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Questions and Answers
What primary role does calcitonin serve in the body?
What condition is characterized by the thyroid gland's inability to produce sufficient thyroid hormone?
Which of the following is NOT a common cause of primary hypothyroidism?
What hormone from the pituitary gland stimulates the thyroid to release T3 and T4?
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Which of the following clinical manifestations is commonly associated with hypothyroidism?
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What life-threatening condition arises from severe, long-standing low levels of thyroid hormone?
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What primarily distinguishes type 1 diabetes from type 2 diabetes?
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Which of the following is a recognized risk factor for developing diabetes mellitus?
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What is the normal range for glucose levels in the bloodstream?
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What role does insulin play in glucose metabolism?
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Which hormone acts counter to the effects of insulin?
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Which group is NOT considered a minority group at higher risk for diabetes?
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What is a common consequence of untreated diabetes mellitus?
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What is a likely effect of counterregulatory hormones during a fasting state?
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Which factor is least likely to contribute to the development of diabetes mellitus?
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What is a primary clinical manifestation of ketoacidosis?
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What is the blood glucose level typically observed in Hyperosmolar Hyperglycemic Syndrome (HHS)?
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Which intervention is a priority for nursing management of HHS?
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What results from the breakdown of fat cells for glucose stores during ketoacidosis?
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What electrolyte monitoring is essential during the management of ketoacidosis and HHS?
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Which of the following factors is commonly associated with Hyperosmolar Hyperglycemic Syndrome (HHS)?
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Which respiratory pattern is associated with severe metabolic acidosis in ketoacidosis?
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What is a major risk factor for the development of HHS in patients with type 2 diabetes?
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What lab value indicates severe metabolic acidosis in patients experiencing ketoacidosis?
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In HHS, why are ketone bodies often absent or minimal?
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What is a true statement regarding the use of insulin pumps?
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Which condition is characterized by hyperglycemia upon awakening?
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What is a common complication that can occur from frequent use of the same injection sites?
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What is a primary characteristic of diabetic ketoacidosis (DKA)?
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Which treatment is appropriate for hypoglycemia after 20 minutes of administering glucagon without progression?
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What is the recommended angle for injecting insulin?
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What is the risk associated with insulin pump therapy?
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Which of the following best describes the Somogyi effect?
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Which of the following is a treatment method for the dawn phenomenon?
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What is the proper way to prepare the skin before self-injecting insulin?
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What is the primary mechanism by which sulfonylureas work?
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Which of the following is a complication associated with long-term diabetes?
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What is the recommended blood pressure for patients with diabetes at high risk?
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What is a common side effect of meglitinides?
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What is the primary function of the parathyroid glands?
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What is a recommended annual check-up for patients with diabetes?
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Which symptom indicates potential neuropathy in diabetes patients?
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In the case of a patient being sick, what is the reasoning behind continuing oral antidiabetic medication?
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What complication of diabetes is characterized by damage to the kidneys?
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Which of the following is NOT typically assessed during nursing evaluations of a diabetic patient?
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Study Notes
Diabetes Mellitus
- Chronic multisystem disease characterized by hyperglycemia due to abnormal insulin production, impaired insulin utilization, or both
- 8th leading cause of death in the US
- Leading cause of end-stage renal disease, adult blindness, and non-traumatic lower limb amputations
Risk Factors
- Family history
- Gestational diabetes
- Minority groups (American Indians, African Americans, Hispanics, Asian Americans)
- Age over 35
- Obesity (BMI > 30)
- Giving birth to an infant over 9 pounds
- Inactivity
Etiology and Pathophysiology
- Combination of genetic, autoimmune, and environmental factors
- Primarily a disorder of glucose metabolism related to absent or insufficient insulin supply and/or ineffective use of available insulin.
Normal Insulin Metabolism
- Produced by beta cells in the islets of Langerhans
- Released continuously into the bloodstream in small increments with larger amounts released after food
- Stabilizes glucose level in the range of 70 to 120 mg/dL
Insulin's Role
- Promotes glucose transport from the bloodstream across the cell membrane to the cytoplasm of the cell
- Acts as a key to allow glucose into the cell and out of the bloodstream
Counterregulatory Hormones
- Glucagon, epinephrine, growth hormone, and cortisol
- Work against the effects of insulin
- Increase glucose levels by stimulating glucose production and release by the liver and decreasing glucose movement into cells.
- Collaborate with insulin to maintain glucose levels within the normal range by regulating glucose release for energy during food intake and periods of fasting.
Insulin Therapy
- Usually available as U100 insulin (1mL contains 100 U of insulin)
- Inject at a 45 to 90-degree angle
- Wash injection site with soap and water, do not use alcohol swabs (can dry out skin)
Insulin Pump
- Delivers a continuous subcutaneous insulin infusion through a small device
- Delivers short-acting insulin
- Preprogrammed to deliver varying hourly basal rates
- Ideal for people who have failed to control diabetes on other regimens, pregnant individuals, or those desiring increased daily flexibility
- Expensive ($7,000)
- Risk of infection at the site progressing to sepsis
- Change the infusion site every 24-48 hours
Problems with Insulin Therapy
Hypoglycemia
- Treatment includes administering glucagon 0.5-2 mg IM
- After 20 minutes of no progression, administer again
- When aroused, give 15 g of carbohydrates and wait 15 minutes
Allergic Reaction
- Local inflammatory reactions to insulin may occur, such as itching and burning around the injection site
- Local reactions may be self-limiting within 1 to 3 months or may improve with a low dose of antihistamine
Lipodystrophy
- Changes in subcutaneous tissue
- May occur if the same injection sites are used frequently
Somogyi Effect
- Hyperglycemia in the morning may be due to the Somogyi effect
- Patient takes insulin at night, then in the morning the sugar is very low
- Rebound hyperglycemia occurs because a high dose of insulin causes a decline in glucose levels overnight, and counterregulatory hormones are released
Dawn Phenomenon
- Also characterized by hyperglycemia on awakening
- Due to the release of counterregulatory hormones
- Unrelated to the amount of insulin given at night
- Treatment involves increasing insulin or adjusting administration time
Acute Complications
Diabetic Ketoacidosis (DKA)
- Associated with excessive levels of ketones in the body
- Serious condition that progresses rapidly and must be promptly treated
- Caused by a profound deficiency of insulin
- Characterized by hyperglycemia, ketosis, acidosis, and dehydration
Hyperglycemia
- Cells lack insulin to allow glucose into the cell. This forces the body to use fat cells to break down glucose for energy.
Ketoacidosis
- The after-effect of fat cells being broken down for glucose stores.
Dehydration
- Cells are hungry and lack food, leading to severe dehydration. An overload of sugar in the extracellular fluid leads to vomiting as the body attempts to excrete excess sugar.
Clinical Manifestations
- Dehydration, lethargy, sweet fruity breath, Kussmaul respirations (rapid, deep breathing with dyspnea)
- Labs: Blood glucose > 250, pH < 7.3
Interprofessional Care
- First goal: establish IV for fluid and electrolyte replacement
- Assess renal status, cardiopulmonary status, and level of consciousness
Hyperosmolar Hyperglycemic Syndrome (HHS)
- Due to insulin deficiency
- Blood sugar can reach 600, requiring ICU care, life-threatening
- Life-threatening syndrome that can occur in a patient with diabetes making enough insulin to prevent DKA but not enough to prevent severe hyperglycemia
- Less common than DKA, occurring often in patients over 60 with type 2 diabetes
- Often related to impaired thirst sensation and/or a functional inability to replace fluids
- Usually a history of inadequate fluid intake, increasing mental depression or cognitive impairment
- Lab values in HHS include a blood glucose level > 600 mg/dL and a marked increase in serum osmolality. Ketone bodies are absent or minimal in both blood and urine
Nursing Management
- HHS is a medical emergency with a high mortality rate
- Immediate IV administration of insulin and either 0.9% or 0.45% NaCl
- Monitor administration of IV fluids to correct dehydration, insulin therapy to reduce blood glucose and serum ketone levels, and electrolyte replacement
Medications
Sulfonylureas
- Glucotrol, Glynase
- Stimulates pancreatic cells to secrete more insulin and peripheral cells' sensitivity to insulin
- Most common side effect: hypoglycemia
Meglitinides
- Prandin
- Stimulates the release of insulin from the pancreatic islet cells, rapid-acting
- Hypoglycemia is a common side effect
Long-Term Diabetes Complications
Nephropathy
- Damage to the kidneys
- Early glomerular hypertrophy
- Increased glomerular filtration
- Microalbuminuria
Cardiovascular
- Coronary artery disease
- Stroke
- Hypertension
- American Diabetes Association recommends <140/90
- 130/80 if at high risk
Retinopathy
- Can lead to blindness
- Encourage eye exam annually
Neuropathy
- Decreased feeling in feet or hands
- Hot, burning sensation
Gastroparesis
- Low GI motility
- Constipation, vomiting, anorexia, heartburn
Infections
Sexual Dysfunction
Nursing Assessment
- Health History: Visual changes, numbness in hands or feet, pain when walking, appetite, nausea/vomiting, frequent vomiting, infections
- Physical Assessment: Height/weight, vital signs, peripheral pulses, skin, feet, injection sites
- Patient Education: Medications, insulin administration, finger sticks or continuous glucose monitoring, foot care, diet
Tests and/or Areas to Check Annually
- Glycosylated Hemoglobin (2-4 times a year)
- Kidney function
- Cholesterol and triglycerides
- Foot exam
- Eye exam
- Blood Pressure
If a Patient is Sick
- Continue taking oral antidiabetic medications due to the stress hormone cortisol being released, increasing blood sugar.
Disorders of the Parathyroid Glands
- Parathyroid gland is located on the posterior surface of the thyroid, secretes parathyroid hormone
- About the size of a grain of rice
- Primary Function: Regulate calcium levels, to a lesser degree regulates phosphate levels
- Calcium is stored in the bones, readily available to the rest of the body at the request of the parathyroid glands
- ECG monitoring is necessary when giving calcium (can cause arrhythmias/cardiac arrest)
- ICU care is typically required
Anatomy and Physiology
Thyroid Gland
- Located in the front of the neck
- Primary function is to produce thyroid hormone
- Thyroid hormone controls metabolic rate, metabolism, and growth/development
Thyroid Hormones
- Calcitonin: Controls body use of calcium, lowers excess calcium in the blood (calciTONin TONES down calcium in the blood)
- T3: Composed of iodine, regulates metabolism - iodine comes from salt! Goiter can develop from lack of iodine
- T4: Composed of iodine, regulates metabolism
- With iodine deficiency, the thyroid cannot secrete sufficient thyroid hormone
- TSH: Released from the pituitary gland, stimulating the thyroid to release T3 and T4
Disorders of the Thyroid Gland
- TSH and T4 levels are measured to determine whether a goiter is associated with normal thyroid function, hyperthyroidism, or hypothyroidism
Hypothyroidism
- Condition in which the thyroid gland produces inadequate amounts of thyroid hormone
Primary Hypothyroidism
- Thyroid gland malfunction, the gland fails to produce enough thyroid hormone to sustain normal metabolic function
- Causes: Insufficient iodine diet, Hashimoto's disease (autoimmune disease attacking the thyroid gland), surgical removal of the thyroid, therapeutic radiation for hyperthyroidism, atrophy of the thyroid gland, tumors of the thyroid gland
Secondary Hypothyroidism
- Cause related to pituitary tumors and other pituitary disorders; results from alterations in the hypothalamic-pituitary axis
Clinical Manifestations of Hypothyroidism
- Fatigue
- Weight gain
- Cold intolerance
- Constipation
- Dry skin
- Thinning hair
- Periorbital edema
Myxedema Coma
- Severe hypothyroidism
- Loss of brain function as a result of severe and prolonged low levels of thyroid hormone
- Life-threatening!
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Description
Explore the foundational aspects of Diabetes Mellitus, a chronic disease affecting glucose metabolism. This quiz covers risk factors, etiology, pathophysiology, and insulin metabolism related to the condition. Test your knowledge and understanding of this prevalent health issue.
