Endocrine#2%20diabetes2010

Endocrine#2%20diabetes2010 - Role of Endocrine System Role...

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Unformatted text preview: Role of Endocrine System Role Nur 214 EVERY 24 HOURS EVERY 4100 new cases 230 amputations 120 kidney failures 55 blindness 810 associated deaths Endocrine Pancreas Endocrine Islets of Langerhans Islets 4 types of hormone­secreting cells Alpha cells Beta cells Secrete glucagon Secrete insulin and amylin Secrete gastrin and somatostatin Secrete pancreatic polypeptide Delta cells F cells Pancreatic Hormone Actions Pancreatic Insulin ** the only hormone to ↓ BS and conversion to glycogen Promotes cellular uptake of glucose Functions mainly in liver, muscle and fat Promotes liver and muscle uptake of glucose Stimulates muscle to convert aa to protein Stimulates fat cells to convert glucose to fat Acts on hypothalmus to decrease appetite Pancreatic Hormone Action Pancreatic Amylin co-secreted with insulin Delays nutrient uptake Suppresses glucagon secretion antihyperglycemic effect Pancreatic Hormone Action Pancreatic Glucagon-antagonistic to insulin Decrease tissue uptake of glucose Promotes muscle wasting Promotes glycogen breakdown Ketosis Pancreatic Hormone Actions Con’t Pancreatic Somatostatin-slows absorption of food Somatostatin-slows Regulates alpha and beta cell function Essential in CHO, Fat, and PRO metabolism Inhibits secretion of insulin, glucagon, and pancreatic polypeptides Polypeptide released in hypoglycemia Polypeptide Inhibits GB and exocrine secretion Blood Sugar Control Mechanisms Blood Normal FBS= 70­ 120mg/dl Hyperglycemia Elevated BS Hypoglycemia Low BS Disorders of Glucose Regulation Disorders Hyperglycemia Diabetes Mellitus Hypoglycemia Diabetes Mellitus Diabetes Definition & CHO, PRO, Fat Metabolism Issues Types Syndrome of chronic hyperglycemia Type 1 Type 2 Autoimmune destruction beta cells on pancrease Cannot make adequate insulin Rapid onset – most severe presentation Familial link Obesity – imparts some degree insulin resistance Epidemiology of Diabetes Epidemiology 21 million diabetics in U.S. (95% are Type 2) 52 million prediabetics in U.S. Leading cause of blindness, end stage renal disease and limb amputations Cost to US healthcare is $132 million dollars/yr Understanding Diabetes Understanding how insulin works Diagnosing Diabetes Diagnosing 3 month average below 7% Fasting Blood Sugar Glucose Tolerance Test Home BS testing Glycosylated Hgb (A1C) Urine testing glucose and ketones Diabetes Symptoms Diabetes Type 1 Polydipsia Polyphagia Polyuria Weight Loss Fatigue Poor wound healing Visual changes Type 2 Recurrent infections Visual changes Candida infections Fatigue Weight Gain If severe ↑ BS, will BS, present with Type 1 symptoms symptoms Diabetes Treatment Diabetes Type 1 Exogenous insulin administration Type 2 Diet controlled Weight loss Oral anti­diabetic drugs Insulin Insulin Delivery Options Insulin Insulin Delivery Options Con’t Insulin Acute Diabetes Complications Acute Hypoglycemia (insulin shock) Ketoacidosis (DKA) Somogyi Effect Dawn Phenomenon HHNK Hyperosmolar, hyperglycemic, non­ketotic syndrome Hypoglycemia (Insulin shock) Hypoglycemia Acute onset BS ↓ 50mg/dl Impacts cerebral function HA, blurred vision Slurred speech, impaired problem solving Coma, convulsions Activates the Autonomic Nervous System Hunger (parasympathetic) Pallor, tachycardia, shaking, sweating (sympathetic) Treatment Diabetic Ketoacidosis Diabetic Usually seen with Type 1 Gradual increased use of of fat as energy source of Fruity odor to breath ↓ serum pH- build up of organic acids and ketones in the blood ketones Significant dehydration/ electrolyte imbalance Common cause is infection or new diagnosis Diabetic Ketoacidosis Diabetic Can become life threatening Treatment IV fluids To reverse dehydration To dilute intravascular sugar & acid levels Insulin Somogyi Effect Somogyi ↓ BS followed by Rebound hyperglycemia Rebound hyperglycemia Counterregulatory hormone effect Epinephrine GH Corticosteroids Treatment Tight glycemic control Dawn Phenomenon Dawn Early morning rise in BS without Hypoglycemia during the night Due to nocturnal elevation of GH Treatment Alter time & dose of insulin hyperosmolar, hyperglycemic, non-ketotic syndrome HHNK HHNK Usually seen Type 2 Significant complication ­ ↑ mortality rate ↑↑↑ BS (above 500mg/dl) ↑↑↑ BS ↑ serum osmotic pressure serum Severe dehydration Low blood volume / perfusion Ketosis not common Enough insulin present to prevent lypolysis & CHO Enough metabolism metabolism HHNK Treatment HHNK Tight glycemic control Aggressive fluid & electrolyte resuscitation Chronic Diabetes Complications Chronic Renal impairment / failure Neuropathies Retinopathies Vascular disorders Leading cause of blindness Coronary artery disease Vascular disease of feet / legs Infections EVERY 24 HOURS EVERY 4100 new cases 230 amputations 120 kidney failures 55 blindness 810 associated deaths ...
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