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Endocrine Focus #3:Diabetes Mellitus and Hypoglycemia

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DM and hypoglycemia
Answer
show chronic disorder characterized by impaired metabolism and by vascular and neurologic complications  
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endogenous   show
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show comes from an external source  
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show characterized by the absence of endogenous insulin. Most commonly occurs in juveniles and young adults. Persons will require exogenous insulin for a lifetime  
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show characterized by inadequate endogenous insulin and the body's inability to properly use insulin. Beta cells respond inadequately to hyperglycemia & beta cells become desensitized to high levels of glucose in blood.  
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show diagnosed when a woman is found to have glucose intolerance for first time during pregancy. P delivery, condition resolves.  
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the three P's of DM (s/s)   show
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show transport of glucose into resting muscle, regulates carbohydrate use, promotes fatty acid synthesis, spares fat, stimulates protein synthesis, inhibits conversion of protein into glucose, promotes conversion of glucose to glycogen/inhibit glycogen-glucose  
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show stimulates the conversion of glycogen to glucose, permits fat stores to break down, increases triglyceide storage in the liver, halts the storage of proteins, and causes protein to be dumped into the bloodstream  
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show attributed to genetic, immunologic, and environmental factors. A possible autoimmune disorder where the lympocytes and phagocytes turn on the healthy cells of the islets of Langerhans in pancreas. Islet cell antibodies found in 80% pt c dx of type 1 DM  
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DM type 2:risk factors   show
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show retinopathy, nephropathy, macrovascular, neuropathic (mononeuropathy, polyneuropathy, & automatic neuropathy), hypoglycemic unawareness, foot complications  
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causes of neuropathic ulcers   show
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show can be triggered by taking too much insulin, not eating enough food or at the right time, and inconsistent patterns of exercise  
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show shakiness, nervousness, irritability, tachycardia, anxiety, lightheadedness, hunger, tingling or numbness of the lips or toungue, and diaphoresis.  
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s/s acute hypoglycemia (neuroglucopenia)   show
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tx for hypoglycemia   show
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show a life-threatening emergency caused by a relative or absolute deficiency of insulin. This results in disorders in the metabolism of carbs, fats and protein  
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first 3 sequences of events in DKA   show
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show 4. The sympathetic nervous system responds to the cellular need for fuel by converting glycogen to glucose and manufacturing additional glucose. 5. As glycogen stores are depleted, the body begins to burn fat and protein for energy.  
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the last 2 sequences of DKA (6-7)   show
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show anorexia, HA, fatigue, polydipsia, polyuria, and polyphagia  
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moderate s/s DKA   show
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show air hunger (those that are seen in Kussmaul's respirations), coma, and shock. death can result if prompt medical care is not instituted.  
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show hyperglycemia (300 mg/dL); ketonuria; and acidosis, c a pH of < 7.3 or a bicarbonate level of < 15 mEq/L  
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show 1000 mL NS to run over 1st hour. 2000-8000 mL IV NS over next 24 hr. K replacements (only p adequate urine output is made.) and slow IV insulin. when glucose is @ 250-300, dextrose solution is added. IV drip is cont until bicarbonate is @ 15-18 mEq/L  
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show condition in which a pt goes into a coma from extremely high glucose levels (>600 mg/dL) but there is no evidence of elevated ketones  
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show pt's pancreas produces enough insulin to break down fatty acid and formation of ketones, but not enough insulin to prevent hyperglycemia. Basic defect is lack of effective insulin or the inability to use available insulin.  
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Dx:diabetes mellitus   show
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Impaired Glucose Tolerance   show
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Oral Glucose Tolerance Test (OGTT)   show
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show hyperglycemia can result because insulin is inadequate. The liver may release mor glucose than metabolized and if pancreas isn't making enough insulin, the body's free fatty acids begin to form ketones, increasing the hazard of ketosis.  
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show in pt's c type 2, exercise makes insulin receptor sites more sensitive to insulin and lowers plasma glucose levels. Much of the morbidity is caused by the arherosclerosis and puts the pt @ risk for CVA. stretching and cool-down exercises are recommended  
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show avoid exercise when serum glucose is 250 mg/dL or greater, warm-up 5-10 min b/4, exercise shortly p eating or have a small snack if glucose is <100 mg/dL, avoid exercise @ peak of insulin, IJ insulin in abd, have food available if hypoglycemia occurs  
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