- A baseline cortisol AND ACTH sample are obtained
- Cosyntropin is administered in a dose of 0.25 mg intramuscularly or intravenously
- Samples for plasma cortisol are obtained at
- 30 and 60 minutes following the injection.
14
Q
How to interrupt a Cosyntropin Stimulation Test
A
- A rise from the baseline of at least 7 μg/dL to 10 μg/dL of cortisol, reaching at least 18 μg/dL at 60 minutes post stimulation effectively rules out primary adrenal insufficiency.
- Suggesting that adrenal suppression is minimal
15
Q
Acute Adrenal Insufficiency Treatment
A
- Remember Acute Adrenal Insufficiency is a Medical Emergency
- Always think of Acute Adrenal Insufficiency when a patient is in Shock
16
Q
Adrenal InsufficiencyRadiological Testing
A
- The gold standard of adrenal imaging is a CT scan (CAT scan). An “adrenal-protocol, contrast enhancement CT scan” is best.
- CT scan of the adrenal with and without contrast should always be the first scan ordered, and in more than 90% of cases, the ONLY scan a patient will need.
17
Q
Treatment of Secondary Adrenal Insufficiency
A
- Remember Adrenal insufficiency ( Addison DX can be deadly)
- Addison DX should be initially treated in the hospital with IV hydration, IV corticosteroids until the patient is stabilized and then will have to be continued for the rest of the patient’s life.
- Cortisol deficiency is treated with replacement oral glucocorticoid medication. Hydrocortisone is usually used, but the synthetic steroid prednisone may be used. Unless aldosterone deficiency is present, mineralocorticoid treatment with fludrocortisone is usually not needed.
- Oral Dose is typically 25-30 mg/day divided BID
18
Q
Cushing Disease
A
- Cushing disease is a rare condition, only affecting 10 to 15 people per million every year. It is more common in women and occurs most often in people between the ages of 20 and 50
- It caused by the overproduction of ACTH
- Two Types
- Endogenous Cushing syndrome
- Exogenous Cushing Syndrome
19
Q
Endogenous Cushing syndrome
A
- A pituitary adenoma is the most common cause of endogenous Cushing.
- These tumors produce excess of ACTH
- These tumors are typically very small < 5mm usually located in the anterior lobe of the pituitary gland
- Adrenal tumor on one of the two adrenal glands causes about 15% of all cases of Cushing’s syndrome. These tumors produce an excess of Cortisol.
20
Q
Exogenous Cushing Syndrome
A
- Exogenous Cushing Syndrome: is due to people taking cortisol-like medications such as prednisone.
21
Q
Cushing SyndromeSymptoms
A
- Patient’s gain weight in unusual ways
- affects the face, neck, trunk, and abdomen more than the limbs, which may be thin
- Bruise easily or feel weak, tired and sad. Women and men may also notice fertility and other problems.
- CS is most often found in adults between the ages of 20 and 50.
22
Q
Laboratory Testing and Findings
A
- 24-hour urine test for cortisol.
- Saliva test
- Dexamethasone-suppression test
23
Q
24-hour urine test for cortisol
A
- Patients are asked to void first thing in the morning into the toilet and to collect ever urine sample through out the next 24 hours.
- Each laboratory is different with regards to refrigerating the sample so instruct your patient’s to follow their specific labs directions carefully
- Results- The normal range is10 to 100 mcg/24 hr, anything higher suggests Cushing Disease
24
Q
Saliva test
A
- It’s normal for cortisol levels to change throughout the day—levels are highest in the morning and very low or undetectable around midnight.
- People with Cushing’s syndrome show less variability in their cortisol levels and have higher levels than normal at night.
- Cortisol levels can be tested by using a small late-night salivary sample.
25
Low Dose Dexamethasone-suppression test
- LDDST helps in the initial diagnosis of Cushing syndrome, as a screening or a confirmatory test. It can be performed either as an overnight or a two-day test.
- Overnight, 1 mg test: Due to ease and convenience, the overnight test is the most commonly used screening test. Dexamethasone 1 mg is administered orally between 11 PM and midnight. Serum cortisol levels are drawn the next morning between 8 and 9 AM.
- Two-day, 2 mg test: Dexamethasone 0.5 mg is administered orally every 6 hours (9 AM, 3 PM, 9 PM, 3 AM) for two days (total dose 4 mg). Serum cortisol level is drawn 6 hours (9 AM) after the last administered dose.
26
Treatment of Cushing Disease
- Treatment of choice for endogenous Cushing syndrome caused by a pituitary ademoma
- Transsphenoidal surgical resection of that tumor
- The primary therapy for adrenal tumors
- Adrenalectomy
- Treatment of choice for exogenous Cushing syndrome is the slow reduction of chronic steroid use if the patient’s other disease process will allow for it.
27
Hyperthyroid
- Hyperthyroidism has several causes
- Graves’ Disease
- Overactive thyroid nodules
- Inflammation of the thyroid gland, called thyroiditis (Amiodarone)
- Too much iodine
- Too much thyroid hormone medicine
- A noncancerous tumor of the pituitary gland
28
Graves’ Disease
- Autoimmune disorder
- Occurs in people between the ages of 30 and 50, but it can affect children and older adults.
- Your risk of developing Graves’ disease increases if you have a family history of thyroid disease and/or you smoke cigarettes.
- You’re also more likely to get Graves’ disease if you have another autoimmune disease, such as:
- Rheumatoid Arthritis
- Lupus
- Type 1 Diabetes
- Celiac Disease
- Vitiligo
29
Graves’ Disease
- Signs and Symptoms
- Weight loss despite increased appetite
- Restlessness
- Tremors
- Difficulty sleeping and disturbed sleep (insomnia)
- Heat intolerance and sweating
- Chest pain, palpitations, and rapid or irregular heartbeats
- Shortness of breath and difficulty breathing
- Increased stool frequency (with or without diarrhea)
- Irregular or stopped periods
- Muscle weakness
- Difficulty controlling diabetes
- Fatigue
30
Graves’ Disease Diagnosis of Graves’ Disease
- Thyroid panel- TSH , T3 T4
- Thyroid Ultrasound
- Radioactive iodine uptake
- a small amount of radioactive iodine is given and then the rate at which your thyroid gland absorbs it is measured.
- This test can help determine if a patient with a thyroid nodule has a hot or cold nodule
31
Graves’ Disease Treatment
- Radioactive Iodine therapy- given orally
- Because the thyroid needs iodine to produce hormones, the thyroid takes the radioiodine into the thyroid cells and the radiation destroys the overactive thyroid cells over time
32
Graves’ Disease Treatment
- Surgical removal of all or part of your thyroid (thyroidectomy or subtotal thyroidectomy) also is an option for the treatment of Graves' disease
33
Graves’ Disease Treatment
- Anti-thyroid medications interfere with the thyroid's use of iodine to produce hormones. These prescription medications include propylthiouracil (PTU) and methimazole (Tapazole).
- PTU is the preferred drug for pregnancy
34
Graves’ Disease Symptom Management
- Beta Blockers do not inhibit the production of thyroid hormones, but they do block the effect of hormones on the body.
- They may provide fairly rapid relief of irregular heartbeats, tremors, anxiety or irritability, heat intolerance, sweating, diarrhea, and muscle weakness.
- Propranolol (Inderal, InnoPran XL)
35
Hypothyroid
- Hashimoto's disease, an autoimmune disorder where your immune system attacks your thyroid. This is the most common cause.
- Thyroiditis, inflammation of the thyroid
- Congenital hypothyroidism, hypothyroidism that is present at birth
- Surgical removal of part or all of the thyroid
- Radiation treatment for Graves’ disease
- Certain medicines
- In rare cases, a pituitary disease or too much or too little iodine in your diet
- Worldwide the major cause of hypothyroidism is iodine deficiency
36
Hypothyroid
- Hashimoto's disease: your body thinks your thyroid cells are foreign invaders. The immune system sends thyroid peroxidase antibodies (TPOAb) to attack your thyroid.
- This can first cause the signs and symptoms of hyperthyroid; however over time the damage to the thyroid cells leads to the decreased production of thyroid hormones T3 and T4.
- This is why follow up is important
37
Hypothyroid Treatment
- Mainstay of treatment is the oral replacement of the missing hormones
- Typically patient’s are treated with levothyroxine (synthetic T4)
- Cytomel can be used but according to the American Thyroid Association clinical trials have not any benefit to adding Cytomel ( T3)
- Daily dosing, taking at the same time daily
- With laboratory monitoring every 6 weeks until an acceptable TSH level is reached , along with a decrease in symptoms.
38
Thyroid Case Study
- 45 year old female presents with complaints of anxiety, tremors, racing heart and a 15 lb weight loss in the last 2 months. She was recently diagnosis with hashimotos and started on synthroid 25 mcg daily to be taken on an empty stomach. She has no other past medical history, she is on multiple over the counter nutritional supplements and adhere to a vegetarian diet.
- Vital signs
- Blood pressure 150/110
- HR 120
- Temp 99.0
- Respirations 22
39
Thyroid Case Study
- What Questions do you ask?
- Have you been taking the synthroid as directed ?
- Have you been taking any new medications ?
40
Thyroid Case Study
- When asked about her synthroid she states she does not trust the FDA and will not take anything “those people” say is safe !
- When asked about any other new medications she presents to you a bottle of organic natural thyroid supplements. Which she has been taking for the last 2 months.
- You exam the bottle and read the ingredients.
- Number 1 ingredient is Bovine Pituitary gland
- Number 2 ingredient was Bovine thyroid gland
- Number 3 ingredient is Porcine thyroid
41
Thyroid Case Study
- Now mind you Porcine thyroid is sold under the brand name Armour thyroid and is made from dried thyroid glands of animals. It is not FDA approved and there are small studies that show some people feel better when using this drug.
- The problem with this patient is she bought her supplements on the internet and was not aware that the word Bovine means from a cow and the word Porcine means from a pig
- Armour has been shown to put patient’s at a greater risk of thyrotoxicosis.
- On top of that the particular supplement she was using also contained Bovine pituitary gland.
- Remember she is a vegetarian
- She did not know she was consuming dried Cow and Pig organs, including a part of a Cow’s brain.
42
Diabetes
- Type 1 Diabetes
- Type 2 Diabetes
- Gestational diabetes
- Prediabetes
- More than 37 million Americans are living with diabetes estimated 28.7 million people have been diagnosed already. Approximately 8.5 million people have diabetes but have not yet been diagnosed.
- And more than 96 million American have prediabetes, Of those with prediabetes, more than 80% don't know they have it !
43
Symptoms of Diabetes
- Urinate (pee) a lot, often at night (polyuria)
- Are very thirsty (Polydipsia)
- Lose weight without trying
- Are very hungry (polyphagia)
- Have blurry vision
- Have numb or tingling hands or feet
- Feel very tired
- Have very dry skin
- Have sores that heal slowly
- Have more infections than usual
44
Type 1 Diabetes
- Type 1 diabetes is thought to be caused by an autoimmune reaction
- This reaction destroys beta cells.
- This process can go on for months or years before any symptoms appear.
- This leads to little to no insulin production
45
Type 1 DM Symptoms
- People with Type 1 DM may also have nausea, vomiting, or stomach pains. Type 1 diabetes symptoms can develop in just a few weeks or months and can be severe.
- Diabetes Ketoacidosis can be the presenting scenario: anorexia nausea, vomiting, fruity breath, coma, Kussmaul breath ( abnormal breathing pattern characterized by rapid, deep breathing at a consistent pace)
- Diabetes Ketoacidosis is a medical life threatening emergency. If a patient presents to your office with these symptoms you must call 911 !
46
Type 1 DM Diagnosis
- Glycated hemoglobin (A1C) test- A1C level of 6.5% or higher on two separate tests means you have diabetes.
- Random blood sugar level of 200 mg/dL (11.1 mmol/L) or higher suggests diabetes
- Fasting blood sugar level from 100 to 125 mg/dL (5.6 to 6.9 mmol/L) is considered prediabetes. If it's 126 mg/dL (7 mmol/L) or higher on two separate tests, you have diabetes
- Autoantibodies that are common in type 1 diabetes. The tests help your provider decide between type 1 and type 2 diabetes when the diagnosis isn't certain.
47
Type 1 DM Treatment
- Treatment aims at maintaining normal blood sugar levels through regular monitoring, insulin therapy, diet, and exercise.
- How to get started
48
How Your Body Secretes Insulin
- Insulin
- Time
- Bolus Insulin
- Basal Insulin
49
Insulin
- Rapid-acting
- Less variability
- Humalog®, Novolog®, and Apidra®
- 5 to 15 mins
- 4 to 6 hrs
- Yes
- Short-acting
- (regular)
- Intermediate-
- acting
- Long-acting
- Lantus® and Levemir ®
- 30 to 60 mins
- 1 to 2 hrs
- 1 to 2 hrs
- 6 to 10 hrs
- 10 to 18 hrs
- 24 hrs
- Yes
- Yes
- No
- Type
- Brand names
- Onset of effect
- Duration of effect
- Peak
- Humalog and Humulin are registered trademarks of Eli Lilly and Company.
- Novalog and Levemir are registered trademarks of Novo Nordisk A/S.
- Apidra and Lantus are registered trademarks of Sanofi-Aventis US, LLC.
- Humulin® R
- NPH
50
Conventional Insulin Therapy
- Time
- Benefits
- Two injections per day (no mealtime bolus injections)
- Doses are fixed (no calculations needed)
- Disadvantages
- No flexibility in diet
- No flexibility in schedule
- Doses do not match how a pancreas maintains the insulin/glucose balance
- Insulin
- .
51
Multiple Daily Injection (MDI) Therapy
- Benefits
- Provides intensive glucose control
- More flexible lifestyle
- Basal and bolus rates can be calculated separately
- Disadvantages
- Four to eight injections per day in several different areas of your body
- Limited to one basal dose per day
- Complicated math calculations
- Bolus doses not always accurate due to math and guessing
- Lantus® or
- Levemir®
- Insulin
- Time
- Bolus Insulin
- Basal Insulin
- Humalog®, Novolog® or Apidra®
- Schematic representation only.
- Humalog is a registered trademark of Eli Lilly and Company.
- Novalog and Levemir are registered trademarks of Novo Nordisk A/S.
- Apidra and Lantus are registered trademarks of Sanofi-Aventis US, LLC.
- MDI with Lantus® and Rapid-Acting Insulin
52
Insulin Pump Therapy
- Insulin pump therapy more closely mimics a healthy pancreas than injections
- Insulin
- Time
- Normal Insulin Secretion
- Insulin Pump Delivery
53
Basal Insulin Dosing
- Insulin naïve patients
- 0.2 units/kg
- If the presenting blood glucose level is >200mg/dl, adding a pre-meal is appropriate.
54
Pre-meal Insulin Dosing
- Dose should be 0.2units/kg divided by three meals.
- Remember this dose is to accommodate a patients for the food he or she is eating. One must also add a correction dose as well.
- A correction dose of 1 to 2 units of rapid acting insulin per 50mg/dl over a goal blood sugar of 150.
- Basal or pre-meal insulin doses need to be adjusted daily if correction doses are given often, extreme values >300 or <60mg/dl.
55
Insulin Dose Example
- You have a patient who weighs 80kg and has blood sugar of 250mg/dl:
- 80kg X 0.2 units = 16units of long acting insulin
- Pre-meal:
- 80kg X 0.2 units=16units
- 16units/3= 5 units pre-meal
- Correction Dose:
- 1 unit per 50mg/dl over goal blood sugar of 150
- 250-150=100 points over goal
- 100/50=2 units of rapid acting insulin for correction
56
Type 2 DM
- Peripheral insulin resistance
- impaired regulation of hepatic glucose production
- Declining β-cell function
- Eventually leading toβ -cell failure
- Symptoms often take several years to develop. Some people don’t notice any symptoms at all.
- This is why it is important to diagnosis type 2 diabetes early!
57
Type 2 Diabetes Risk Factors
- Have prediabetes.
- Are overweight.
- Are 45 years or older.
- Have a parent, brother, or sister with type 2 diabetes.
- Are physically active less than 3 times a week.
- Have ever had gestational diabetes (diabetes during pregnancy) or given birth to a baby who weighed over 9 pounds.
- Are an African American, Hispanic or Latino, American Indian, or Alaska Native person. Some Pacific Islanders and Asian American people are also at higher risk
58
Type 2 DM Treatment
- Treatment aims at maintaining normal blood sugar levels through regular monitoring, medication both oral and Insulin, diet, and exercise.
- Mainstay of treatment will always be Life style changes
- Reduction of Carbohydrate intake. Remember not every one knows what a carbohydrate is ! It is our job to teach them.
- Exercise- remember it is easy to tell a patient to exercise but we must teach them why it is so important in the management of type 2 DM
59
Carbohydrates Examples
- Bread
- Rice
- Cereal
- Pasta
- Candy
- Soda
- Fruits
- Cake
- Cookies
- The list goes on
- We must teach about portion control: what is a cup of rice
- Asked them to show you with their hands how much they eat
- Teach our patient about hidden Carbohydrate
- Fancy Coffee, ETOH, Vitamin Water etc
60
Medications to Treat Type 2 DM
- Metformin First line of treatment
- Sulfonylureas help the body secrete more insulin. Examples include glyburide glipizide, Amaryl.
- Glinides stimulate the pancreas to secrete more insulin. They're faster acting than sulfonylureas. But their effect in the body is shorter. Examples include repaglinide and nateglinide.
- Thiazolidinediones make the body's tissues more sensitive to insulin. An example of this medicine is pioglitazone (Actos)
- DPP-4 inhibitors help reduce blood sugar levels but tend to have a very modest effect. Examples include sitagliptin ,Januvia.
61
Medications to Treat Type 2 DM
- GLP-1 receptor agonists are injectable medications that slow digestion and help lower blood sugar levels. Associated with weight loss, and some may reduce the risk of heart attack and stroke. Examples include Byetta, Ozempic.
- SGLT2 inhibitors affect the blood-filtering functions in the kidneys by blocking the return of glucose to the bloodstream. As a result, glucose is removed in the urine. Examples include Invokana, dapagliflozin, Farxiga, Jardiance.
62
Metformin
- It decreases the amount of glucose you absorb from your food and the amount of glucose made by your liver.
- Side effects:
- Nausea
- Diarrhea
- Loss of appetite
- Metallic taste in your mouth
- Rarely can cause lactic acidosis
63
Sulfonylureas
- Directly stimulate release of insulin from pancreatic beta cells and thereby lower blood glucose concentrations
- Side effects:
- hypoglycemia
- Weight gain
- Increase in cardiac events
- Endocrinologists are staying away from these drugs, long term use leads to early beta cell burn out.
64
Glinides
- Bind to the SUR1 receptor on the β-cell, although with lower affinity than sulfonylureas, and stimulate insulin release in the same way.
- Side effects:
- Hypoglycemic
- Weight gain- People can gain up to 7 pounds during the first 3 months of starting glinides
- Endocrinologists are staying away from these drugs, long term use leads to early beta cell burn out
65
Thiazolidinediones
- Insulin sensitizers that act on intracellular metabolic pathways to enhance insulin action and increase insulin sensitivity in critical tissues
- Also increase adiponectin levels, decrease hepatic gluconeogenesis, and increase insulin-dependent glucose uptake in muscle and fat
- Side effects:
- Edema and Congestive Heart Failure.
- Weight Gain.
- Fractures.
- Bladder Cancer.
- Hepatotoxicity.
- Diabetic Macular Edema.
- Increased Ovulation and Teratogenic Effects.
66
DDP 4 Inhibitors
- Blocking the action of DPP-4, an enzyme which destroys the hormone incretin.
- Side effects:
- gastrointestinal problems – including nausea, diarrhoea and stomach pain.
- flu-like symptoms – headache, runny nose, sore throat.
- skin reactions – painful skin followed by a red or purple rash
67
GLP-1 receptor agonists
- Mimicking the effects of the hormone glucagon-like peptide to regulate appetite and blood glucose levels. GLP-1 is a type of incretin hormone, meaning it's created in the gut and released after eating a meal.
- Incretin (GLP-1 and GIP), inhibits glucagon release, which in turn increases insulin secretion, decreases gastric emptying, and decreases blood glucose levels.
- Side effects:
- Nausea
- Vomiting
- Diarrhea
- Rare cases in animal studies of increase in medullary thyroid carcinoma
68
SGLT2 inhibitors
- Reducing renal tubular glucose reabsorption, producing a reduction in blood glucose without stimulating insulin release.
- Side effects:
- Genital yeast infections
- Flu-like symptoms
- A sudden urge to urinate.
- The U.S. Food and Drug Administration also warns of more rare but serious issues such as amputations, kidney injury and ketoacidosis.
69
Type 2 Diabetes Insulin
- I tell every patient the longer you live with uncontrolled Type 2 DM the higher the probability you will need Insulin at some point in their life.
- How to start insulin in a patient with Type 2 DM
- Initiation of basal insulin at 10 units/day or 0.1–0.2 units/kg/day, adjusted by 10–15% or 2–4 units once or twice weekly until the patient reaches a target fasting blood sugar.
- Refer to Endocrinologist for tighter control
70
Hypoglycemia
- Low Blood sugar
- 4 main causes
- Skipping a meal
- Increased physical activity
- Taking to much insulin
- Drinking alcohol
71
Hypoglycemia Signs and Symptoms
- Feeling hungry
- Trembling or shakiness
- Sweating
- Lightheadedness
- Dizzy
- Confused
- Aggressive
- Syncope
- Seizure
72
Hypoglycemia Treatment
- If a person is awake and able to follow commands
- Treat by having them eat or drink 15-20 grams of fast acting carbohydrate, such as juice, glucose tablets (not milk, milk has fat and is not quick enough)
- If a person is not awake or unable to follow commands
- Treat them with a buccal glucose such as a glucose gel, cake frosting, honey
- If the patient has a glucagon pen then that is the treatment of choice
73
Hypoglycemia Treatment
- After the initial treatment recheck the patient’s blood sugar if it is still not above 70 treat the patient again with a rapid acting glucose.
- If the patient is still not responsive and you are in an outpatient setting you might want to consider calling 911
- Once the patient’s blood sugars are above 70 and they are able to follow commands have them eat a complex carbohydrate
- Cheese sandwich
- Peanut butter and crackers
- Something with carbohydrates and fat.
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Diabetes Complications
- Heart Disease
- Stroke
- Diabetic Nephropathy (Kidney Disease)
- Diabetic Neuropathy (Nerve Damage)
- Diabetic Retinopathy (Eye Damage)
- Gastroparesis
- Erectile Dysfunction
- Skin Problems
- Infection
- Dental Problems in Diabetes
