Endocrine Emergencies and Diabetes Overview
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Questions and Answers

What is the recommended blood sugar decrease per hour while on an insulin drip?

  • 20% per hour
  • 10% per hour (correct)
  • 50 mg/dL per hour (correct)
  • 5% per hour

    • In which scenario may subcutaneous insulin absorption be inadequate?

  • Diabetic patient with normal blood sugar
  • Patient with good hydration
  • Patient with hypovolemia (correct)
  • Patient undergoing surgery

    • What is the peak action time for rapid-acting insulins?

  • 120 minutes
  • 60 minutes
  • 30 minutes
  • 90 minutes (correct)

    • Which of the following insulins does not require a wait time prior to a meal?

    <p>Insulin lispro</p> Signup and view all the answers

    What action should be taken if blood sugar decreases faster than 50 mg/dL per hour?

    <p>Decrease the insulin infusion rate</p> Signup and view all the answers

    What is the most common complication experienced by patients with diabetes?

    <p>Hypoglycemia</p> Signup and view all the answers

    What condition may result from a blood sugar level that is too high?

    <p>Ketoacidosis</p> Signup and view all the answers

    What should patients do to achieve better long-term outcomes in diabetes management?

    <p>Maintain tight control of blood sugar</p> Signup and view all the answers

    Which of the following symptoms may indicate hypoglycemia?

    <p>Tachycardia</p> Signup and view all the answers

    What is a potential consequence of tight control of blood glucose levels?

    <p>Increased risk of iatrogenic hypoglycemia</p> Signup and view all the answers

    What is the likely outcome when a patient with diabetes develops hypoglycemic unawareness?

    <p>Increased frequency of hypoglycemic episodes</p> Signup and view all the answers

    What type of intervention is necessary for moderate hypoglycemia?

    <p>Medical assistance from another person</p> Signup and view all the answers

    Which body mechanisms are typically activated to combat a significant drop in blood glucose levels?

    <p>Release of catecholamines, glucagon, and cortisol</p> Signup and view all the answers

    What primarily causes glucose to spill into the urine in patients with elevated blood glucose levels?

    <p>Exceeding the kidney's reabsorption capacity</p> Signup and view all the answers

    What is the typical serum blood glucose level at which glucose begins to appear in urine?

    <p>300 mg/dL</p> Signup and view all the answers

    Which symptom is NOT typically associated with Diabetic Ketoacidosis (DKA)?

    <p>Decreased heart rate</p> Signup and view all the answers

    When managing DKA, what is the primary concern regarding fluid replacement?

    <p>Fluid replacement needs to be undertaken slowly unless cardiovascular instability is present</p> Signup and view all the answers

    What can occur if dextrose is administered before thiamine to malnourished or alcoholic patients?

    <p>Wernicke-Korsakoff syndrome</p> Signup and view all the answers

    What should the initial IV fluid bolus consist of for DKA treatment?

    <p>Normal saline or Ringer’s lactate</p> Signup and view all the answers

    In diabetic ketoacidosis (DKA), what primarily causes blood glucose levels to rise?

    <p>Insufficient insulin production</p> Signup and view all the answers

    Why should potassium replacement be initially avoided in DKA treatment?

    <p>Ketoacidosis indicates potential hyperkalemia</p> Signup and view all the answers

    Which method is generally considered less desirable for managing hyperglycemia in DKA compared to an insulin infusion?

    <p>IV bolus insulin administration</p> Signup and view all the answers

    Which type of acidosis is associated with diabetic ketoacidosis?

    <p>Ketoacidosis</p> Signup and view all the answers

    What is the primary cause of hypoglycemia?

    <p>Insufficient sugar intake from dietary inadequacies</p> Signup and view all the answers

    What characteristic breath odor might you expect in a patient with DKA?

    <p>Fruity</p> Signup and view all the answers

    What is the most effective treatment for a conscious patient experiencing hypoglycemia?

    <p>Oral glucose</p> Signup and view all the answers

    How often should blood glucose levels be checked in patients with hypoglycemia who require close monitoring?

    <p>Every 30 minutes</p> Signup and view all the answers

    What should be done if a patient has an altered level of consciousness due to hypoglycemia?

    <p>Provide IV dextrose administration</p> Signup and view all the answers

    What metabolic process occurs due to the lack of insulin in diabetic patients, leading to ketone body production?

    <p>Fat breakdown</p> Signup and view all the answers

    What bodily effect can high blood glucose levels lead to, due to the loss of glucose in urine?

    <p>Loss of electrolytes</p> Signup and view all the answers

    Why is glucose gel preferred over glucose tablets in certain situations?

    <p>It is easier to tolerate and reduces choking risk</p> Signup and view all the answers

    What is the correct concentration of dextrose in a 50% dextrose solution?

    <p>50 g of dextrose in 100 mL</p> Signup and view all the answers

    Which condition manifests as amnesia, confabulation, attentional deficit, disorientation, and vision impairment?

    <p>Wernicke-Korsakoff syndrome</p> Signup and view all the answers

    What complication can arise from administering dextrose solutions more concentrated than 5% too quickly?

    <p>Irritation and pain at the injection site</p> Signup and view all the answers

    What is a significant difference between ketoacidosis and lactic acidosis?

    <p>Ketoacidosis results from insulin deficiency</p> Signup and view all the answers

    What should be done if IV access is not possible in a patient with hypoglycemia?

    <p>Give IM glucagon</p> Signup and view all the answers

    Which of the following is NOT a sign of hypoglycemia?

    <p>Increased heart rate</p> Signup and view all the answers

    What characterizes type 1 diabetes?

    <p>The pancreas does not produce insulin.</p> Signup and view all the answers

    Which type of diabetes is primarily associated with insulin resistance?

    <p>Type 2 diabetes</p> Signup and view all the answers

    What is the primary role of insulin in the body?

    <p>To facilitate the uptake of glucose by cells.</p> Signup and view all the answers

    Which statement about oral hypoglycemic medications is true?

    <p>They can cause hypoglycemia, especially in certain populations.</p> Signup and view all the answers

    What is the main reason paramedics are likely to administer regular insulin?

    <p>It is the most commonly administered type in emergencies.</p> Signup and view all the answers

    Which of the following best explains the difference between type 1 and type 2 diabetes?

    <p>Type 1 is primarily due to autoimmune factors; type 2 involves insulin resistance.</p> Signup and view all the answers

    What role do potassium levels play in relation to insulin?

    <p>Potassium follows glucose into the cell after insulin action.</p> Signup and view all the answers

    What is a key factor that distinguishes various types of insulin?

    <p>The time of onset and duration of action.</p> Signup and view all the answers

    Study Notes

    Endocrine Emergencies

    • Endocrine emergencies involve fast-acting conditions related to the endocrine system, such as diabetes.

    Overview of Diabetes

    • Diabetes is a disease involving dysfunction in the pancreas.
    • Insulin is crucial for converting sugars into energy for the body.
    • Diabetes exists in two primary forms: type 1 and type 2.
    • Type 1 diabetes patients do not produce insulin, so their cells cannot absorb sugar for energy, much like a car without fuel.
    • Type 2 diabetes patients produce insulin but their body's cells do not properly utilize it, leading to insulin resistance.
    • The majority of people with diabetes have type 2 diabetes.
    • Insulin is used in type 1 diabetes and some type 2 diabetes patients.
    • Insulin encourages the uptake of glucose by body cells and reduces blood sugar levels.
    • Glucose enters cells, and potassium follows.
    • Oral hypoglycemic medications are used for managing most type 2 diabetes cases.

    Overview of Diabetes (Continued)

    • These medications work on the insulin-producing cells in the pancreas or aid insulin function in the body.
    • Some oral hypoglycemic medications increase the tendency towards hypoglycemia in certain groups like the elderly and people with kidney or liver diseases.

    Type 1 Diabetes

    • The disease is considered chronic.
    • It is treatable with medications only.

    Type 2 Diabetes

    • This disease is considered chronic.
    • It can be treated through lifestyle changes and medication.

    Hypoglycemia

    • Hypoglycemia (low blood sugar) is a potentially life-threatening complication of diabetes and is among the most common complications.
    • It is often referred to as insulin shock.
    • Research shows that strictly controlling blood sugar levels in diabetic patients can lead to fewer complications.
    • Factors affecting the risk of hypoglycemia include diet and the dosage of medications.
    • Maintaining appropriate blood sugar is important to prevent long-term complications.
    • Mild hypoglycemia can typically be treated with oral glucose.
    • More severe cases of hypoglycemia require medical intervention but can often have little to no warning signs.
    • A significant drop in blood sugar triggers a defense mechanism in the body through chemicals like catecholamines, glucagon, and cortisol to raise glucose and improve blood sugar toward the brain.
    • Hypoglycemic unawareness is a condition where patients do not detect symptoms of hypoglycemia before nerve damage occurs.
    • Hypoglycemia can result from inadequate sugar intake or excessive insulin intake.
    • Exercise or physical activity can cause blood sugar levels to drop quickly.
    • Factors such as poor perfusion and shock can interfere with insulin absorption, potentially leading to slower onset effects.

    Hypoglycemia Management

    • When possible, oral glucose is the preferred treatment.
    • Consciousness should be evaluated before deciding on treatment.
    • Oral glucose can be administered as glucose tablets or gel.
    • Glucose gel is easier to tolerate and helps prevent choking if consciousness is altered.

    Management (Parenteral Glucose)

    • When consciousness is altered or an airway is compromised, intravenous (IV) glucose administration is preferred.
    • The most common 50% dextrose solution is used for emergency situations. This contains 50 grams of dextrose per 100 mL.
    • Pre-filled syringes containing dextrose (50 mL, 25g) are frequently utilized in emergency scenarios.
    • Other concentrations include 25% dextrose, which is 25 g/100 ml solution.
    • 10% dextrose is 10 g/100 ml.
    • Dextrose concentrations of more than 5% can cause pain and irritation on injection. These should be administered slowly and not via intramuscular or subcutaneous routes.
    • If IV access is impossible, IM glucagon or IV glucose administration can be necessary.

    Diabetes Ketoacidosis (DKA) Management

    • DKA treatment involves correcting dehydration and acidosis using IV fluids and insulin.
    • Fluid replacement should be gradual, considering potential weight loss and deterioration during the three-week period.
    • IV fluid administration should not be overly aggressive unless cardiovascular instability is observed.
    • 15 to 20 mL per kilogram initial dosage for normal saline is recommended to adults.
    • IV fluid should ideally not include potassium during the early stages, due to high potassium likely already present.
    • Once urine output is established, and electrolyte status can be determined at a hospital, potassium replacement becomes increasingly important.
    • Prehospital treatment should involve isotonic solution such as normal saline or Ringer's lactate.

    Management (Insulin Administration)

    • Many EMS agencies do not carry insulin, so IV fluid administration is often sufficient in the early stages to manage hyperglycemia and metabolic acidosis until proper treatment can be provided.
    • IV insulin can be administered as a bolus or drip if available.
    • IV bolus insulin use is less desirable than continuous insulin infusion.
    • IV insulin is more effective than intramuscular or subcutaneous injection, particularly in the initial treatment of DKAT.

    Management (Further Considerations)

    • In patients with poor hypovolemic or shock-related perfusion, subcutaneous insulin may not be effectively absorbed, leading to a slow onset of action.
    • Blood sugar monitoring every 30-60 minutes is crucial during insulin administration.
    • The desired response is a 10% blood glucose decrease per hour, or less than 50mg/dL per hour. If exceeding 50 mg/dL decrease, the insulin rate should be reduced.
    • If thiamine is administered before dextrose, it can prevent Wernicke-Korsakoff syndrome, an acute brain disorder in those with nutritional deficiencies. This is particularly important in alcoholic or malnourished patients.
    • DKA treatment also depends on an adequate airway and circulatory conditions as well as the person's level of consciousness.

    Rapid-Acting Insulins

    • Insulin lispro (Humalog), insulin aspart (NovoLog), and insulin glulisine (Apidra) are rapid-acting insulins.
    • Their structure makes them ideal for type 1 diabetes treatment.
    • The onset of action is typically within 10 minutes, and peak action occurs around 90 minutes, with duration around 2-4 hours.
    • These insulins can be administered immediately after meals, without a 30-minute delay.

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    Description

    This quiz covers essential information about endocrine emergencies, particularly focusing on diabetes. It details the different types of diabetes, their mechanisms, and how insulin and medications are used to manage them. Test your knowledge on the impact of these conditions on the body and treatment strategies.

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