Thyroid/Diabetes Flashcards
(143 cards)
1
Q
What is Graves Disease?
under the grave you wont be very…
A
Antibody mediated autoimmune disease resulting in hyperthyroidism
treated with adjuvent beta blockers
2
Q
What is Hashimoto’s Thyroiditis?
A
Autoimmune disease often resulting in hypothyroidism
3
Q
What are the functions of thyroid hormones?
A
- Stimulates metabolic activity and oxygen consumption of cells
- Produces heat and thermogenesis
- Stimulates carbohydrate, fat and protein metabolism
- Increases rate of glucose absorption
- Increases erythropoiesis
- Influences mood
- Works with growth hormone, insulin, and sex steroids to promote growth
- Required for normal respiratory response to hypoxia and hypercapnia
- Critical for fetal neural and skeletal development
4
Q
What are the normal thyroid levels for TSH?
A
0.4 to 4.5
5
Q
What TSH level indicates hyperthyroidism?
A
Less than 0.4
6
Q
What TSH level indicates hypothyroidism?
A
Above 4.5
Can be primary or autoimmune (Hasimotos, thyroiditis)
7
Q
List some symptoms of hypothyroidism.
A
- Fatigue
- Depression
- Dry Skin
- Constipation
- Bradycardia
- Altered menstrual cycles
- Weight gain
- Changes in hair
- Cold intolerance
8
Q
What is myxedema?
A
Severe hypothyroidism
9
Q
What medication is commonly used for hypothyroidism?
A
Levothyroxine
10
Q
What is the brand name for synthetic T4?
A
Synthroid, Levoxyl
levothyroxine
11
Q
What is the half-life of Levothyroxine?
A
6-7 days
12
Q
What should be avoided when taking Levothyroxine/ Armour Thyroid
A
Calcium containing medications, antacids, or iron supplements
13
Q
What is hyperthyroidism?
A
Increased in circulating T3 and T4 from overactive thyroid or excessive thyroid hormone production
Graves disease is hyper-functioning thyroid
14
Q
What is the main treatment for Graves Disease?
A
Beta blockers (e.g., Propranolol or Atenolol)
15
Q
What are the symptoms of hyperthyroidism?
A
- Anxiety
- Restlessness
- Diaphoresis
- Diarrhea, N/V
- Tachycardia / AFib
- Weight loss
- Heat intolerance
- Exophthalmos
- Changes in menstrual cycle
- Insomnia
16
Q
What is Lugol’s Solution used for?
IODINE
A
- Inhibits release of T3 and T4
- short-term use
- can cause iodinism
17
Q
What are the side effects of Iodine Solutions?
A
- Metallic taste
- Stomatitis
- Sore throat
- Hypersensitivity
18
Q
What is desiccated thyroid?
AMOUR THYROID
A
Thyroid extract from animal thyroid glands that have been dried and powdered
-Contains both T3/T4
Side Effects: Change in appetite, chest pain, diarrhea
safe during pregnancy
HYPOTHYROID
19
Q
What is the drug of choice for hyperthyroidism?
A
Methimazole
20
Q
What does Propylthiouracil (PTU) do?
A
Inhibits Conversion T4 to T3
Medscape: Inhibits synthesis of thyroid hormone by blocking oxidation of iodine in thyroid gland; blocks synthesis of T4 and T3
21
Q
What is the treatment goal for hyperthyroidism?
A
Decreasing thyroid hyperactivity and preventing complications
22
Q
What must be monitored when using PTU?
A
- LFTs
- CBC
23
Q
What is the usual duration for checking TSH after starting thyroid medication?
A
6-8 weeks after starting and after dose changes
24
Q
Can thyroid medications be used safely during pregnancy?
A
It depends on which ones. PTU can be used in first trimester. Desiccated thyroid can be. Methimazole shouldn’t be used, same with I-131
25
Explain the process of insulin resistance and how it leads to the development of Type 2 DM
online: Initially, the body compensates by producing more insulin, but over time, the pancreas struggles to keep up, leading to elevated blood sugar levels and eventually, T2DM
From her slides in diff power point: Initially there is increased insulin secretion by the Beta cells to bring down the BS. Insulin not effective/cant bring down blood glucose/ then body needs to increase levels of glucose/beta cells become exhausted
26
How does metformin reduce blood sugar in the Type 2 DM?
- Improves how insulin works in the body (Insulin sensitizer)
- Decreases absorption of carbohydrates
- Decreases glucose production in the liver
- Decreases appetite
27
Most frequent side effects of metformin?
* GI side effects (common)
* Bloating
* Diarrhea
* Abdominal pain
* Nausea
* Metallic taste
| Increased risk for B12 deficiency
28
What are the significant nursing interventions needed for those patients who take Metformin?
- Hold 48 hours prior to contrast dyes
(may lead to lactic acidosis or acute
kidney injury)
- Contraindicated in patients with renal
or hepatic impairment, and heart
failure
29
What lab test other than the BS should the nurse be aware when administering metformin?
Renal/hepatic?
30
How do the sulfonylureas reduce blood sugar?
| G G sulfur stinks
Stimulates Beta cells to secrete insulin
Decrease glucose production by the liver
| *Glipizide and glyburide*
## Footnote
Can cause hypoglycemia
31
Why do sulfonylureas cause weight gain?
| G G sulfar stinks
Stimulates B cells by decrasing glucose prodcution. Increases insulin. IT JUST DOES
| GLipizide/Glyburide
## Footnote
Causes hypoglycemia
32
What are the nursing interventions for Sulfonylureas?
Onset?
* Monitor for hypoglycemia
* Onset at 90 minutes and peak in 2-3 hours
33
Patients allergic to what medications should take sulfonylureas with caution?
DO NOT GIVE IF ALLERGIC TO SULFA DRUGS
## Footnote
ALso not for pregnant/lactating women/beta blockers
34
How are the Meglitinides the same as the sulfonlyureas? different from the sulfonylureas
online: They induce insulin secretion from pancreas, with a different mechanism of action from sulfonylureas
35
How will the nurse know if Meglintinides are working?
| When should pt take it?
Check BS levels??
Onset at 90 minutes and peak in 2-3 hours
## Footnote
Should be taken with first bite of food (CUZ IM MEGA HUNGRY)
36
How do alpha glucosidase inhibitors work to decrease blood sugar?/ When are these meds used most frequently?
"Starch Blocker"
Inhibit alpha-glucosidase, by delaying
the absorption of glucose in the small
intestines after a meal; does not
increase insulin secretion
Online: used to manage post-meal blood sugar spikes by slowing down carbohydrate absorption.
| Precose anad Glyset
37
-How do Thiazolidinediones work to reduce blood sugar?
-Contraindicated for which group of patients?
-Why do these patients gain weight?
-Improve the effectiveness of insulin by decreasing insulin resistance in adipose and muscles cells
-Contraindicated in those patients with heart failure or hepatic impairment
-online: fluid retention, increased fat storage, and a shift in fat distribution towards subcutaneous fat can cause weight gain
38
Explain the role of the incretins in glucose control?
| GLP-1 Agonist
enhancing insulin release, suppressing glucagon, slowing digestion, and reducing appetite, ultimately improving blood sugar control and potentially leading to weight loss
39
# INCRETINS (GLP-1)
-Why do these patietns often lose weight on these meds?
-Who should NOT receive these meds?
online: because these medications mimic the effects of the natural hormone glucagon-like peptide-1 (GLP-1), which helps regulate appetite, slows down digestion, and increases feelings of fullness, leading to reduced food intake and weight loss.
online: Patients with hx of pancreatitis?
40
How do the DPP-4 inhibitors work to decrease blood sugar?
* Inhibits dipeptidyl peptidase 4 (DDP-4) enzyme, which destroys the GI incretin hormones GLP-1 and GIP
* Increase insulin secretion
* Decrease glucagon secretion to decrease glucose production
* Allows incretin hormones to remain in circulation longer
41
Major nursing considerations for DPP-4?
Hypoglycemia
42
How do sodium glucose co transport inhibitors work?
Inhibit reabsorption of glucose in the proximal renal tubules; promote glucose excretion in urine
43
Side effects of sodium glucose co transport inhibitors?
Increase risk :
Yeast infections, UTIs, and Amputation?
44
Glycemic Targets (ADA)
A1C
FPG
PPG
* A1C < 7%
* FPG 80-130
* PPG <140
45
What is the primary action of insulin?
Hormones that controls the storage and metabolism of carbohydrates, proteins, and fats
## Footnote
This activity occurs primarily in the liver, in muscle, and in adipose tissues.
46
What does insulin stimulate in the liver?
Synthesis of glycogen
47
How does insulin affect protein and fat storage?
Promotes protein synthesis and helps store fat by preventing its breakdown for energy
48
From where is insulin released?
Beta cells of the Islet of Langerhans in response to increased blood sugar
49
What is the goal of insulin therapy?
To mimic the physiological control of blood glucose levels
50
What are the two physiological blood glucose levels of insulin secretion?
* Basal insulin levels – during fasting
* Postprandial levels – after eating
51
What are the indications for insulin use?
* Diabetes Type 1
* Diabetes Type 2
* When not controlled with lifestyle and oral meds
* Treat severe DKA or diabetic coma
* Treat hyperkalemia in combination with glucose
52
What is the recommended method of insulin administration?
Only use an insulin syringe and administer subcutaneously
53
What is lipodystrophy?
A condition that can be prevented by rotating injection sites
## Footnote
Keep injections about 1.5 in away from eachother and if BID use both L and R side
54
What should be the distance between insulin injection sites?
About 1.5 inches away from each other
55
What are the methods of insulin administration?
* Insulin pumps
* Insulin pen injectors
* Insulin syringes
56
Name the types of insulin.
* Rapid-Acting
* Short-Acting (Regular)
* Intermediate
* Long-Acting
57
What are the names of rapid-acting insulin drugs?
All, guys, like, (cumming) Inside.
Which is rapid…and deadly..
* Aspart
* Glulisine
* Lispro
* Inhaled Insulin
| most deadly type of insulin
## Footnote
Peak time 30-90 minutes. 12-15 for inhales. Lasts 3-5 hours
58
What is the onset time for Aspart, Glulisine, and Lispro?
5-15 minutes
## Footnote
Inhaled insulin onsent within ONE minute
59
What is the peak time for rapid-acting insulin?
30-90 minutes
## Footnote
inhaled insulin within 12-15 min
60
True or False: Food must be present when administering rapid-acting insulin.
True
61
What is the duration of action for rapid-acting insulin?
3-5 hours
62
What is the primary use for short-acting insulin?
| AKA REGULAR INSULIN
To cover the glucose rise after eating a meal
63
When should short-acting insulin be administered?
30 minutes before meals
64
What happens if regular insulin is cloudy?
Throw it out
65
What is intermediate-acting insulin also known as?
Isophane or NPH (Neutral Protamine Hagedorn)
66
How often is intermediate-acting insulin usually given?
Twice a day
67
What is the typical dosing schedule for intermediate-acting insulin?
2/3 in the morning and 1/3 in the evening
## Footnote
Can be pre made in a 70/30 mixture of regular/NPH.
-Supplied as a pen which makes for very easy administration.
-Can be at room temp for 10 days
68
What is the onset of action for long-acting insulin?
Up to 1.5 – 2 hours
69
What is the duration of action for long-acting insulin?
24+ hours
70
What is a notable characteristic of long-acting insulin absorption?
Even absorption with no peaks and valleys
| Frequently used in Type 2 DM
71
What is the dosing range for insulin?
0.6-0.8 units/kg/day
72
What is sliding-scale insulin?
Adjusted doses dependent on individual blood glucose, usually reserved for inpatient use
73
How should unopened vials of insulin be stored?
Refrigerated until needed
74
How long can opened insulin vials be stored at room temperature?
1 month
75
What is the antidote for hypoglycemia?
Sugar
76
What should patients with Type 1 DM do even if NPO?
Will need insulin
77
What should diabetic patients wear as a precaution?
A medical alert tag
78
Nursing considerations for Rapid- Acting Insulin
* Must be given with food
* Usually given in conjunction with intermediate acting insulin
* Always monitor for hyPOglycemia
79
Nursing considerations: Short acting (Normal) insulin
If Regular insulin (clear) is mixed with NPH human insulin (cloudy), the Regular insulin should be drawn into the syringe first.
*May be given IV
80
Hypothroid medications (2)
Levothyroxine
Armour Thyroid (desiccated)
81
Hyperthyroid medications
Methimazole
Propylthiouracil (PTU)
Iodine Solutions
82
Nursing Considerations: Armour thyroid
Based on TSH results
Life-long medications
Safe in pregnancy
Should have TSH checked regularly until stablized (6-8 weeks after then annually)
83
Thioamides
Baseline labs?
When to take?
| Inhibits what? Methimazole/PTU
* Inhibits formation of thyroid hormones in the cells
* Inhibits conversion of T4 --> T3
* Need baseline CBC/LFTs
* Take on empty stomach/30 minutes before eating
* Takes several weeks to see effect
84
Medication given for Thioamides
| Both have THI?
Methimazole
Propylthiouracil (PTU)
85
Methimazole
| THIOAMIDE
Thioamide-
* Drug of choice unless pregnant
* Side Effects: Less GI effects
* Can cause bone marrow suppression
Pharmacology (Medscape):
- Inhibits synthesis of thyroid hormone by blocking oxidation of iodine in thyroid gland
- blocks synthesis of thyroxine (T4) and triiodothyronine (T3)
86
PTU
| THIOAMIDE
Thioamide
* inhibits Conversion of T4-T3
* Can be used during first trimester of pregnancy only
* Need to monitor LFT's/CBC
Medscape:
- Inhibits synthesis of thyroid hormone by blocking oxidation of iodine in thyroid gland
- blocks synthesis of T4 and T3
87
I-131
* Iodine (Radioactive)
* Use for thyroid cancer, thyrotoxicosis/special cases
* Not for pregnancy
* Increase fluid intake
* Radiation precautions
88
Adjuvant therapy-Beta blockers
| hyperthyroidism
* Propanolol/Atenolol
* To control symptoms
* Used in Tachy/arrythmic/HTN adults
* Used to control sxs while waiting for meds to take effect
89
What is polyuria?
Increased amount and frequency of urination due to renal threshold for glucose reabsorption being exceeded.
| Glucose >180
## Footnote
Results in glucose remaining in renal tubule and an osmotic gradient that pulls water from tubule cells into urine.
90
What are the classic symptoms of Type 1 Diabetes Mellitus?
3 P’s
* Polyuria
* Polydipsia
* Polyphagia
## Footnote
Other symptoms may include blurred vision, fatigue, and weakness.
91
What is diabetic ketoacidosis (DKA)?
symptoms? (4)
Occurs mainly in?
A hyperglycemic emergency characterized by hyperglycemia, metabolic acidosis, dehydration, and electrolyte loss.
## Footnote
Often presents in Type 1 Diabetes but can occur in Type 2.
-stored fatty acids can cause DKA
92
What triggers ketosis in diabetes?
Insulin deficiency leads to the breakdown of fat into free fatty acids and glycerol, converted into ketones by the liver.
## Footnote
Ketones are strong acids that can lead to metabolic acidosis.
93
What is the dawn phenomenon?
Increase in fasting blood glucose and/or insulin requirements during early morning hours due to nocturnal elevation of growth hormone.
## Footnote
Not triggered by nocturnal hypoglycemic events.
94
What is the Somogyi effect?
Nocturnal hypoglycemia followed by rebound hyperglycemia due to counter-regulatory hormone release.
## Footnote
Occurs from too much or too little insulin at bedtime.
95
What are the three main causes of DKA?
* Infection or illness
* Lack of Insulin
* Undiagnosed or undertreated diabetes
## Footnote
These factors can precipitate DKA in patients.
96
What is the initial treatment for DKA?
Fluid replacement to restore intravascular volume and correct electrolyte imbalances.
## Footnote
Insulin therapy is also initiated once fluids are administered.
97
What are the clinical manifestations of DKA?
* Extreme dehydration
* Poor skin turgor
* Dry mucous membranes
* Tachycardia
* Hypotension
* Acetone breath
* Kussmaul respirations
* Changes in LOC
## Footnote
Presenting symptoms also include the 3 P’s and weight loss.
98
What does hyperglycemia cause in relation to thirst?
Increased osmotic pressure in the extracellular compartment causes water to shift out of the intracellular space, leading to cellular dehydration and thirst sensation.
## Footnote
This condition is known as polydipsia.
99
Define hypoglycemia.
Blood glucose level < 70 mg/dL with or without symptoms.
## Footnote
Most commonly occurs in patients treated with insulin.
100
What are common electrolyte issues in DKA?
* Hyponatremia
* Hyperkalemia
## Footnote
These imbalances need to be monitored during treatment.
101
what is Type-1 Diabetes Mellitus
| types?
-Total destruction of the pancreatic beta cells
-autoimmune
-Types :
-1A (90-95%)
- Type B (idiopathic, no autoimmune)
- Rapid destruction in kids/Slower in adults
102
What is ketosis?
A metabolic state where the body uses free fatty acids for energy instead of glucose
103
Clinical manifestations of Diabetes type-1
* Three “P’s”:
* Polydipsia
* Polyuria
* Polyphagia
* Weight loss
* Abdominal pain
* Neuro symptoms
* Blurred vision (accumulation of aqueous humor in the eye)
* Other symptoms
* Frequent Candida infections
* Extremely elevated glucose
* Ketones in urine
* Metabolic acidosis
104
Polyphagia
Increased appetite with weight loss
-Insulin deficiency-cells not receiving glucose- sets into effect compensatory processes to increase blood glucose levels.
105
Difference between dawn phenomenon and somogyi effect
Check glucose level in the middle of the night
A. Dawn = Normal/High Glucose at 3 AM
B. Somogyi = Low Glucose at 3 AM
106
What causes blurred vision in diabetes?
Accumulation of glucose in aqueous fluid in the cornea alters refraction of light entering the eye
107
What characterizes Type 1 Diabetes Mellitus?
Total destruction of the pancreatic beta cells due to autoimmune response
## Footnote
Includes Type 1A (90-95%) and Type 1B (idiopathic, no autoimmune).
108
What is the glucose range for hypoglycemia?
Common causes?
Defined as blood glucose < 70 mg/dL with or without symptoms
Common causes: Excessive exercise, alcohol, poor food intake, too much insulin, stress, surgery, and medications
109
What is the role of glucagon in hypoglycemia?
Triggers the release of glycogen from the liver
110
What happens during gluconeogenesis?
The body creates glucose from non-carbohydrate sources instead of using the Krebs cycle
111
What are the functions of glucose, fat, and proteins in meeting the energy needs of the body?
Glucose provides energy for cells, fat is the most dense fuel storage, and proteins are building blocks for tissues
## Footnote
Glucose is absorbed into the bloodstream at the intestines and is essential for normal cerebral function.
112
What are counter-regulatory hormones?
Hormones that counteract the effects of insulin:
glucagon, epinephrine, cortisol, and growth hormones
## Footnote
They help increase blood glucose levels when they drop.
113
What distinguishes Type 1 diabetes from Type 2 diabetes?
Type 1 is characterized by autoimmune destruction of pancreatic beta cells; Type 2 involves insulin resistance and deranged insulin secretion/gestational/drug induced
## Footnote
Type 1A is autoimmune, while Type 1B is idiopathic.
114
Define metabolic syndrome and its association with Type 2 diabetes.
Metabolic syndrome is a cluster of conditions that increase the risk of heart disease, stroke, and diabetes, often associated with obesity and insulin resistance
115
What happens to glucose in the presence of oxygen?
It breaks down to form CO2 and water
## Footnote
This process is part of cellular respiration.
116
What happens to glucose after absorption?
It is used for energy, stored as glycogen in the liver, or converted into fat
## Footnote
Excess glucose can also be excreted in urine.
117
What is glycogenolysis?
The breakdown of stored glycogen to make glucose
-This process occurs in the liver and muscle tissue when glucose levels are low. (Prolonged starvation)
-In response to Epinrephrine, glucagon, insulin
118
What is gluconeogenesis?
The synthesis of glucose by the liver from non-carbohydrate sources
## Footnote
It primarily occurs from amino acids and fats. Can lead to development of ketones
119
What role does insulin play in glucose metabolism?
Insulin stimulates the uptake, use, and storage of glucose by promoting glycogen synthesis and inhibiting gluconeogenesis
## Footnote
It is released by beta cells in the pancreas.
120
What are the glucose-regulating hormones?
Amylin, somatostatin, glucagon, and incretins
## Footnote
Amylin slows glucose absorption, while glucagon promotes glucose production.
121
What are the risk factors for Type 2 diabetes?
* Family history
* Obesity
* Ethnicity
* Age
* Gestational diabetes
* Hypertension
* Polycystic ovary syndrome (PCOS)
* Smoking and alcohol
## Footnote
These factors contribute to insulin resistance and deranged insulin secretion.
122
When are insulin levels their highest?
After a meal
## Footnote
Insulin levels decrease during fasting.
123
What are the symptoms of hypoglycemia? (13)
* Fatigue
* Sweating
* Hunger
* Dizziness
* Rapid heart rate
* Anxiety
* Irritability
* Shakiness
* Blurred vision
* Confusion
* Loss of consciousness
* Seizures
* Coma
## Footnote
Symptoms vary from mild to severe depending on blood sugar levels.
124
What is Hyperosmolar Hyperglycemic Syndrome (HHS)? Causes? How is it unlike DKA?
A condition seen only in Type 2 diabetes characterized by severe hyperglycemia(>600), hyperosmolality (like DKA), and dehydration due to insulin resistance
- Can develop over several days to weeks
-Causes: INfection, non-complicance with diet/meds, substance abuse, alcohol
## Footnote
Unlike DKA, there is no ketone formation in HHS.
125
What is the diagnostic criteria for diabetes?
* Fasting blood glucose > 126 (2 readings)
* 2-hour plasma glucose during OGTT > 200
* Random blood glucose > 200 with hyperglycemic symptoms
* Hgb A1C > 6.5% (2 readings)
## Footnote
These criteria help in the accurate diagnosis of diabetes.
126
What causes diabetic neuropathy? Types?
High blood sugar levels leading to nerve damage
Somatic neuropathy:
Diminished perception: Vibration, pain, temp. Hypersensitivity: Light touch, occasionally severe "Burning" pain
Autonomic neuropathy:
Defects in vasomotor and cardiac responses
Urinary retention
Impaired motility of the gastrointestinal tract
Sexual dysfunction
127
What lifestyle factors increase insulin resistance?
* Sedentary lifestyle
* Poor diet (high glycemic carbohydrates)
* Smoking
## Footnote
These factors contribute to obesity and stress on pancreatic beta cells.
128
Fill in the blank: The body responds to increased blood sugar levels by stimulating the pancreas to release _______.
[insulin]
129
True or False: Type 2 diabetes accounts for 90-95% of all diabetes cases.
| Why
True
130
Insulin stimulates the uptake, use, and storage of _____
glucose
131
Which hormone is required to initiate active transport of glucose into the cell?
Insulin
132
Different ways to regulate glucose:
Increased blood glucose
Beta cells
Insulin & Amylin
Vs
Hypoglycemia
Alpha cells
Glucagon
133
What is the normal glucose levels?
70-100
134
What glucose levels are considered prediabetic?
101-125
135
What glucose level is considered to be diabetic?
>126
136
Physical Symptoms of metabolic syndrome
Increased waist circumference or belly fat
High triglycerides
Elevated BP
High BS
Low LDL
Apple Shape
Ancanthosis Nigricans
137
Clinical manifestations of Metabolic syndromes
* Hyperglycemia causes intracellular fluid shifts ------>polydipsia
* Excessive diuresis causes polyuria
* Cell starvation from lack of glucose ---------> polyphagia
* Fatigue
* Weakness
* Weight loss
* Visual disturbances
138
Why does obesity cause insulin resistance?
* Causes increases in adipose and free fatty acids
* Induces inflammation and release of the associated inflammatory mediators
* Increases stress on pancreatic B cells as insulin is increased
* Results in liver increase glucose in the blood (impaired suppression)
139
Glycated Hemoglobin A1c
HgbA1c measures the amount of glucose over 120 days.
Glucose doesnt normally move into RBCs but when glucose is chronically high it will---> once inside it cannot leave.
140
Symptoms/Treatment of HHS (hyperosmolar hyperglycemic state)
Symptoms: extreme glucose level, rapid/thread pulse, hypotension, profound dehydration, polydipsia, polyuria, confusion, disorientation, possible seizure, or coma
Treatment:
Hydration (given first)
IV insulin
Electrolyte replacement
141
Why is it necessary for a person to maintain blood glucose no lower than 70?
To maintain a continuous supply of glucose for energy
142
What are broad-spectrum anticonvulsants used for
effective for treatment of focal and generalized seizures
143
Insulin types/ peaks and trough and onset tables
