on blood sugar, delays digestion so carb effect on blood sugar is delayed Counting Carbs: 10-15 g of carbs for 1 unit of insulin, round to the nearest whole number Rapid Acting Short acting (regular) Intermediate acting Long acting NovoLog Humalog Regular insulin NPH, Lente Lantus Reaches blood in 15 min Reaches blood within 30 min Reaches blood in 2-6 hrs Reaches blood in 6-14 hrs Peaks in 30-90 min Peaks in 2-4 hrs Peaks in 4-14 hrs None Lasts 5 hrs Lasts 4-8 hrs Lasts 14-20 hrs Lasts 20-24 hrs Insulin Admin: consider hypoglycemia, lipodystrophy (when pts constantly use same site for insulin admin, or with pumps), dose depends on carbs eaten, onset action of insulin given, check glucose before!! Use lowest size on syringe that you can Adolescents : wt loss when they don’t admin insulin, rebellious period- drinking alcohol (liver regulates gluconeogenesis & ETOH metabolism), profound hypoglycemia with alcohol consumption, glycogen stores cannot be released Exercise : activity increase insulin absorption (more likely to be hypoglycemic), snacks for activity Hypopituitarism: diminished/deficient secretion of pituitary hormones Growth hormone Deficiency : stimulates linear growth, build muscle mass, increase bone mineralization, regulates glucose secretion in the liver, growth retardation, short stature, delayed bone maturation CC : Idiopathic, CNS infection/disease, infarction of pituitary gland, Tumors of pituitary or hypothalamus Brain traumaChemotherapy S&S: normal birth weight, Height below 3rd percentile, OverweightYouthful facial featuresHigher pitched voiceDelayed dentition, muscle mass, skeletal and sexual maturation HypoglycemiaUndescended testes with micro penis Dx : X ray of hand or wrist to evaluate bone ossification, growth hormone testing- admin meds, look for release of GH, TX : GH replacement (IM or SQ) 3-7 x per wk, stop when acceptable height/closure of episeal plates, expensive, cause legg calve perthes (avascular necrosis of femoral head), rotate inj site, monitor & plot on growth chart, teach how to give inj, reassure, age appropriate activity Hyperpituataryism : excessive secretion of pituitary hormones (prolaction, ACTH, GH) CC: pituitary adenoma, can grow 7-8 ft S&S: acromegaly after plates close DX: abnormally high levels if IGF 1, bone scan Tx: related to cause, growth cannot be reversed, pituiaty hormone replacement after surgery Precocious Puberty: sexual development before 9 in boys, 8 in girls CC: cns insult, idiopathic, topical Full puberty : hypothalamic gonadotropic releasing hormone Partial puberty: abnormal levels of estrogen or testosterone- exposed to ointment with testosterone/estrogen S&S: breast development, enlargement of penis, growth spurts, pubic hair, body odor, menarche, acne *more common in girls DX: inj of LH, 50% stop on own, S&S TX: parent education (dress appropriate, safety concerns, appropriate activities), psychological support, Sexual interest is not advanced beyond childs age
Diabetes Insipidus : decreased ADH (anti pee, pee), acute or chronic CC: head injury, inf, surgery, brain tumor S&S: polydipsia, polyuria
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- Spring '17
- The Maids, fine motor skills, yrs