Understanding Glucose Regulation

• Glucose regulation refers to maintaining blood glucose levels within a normal range.

Glucose Regulation Definitions

• Euglycemia is a state of normal blood glucose levels, seen in healthy individuals and the target for diabetes management.
• Hypoglycemia is a state of low blood glucose levels, less than 70 mg/dL when fasting or 99 mg/dL 2 hours after eating.
• Hyperglycemia is a state of elevated blood glucose levels, more than 100 mg/dL when fasting or 140 mg/dL 2 hours after eating.

Risk Factors for Impaired Glucose Regulation

• Population factors:
  • Age
  • Pregnancy
  • Specific racial and ethnic groups
• Individual factors:
  • Genetics and family history
  • Lifestyle
  • Selected medications
  • Underlying metabolic issues, mainly involving insulin resistance and impaired insulin secretion

Recognizing Compromised Glucose Regulation

• Hypoglycemia signs and symptoms:
  • Weakness
  • Dizziness
  • Headache
  • Hunger
  • Blurred vision
  • Difficulty concentrating
  • Feeling shaky
  • Palpitations
• Hyperglycemia signs and symptoms:
  • Nausea
  • Vomiting
  • Abdominal cramps
  • Fatigue
  • Excessive hunger (polyphagia)
  • Excessive thirst (polydipsia)
  • Symptoms may be associated with dehydration or acidosis

Short-Term Consequences

• Hyperglycemia:
  • Increased thirst and urination
  • Fatigue
  • Blurred vision
  • Headaches
  • Slow wound healing
  • Irritability and difficulty concentrating
  • Nausea and vomiting
• Hypoglycemia:
  • Diaphoresis
  • Nervousness
  • Irritability
  • Shaking
  • Rapid heartbeat
  • Hunger
  • Confusion
  • Difficulty concentrating
  • Dizziness
  • Blurred vision
  • Severe: Loss of consciousness or seizures

Long-Term Consequences

• Hyperglycemia:
  • Cardiovascular complications
  • Neuropathy
  • Nephropathy
  • Retinopathy
  • Poor wound healing and infection
  • Cognitive decline and brain health
  • Bone and joint problems
• Hypoglycemia:
  • Cognitive impairment
  • Hypoglycemia unawareness (no longer experiencing typical warning signs)
  • Cardiovascular events
  • Psychological impact (anxiety, depression)
  • Reduced ability to function
  • Potential for organ damage
  • Death

Relevant Labs

• Hypoglycemia:
  • BG 180 mg/dL

Nursing and Collaborative Interventions

• Client teaching should include diabetes type I & II, Hyper- & Hypoglycemia, goals for test results, lifestyle (nutrition (diet), exercise, weight control), consequences of chronic hyperglycemia & impaired glucose regulation.

Diabetes Types Overview

• Type 1 Diabetes (T1D): An autoimmune condition, leads to destruction of insulin-producing beta cells in the pancreas, requires lifelong insulin therapy.
• Type 2 Diabetes (T2D): Characterized by insulin resistance and eventual beta-cell dysfunction, managed with lifestyle changes, oral hypoglycemic agents, and sometimes insulin.

Hyperglycemia and Hypoglycemia Education

• Hyperglycemia:
  • Signs and symptoms include increased thirst (polydipsia), frequent urination (polyuria), blurred vision, and fatigue
  • Managed by adjusting insulin doses, monitoring blood glucose regularly, maintaining hydration, and engaging in physical activity as appropriate
• Hypoglycemia:
  • Signs and symptoms include shakiness, sweating, confusion, irritability, dizziness, and headache
  • Managed by consuming fast-acting carbohydrates, monitoring blood glucose levels, and carrying quick-acting glucose sources
    • 4-6 oz regular soda or orange juice
    • 5-8 Lifesavers
    • 1 tbsp honey or syrup
    • 4 tsp jelly
    • 1 package dextrose
    • Unconscious: 1 mg glucagon subcutaneous/IM or 20-150 mL of 10% glucose IV
    • Turn client on side to prevent aspiration

Goals for Test Results

• Blood Glucose Monitoring:
  • Fasting blood glucose: Generally 70-99 mg/dL
  • Postprandial blood glucose: Generally 100-139 mg/dL
  • Continuous monitoring: Regular self-monitoring helps adjust therapy and understand personal glycemic patterns
• HbA1c (Glycated Hemoglobin):
  • Goal: Typically less than 7%, which reflects average blood glucose over the past 3 months
  • Importance: Achieving this target reduces the risk of diabetes-related complications

Lifestyle Modifications

• Nutrition (Diet):
  • Carbohydrate counting: Essential for insulin dose adjustments, especially in T1D
  • Balanced diet: Emphasize vegetables, lean proteins, healthy fats, and whole grains; limit processed foods and sugars
  • Meal timing: Regular meals and snacks help maintain stable blood glucose levels
• Exercise:
  • Benefits: Improves insulin sensitivity, helps in weight management, and supports cardiovascular health
  • Recommendations: At least 150 minutes of moderate-intensity aerobic activity per week, along with strength training
  • Precautions: Monitor blood glucose before, during, and after exercise to prevent hypoglycemia; carry glucose sources during physical activity
• Weight Management:
  • Goal: Achieve and maintain a healthy weight to enhance insulin sensitivity and reduce T2D risk
  • Strategies: Combine dietary modifications with regular physical activity
  • Support: Collaborate with healthcare providers to set realistic weight loss goals and monitor progress

Consequences of Chronic Hypoglycemia and Impaired Glucose Regulation

• Microvascular Complications:
  • Retinopathy: Leading cause of blindness; regular eye exams are crucial
  • Nephropathy: Can progress to kidney failure; monitor kidney function regularly
  • Neuropathy: May result in foot ulcers and amputations; daily foot inspections are recommended
• Macrovascular Complications:
  • Cardiovascular disease: Increased risk of heart disease and stroke; manage blood pressure and cholesterol levels
• Other Considerations:
  • Infections: High blood glucose impairs immune function, increasing infection risk
  • Wound healing: Delayed healing due to poor glycemic control

Primary and Secondary Prevention

• Primary Prevention:
  • Goal: Healthy lifestyle behaviors
    • Optimal body weight
    • Regular physical activity
    • Healthy balanced diet
• Secondary Prevention (Screening):
  • Blood glucose screen in high-risk individuals

Pharmacological vs. Non-Pharmacological Interventions

• Pharmacological Interventions:
  • Insulin therapy
  • Oral hypoglycemic agents
    • Biguanides
    • Sulfonylureas
    • Meglitinides
• Non-Pharmacological Interventions:
  • Nutrition therapy:
    • Whole grains
    • Lean proteins
    • Healthy fats
    • Fiber-rich foods
  • Physical activity:
    • Regular exercise
  • Weight management:
    • Weight loss (type 2)
  • Self-Monitoring of Blood Glucose (SMBG)
  • Stress management

Collaborative Interventions

• Engaging a multidisciplinary team
• Nursing Responsibilities:
  • Monitoring blood glucose levels
  • Educating patients
  • Assessing for complications

Effects of Counter-Regulatory Hormones on Glucose Regulation

• Glucagon:
  • Source: Secreted by alpha cells of the pancreas
  • Effect:
    • Stimulates hepatic glycogenolysis (breakdown of glycogen into glucose)
    • Promotes gluconeogenesis (glucose synthesis from non-carbohydrate sources)
    • Increases ketogenesis when glucose availability is low
  • Clinical Implication: Used as an injectable treatment for severe hypoglycemia
• Epinephrine (Adrenaline):
  • Source: Released by the adrenal medulla in response to stress, hypoglycemia, or exercise
  • Effect:
    • Stimulates glycogenolysis and gluconeogenesis
    • Inhibits insulin release
    • Increases lipolysis, providing alternative energy sources
  • Clinical Implications: High levels during stress or illness can lead to hyperglycemia
• Cortisol:
  • Source: Secreted by the adrenal cortex in response to stress (HPA axis activation)
  • Effect:
    • Promotes hepatic gluconeogenesis
    • Induces insulin resistance in peripheral tissues
    • Mobilizes amino acids and fats for glucose production
  • Clinical Implication: Chronic cortisol elevation (e.g., Cushing’s syndrome, prolonged stress, or steroid therapy) contributes to hyperglycemia and insulin resistance
• Growth Hormone (GH):
  • Source: Secreted by the anterior pituitary
  • Effect:
    • Increases lipolysis and fatty acid utilization
    • Reduces glucose uptake in muscle and adipose tissue
    • Enhances hepatic glucose production
  • Clinical Implication: Excess GH (e.g., acromegaly) is associated with insulin resistance and hyperglycemia

Non-Diabetic Medications Affecting Glucose Regulation

• Medications that Increase Blood Glucose (Hyperglycemic Effects):
  • Glucocorticoids
  • Thiazide diuretics
  • Atypical antipsychotics
  • Oral contraceptives
  • Calcineurin inhibitors
• Medications that Lower Blood Glucose (Hypoglycemic Effects):
  • ACE inhibitors
  • Beta blockers
  • Salicylates (high dose)
  • Ethanol (alcohol)