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Metabolism
Diabetes
| Question | Answer |
|---|---|
| Metabolism | The processes of biochemical reactions occurring in the body's cells to maintain optimal blood glucose levels and regulation of hormones associated with the endocrine system |
| Populations at risk for altered metabolism | Pregnant women -Hormonal changes may cause insulin resistance and risk for hyperglycemia |
| Populations at risk for altered metabolism | Infants/Children -Review family history -Large for gestational age at high risk for hypoglycemia at birth -Thyroid should not be palpable -Growth hormone increases during childhood peaking at puberty |
| Populations at risk for altered metabolism | Adolescence -During puberty males release testosterone, females release release estrogen |
| Populations at risk for altered metabolism | Older Adults -Decreased lean muscle mass (where metabolism of glucose occurs) -Thyroid becomes more nodular -Decreased gland activity slows metabolism -Racial/ethnic groups |
| Impaired Metabolism Risk Factors | -Chronic insomnia -Chronic stress -Hypothyroidism/hyperthyroidism -Partial/total thyroidectomy -Liver damage -Genetic predisposition -Poor diet -Meds -Vitamin D deficiency -Obesity -Lack of exercise |
| Impaired Metabolism Assessment | -Complete history (diet, exercise, genetics, organ dysfunction, meds) -Thorough physical exam -Laboratory tests (serum glucose, A1C, LFT, T3&T4 levels, serum electrolytes, serum albumin, BUN, creatinine) |
| Impaired Metabolism Health Promotion | -Promote healthy life habits (diet/exercise) -Teach to avoid excessive alcohol and substances -Educate on regular screenings -Remind patients to take medications regularly -Tailor health promotion to developmental age;include family if needed |
| Pituitary Gland | -"Master gland" -Two parts (anterior pituitary, posterior pituitary) -Anterior: promotes growth of body tissues by enhancing protein synthesis; promotes use of fat for energy |
| Thyroid Gland | -Located anterior to upper trachea; inferior to larynx -Secretes T3 & T4 and calcitonin |
| Parathyroid Gland | -Four to six glands -Secrete parathyroid hormone (PTH) -PTH maintains calcium levels; phosphate metabolism |
| Adrenal Glands | -Two pyramid-shaped glands that sit on top of kidneys -Two organs within each gland (adrenal medulla, adrenal cortex) -Adrenal medulla: epinephrine, norepinephrine -Adrenal cortex: mineralocorticoids, glucocorticoids |
| Pancreas | -Behind stomach, between spleen and duodenum -Endocrine gland and exocrine gland -Endocrine cells produce hormones that regulate carbohydrate metabolism (clustered in pancreatic islets, 3 cell types: alpha, beta, delta) |
| Hormones | -Chemical messengers secreted by endocrine organs -Transported in four ways (endocrine glands, neurons, hypothalamus, paracrine method) |
| Insulin | -Transports and metabolizes glucose for energy -Stimulates storage of glucose in the liver and muscle -Signals liver to STOP release of glucose -Transports amino acids from dietary protein to cells -Inhibits breakdown of store glucose, protein and fat |
| Type 1 Diabetes | -Age <30 years- occurs most often in childhood and adolescence -Genetic predisposition -Autoimmune destruction of beta cells of the islets of Langerhans in the pancreas (the only cells in the body that make insulin) -Environmental (toxins or virus) |
| Type 1 Diabetes Symptoms | -CNS (drowsiness, irritability) -Weakness and fatigue -Fruity breath (acetone production from acidosis) -Weight loss -Ketoacidosis on presentation in 30-40% of cases -Need insulin for survival -Polyphagia -Polydipsia -Polyuria -Abdominal pain |
| Sick Day Management | -BG monitoring Q 4 hrs -Test urine for ketones when glucose above 240 -Continue to take insulin -Drink 8-12oz of liquid every hr -Treat infection -Rest -DO NOT EXERCISE |
| Type 2 Diabetes | -Pancreas doesn't make enough insulin, or body doesn't use insulin correctly -Insulin resistance -Decreased insulin secretion -Occurs at any age -Higher risk in African Americans, Hispanics, Native Americans, Asians, and Pacific Islanders |
| Type 2 Diabetes Symptoms | -Slow onset compared to Type 1 -Fatigue -Weakness -Vision changes -Tingling or numbness in extremities -Poor wound healing -Infections (yeast) -Polyuria & polydipsia |
| Type 2 Diabetes Treatment | -Diabetic education -Diet and exercise (can help prevent) -Weight loss -Oral hypoglycemics -Medical visits at least every 3 months (Hgb A1c goal <6.5-7) -Foot checks -Annual ophthalmic exam -Ultimately insulin therapy |
| Metabolic Syndrome (Pre-Diabetes) | -Central or abdominal obesity (waist circumference for men >40 inches and women >35 inches) -Fasting blood triglycerides >150 mg/dL -Blood HDL (men-<40 mg/dL, women-<50 mg/dL) -BP greater/equal to 130/85 -Fasting glucose greater/equal to 100 |
| Gestational Diabetes | -Caused by decreased insulin sensitivity as pregnancy progresses -Diagnosed by oral glucose tolerance test at 24-28 wk gestation -Usually diagnosed in 2nd or 3rd trimester -Untreated can lead to macrosomia, hypoglycemia, birth trauma, C-Section |
| Hypoglycemia | -BG <50-60 |
| Hypoglycemia Causes | -Too much insulin -Too much oral hypoglycemic -Too little food |
| Hypoglycemia Symptoms | -Reduced cognition -Tremors -Diaphoresis -Weakness -Hunger -Headache -Irritability -Seizure -Dizziness -Mood changes -Paleness |
| Hypoglycemia Treatment | -15 g of fast acting carb, recheck BG every 15 min until it's within limits -Give snack with protein and carb -If severe give oral glucose paste; glucagon injection subQ or IM |
| Hyperglycemia | Fasting blood glucose >130 or PP blood glucose >180 |
| Hyperglycemia Causes | -Not taking medications as prescribed -Eating high sugar and carbohydrates -Illness -Infection -Increased stress -Decreased activity than usual |
| Hyperglycemia Symptoms | -Polydipsia -Polyuria -Polyphagia -Blurred vision -Dry skin -Fatigue -Slow healing wounds -Dehydration -Kussmaul breathing |
| Hyperglycemia Treatment | -Oral anitdiabetics -Insulin |
| Diabetic Ketoacidosis (DKA) | -Severe hyperglycemia (BG 250-1000) -Ph <7.3 (acidosis/low Ph) -Serum and urine ketones -Bicarb <15 (low due to hydorgen ions using bicard to make CO2) -Elevated BUN, creatinine -Can occur in Type 1 and Type 2 |
| DKA Symptoms | -Abdominal pain -N/V -Hyperventilation -Fruity breath -Thirst -Polyuria -Kussmaul's respirations |
| DKA Treatment | -Emergency -Rehydration (decrease glucose) -Monitor I&O -IV insulin bolus then drip 5-7 units/hr -Monitor EKG -Monitor ABG -Monitor electrolytes |
| Cushing Syndrome | -Excessive corticosteroid -Hyperglycemia -HTN -Hypokalemia -Dark purple striae -Rubra facial complexion -Hirsutism -Weight gain -Muscle weakness -Easy bruising |
| Addison's Disease | -Adrenal insufficiency -Insufficient secretion of adrenocortical steroids (cortisol and aldosterone) -Dysfunction of pituitary gland or adrenal cortex -Hyponatremia -Hypovolemia -Hyperkalemia |
| Insulin Waning | Progressive increase in blood glucose from bedtime to morning resulting in morning hyperglycemia |
| Dawn Phenomenon | Normal blood glucose until 3am, then level begins to rise resulting in morning hyperglycemia |
| Somogyi Effect | Normal or elevated bedtime glucose, decreases to hypoglycemic level at 2-3 am with an increase in glucose resulting in morning hyperglycemia caused by the production of counter regulatory hormones |
| Macrovasular Complications of DM | -Cardiovascular disease (CVD) -Corinary artery disease (CAD) -Cerebral vascular accident (CVA) -Peripheral vascular disease (PVD) |
| Microvascular Complications of DM | -Diabetic retinopathy -Nephropathy (microalbuminuria) -Peripheral neuropathy -Autonomic neuropathies (GI: gastroparesis, CV: slight tachy, ortostatic hypotension, silent cardiac ischemia or MI, Renal: neurogenic bladder, Sexual dysfunction) |
| Type 1 Diabetes Treatment | -Sugar-controlled healthy diet -Exercise -Daily insulin injections -Regular blood sugar level testing -Some urine-ketone tests |
| Hypoglycemia Prevention | -Consistent pattern of eating -Take medications regularly at scheduled times -Exercise regularly -Patient should be aware of s/s of hypoglycemia |
| Hyperglycemia Prevention | -Exercise regularly -Low carb healthy diet -Medication management -Stress management |
| Rapid Acting Insulin | Lispro (O: 15-30 min, P: .5-1.5 hr, D: 3-5 hr) Aspart (O: 15-30 min, P: 1-3 hr, D: 3-5 hr) Glulisine (O: 10-15 min, P: 1-1.5 hr, D: 3-5 hr) |
| Short Acting Insulin | Regular insulin (O: 30-60 min, P: 1-5 hr, D: 6-10 hr) |
| Intermediate Acting Insulin | NPH (O: 1-2 hr, P: 4-12 hr, D: 16 hr) |
| Long Acting Insulin | Glargine (O: 3-4 hr, P: continuous, D: 24 hr) Determir (O: unkwn, P: continuous, D: 24 hr) Degludec (O: 1 hr, P: 9 hr, D: 24 hr) |
| Oral Antidiabetics | -Glipizide -Repaglinide -Metformin -Pioglitazone -Acrabose -Sitagliptin -Pramlintide -Exenatide |
| Hyperglycemia Agent | Glucagon |
Created by:
NikkiLeigh83
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