Endocrine Focus #3:Diabetes Mellitus and Hypoglycemia
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| Diabetes Mellitus:definition | show 🗑
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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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| Gestational diabetes mellitus | show 🗑
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| show | polydipsia (excessive thirst), polyuria (excessive urine volume), and polyphagia (excessive hunger)
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| roles of insulin | show 🗑
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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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| Type 1 DM:etiology | show 🗑
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| DM type 2:risk factors | show 🗑
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| Complications of DM | show 🗑
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| show | mechanical irritation, thermal injury, and chemical irritation
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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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| show | 6. Fat metabolism produces acidic substances called ketone bodies that accumulate and lead to metabolic acidosis. 7. Protein metabolism results in the loss of lean muscle mass and a negative nitrogen balance
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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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| late s/s DKA | show 🗑
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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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| show | based on serum glucose levels. Norm fasting serum glucose levels are 80-120 mg/dL. >126 mg/dL merits further investigation. also, the 3 P's of DM, and a two-hr postprandial glucose level > 200 mg/dL, and an impaired fasting glucose test
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| show | shows presence of moderately high glucose levels. May increase until pt has overt diabetes, decrease to norm, or remain unchanged. dx of this test is 1) fasting glucose of 110-125 mg/dL and 2) a 2-hr OGTT result 140-200 mg/dL
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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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| pt teaching for exercise and DM | show 🗑
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