Endocrine Disorders Part 2 of 2(1) [Autosaved].ppt

Endocrine Disorders Part 2 of 2 Diabetes Mellitus and Hypoglycemia Copyright © 2016 by Saunders, an imprint of Elsevier Inc.  2 Pathophysiology  Chronic disorder of impaired metabolism with vascula...

Endocrine Disorders Part 2 of 2 Diabetes Mellitus and Hypoglycemia Copyright © 2016 by Saunders, an imprint of Elsevier Inc.  2 Pathophysiology  Chronic disorder of impaired metabolism with vascular and neurologic complications  Key feature is hyperglycemia  Blood glucose level normally regulated by insulin Copyright © 2016 by Saunders, an imprint of Elsevier Inc.  3 Type 1  Absence of endogenous insulin  Formerly called juvenile-onset diabetes because it most commonly occurs in juveniles and young adults  An autoimmune process, possibly triggered by a viral infection, or anything that destroys beta cells  Affected people require exogenous insulin for the rest of their lives Copyright © 2016 by Saunders, an imprint of Elsevier Inc.  4 Type 2  Inadequate endogenous insulin and body’s inability to properly use insulin  Beta cells respond inadequately to hyperglycemia, which desensitizes them  More common in adults; increasing in children  Controlled by diet and exercise; may require oral hypoglycemic agents or exogenous insulin.  Give metromoform Copyright © 2016 by Saunders, an imprint of Elsevier Inc.  5 Role of Insulin & the Affects of Hyperglycemia Copyright © 2016 by Saunders, an imprint of Elsevier Inc.  6 Role of Insulin  Glucose  Insulin stimulates active transport of glucose into cells  If insulin absent, glucose remains in the bloodstream  Blood becomes thick, which increases its osmolality  Increased osmolality stimulates the thirst center  Increased fluid does not pass into body tissues; high serum osmolality retains fluid in the bloodstream  As blood passes through the kidneys, some glucose eliminated  Osmotic force created by glucose draws extra fluid and electrolytes with it, causing abnormally increased urine volume Copyright © 2016 by Saunders, an imprint of Elsevier Inc.  7 Role of Insulin (cont.)  Fatty acids  Promotes fatty acid synthesis and conversion of fatty acids into fat, which is stored as adipose tissue  Without adequate insulin, fat stores break down and increase triglycerides, which are stored in the liver  Increased fatty acids in the liver can triple the production of lipoproteins; promotes atherosclerosis Copyright © 2016 by Saunders, an imprint of Elsevier Inc.  8 Role of Insulin (cont.)  Protein  Enhances protein synthesis in tissues and inhibits the conversion of protein into glucose  Amino acids are admitted into cells; enhances rate of protein formation while preventing protein degradation  Without adequate insulin, protein storage halts; large amounts of amino acids dumped into the bloodstream  High levels of plasma amino acids place people with diabetes at risk for development of gout  Changes in protein metabolism lead to extreme weakness and poor organ functioning Copyright © 2016 by Saunders, an imprint of Elsevier Inc.  9 Risk Factors  Obesity  Sedentary lifestyle  Family history of diabetes  Age 40 years and older  History of gestational DM  History of delivering infant weighing more than 10 lbs  African American (33% higher risk for type 2 DM)  Latin American/Hispanic (>300% higher risk for type 2 DM)  American Indians (33% to 50% higher risk for type 2 DM)  Polycystic ovary syndrome  Cardiovascular disease and hypertension Copyright © 2016 by Saunders, an imprint of Elsevier Inc.  10 Risk Factors (cont.)  Metabolic syndrome  Thought to be a precursor to diabetes  Impaired glucose tolerance, high serum insulin, in combo with: hypertension, elevated triglycerides, low HDL cholesterol, altered size and density of LDL cholesterol Copyright © 2016 by Saunders, an imprint of Elsevier Inc.  11 Microvascular Complications  Retinopathy  Pathological changes in the retina that are associated with DM  Neuropathy  Nerve damage in the peripheral nerves causing weakness, tingling & numbness  Nephropathy  Kidney damage  Accelerated atherosclerotic changes in the person with diabetes  Can contribute to the development of coronary artery disease (CAD), cerebral vascular accidents (CVA or stroke), and peripheral vascular disease (PVD) Copyright © 2016 by Saunders, an imprint of Elsevier Inc.  12 Foot Complications of Diabetes  May have foot problems associated with neuropathy, inadequate blood supply, or a combination  Mechanical irritation  Thermal injury  Chemical irritation Copyright © 2016 by Saunders, an imprint of Elsevier Inc.  13 Long-Term Complications: Prevention (cont.)  ADA recommends  Blood pressure: 70 mg/dL for adults, 80 to 100 mg/dL for older adults and children  If patient is unable to swallow, an IM or subcutaneous injection of 1 mg of glucagon or an IV dose of 50 mL of 50% dextrose should be given as ordered or per protocol Copyright © 2016 by Saunders, an imprint of Elsevier Inc.  28 Medical Treatment  Inan unconscious patient who has diabetes, hypoglycemia should be suspected until it is ruled out  50 mL of 50% glucose solution should be administered immediately  Thepatient with a milder form of hypoglycemia  Treated with 15 g carbohydrate  If the patient’s condition does not improve, another 15 g of carbohydrate should be given after 10 minutes Copyright © 2016 by Saunders, an imprint of Elsevier Inc.  29 Any questions Copyright © 2016 by Saunders, an imprint of Elsevier Inc.