Endocrine
Anatomy and physiology
The endocrine system is a communication system that controls functions inside the body
Glands secrete messenger hormones
Hormones effect end organs, tissues, or cells
Endocrine disorders are caused by internal communication problems
Glucose metabolism- the brain needs glucose and oxygen
Insulin is necessary for glucose to enter cells, without enough insulin, cells do not get fed
The pancreas produces and stores glucagon and insulin
In the pancreas, islets of Langerhans have alpha and beta cells
Alpha cells produce glucagon
Beta cells produce insulin.
Pathophsiology
Diabetes mellitus impairs the body's ability to use glucose for fuel
Without treatment, blood glucose levels become too high
Complications include blindness, cardiovascular disease, and kidney failure
It is important to know signs and symptoms of blood glucose that is high and low
Hyperglycemia and hypoglycemia can occur with diabetes type one and type two.
All hypoglycemic patients require prompt treatment.
Diabetes mellitus type 1
An autoimmune disorder where the immune system produces antibodies against pancreatic beta cells.
Missing the pancreatic hormone insulin
Without insulin, glucose cannot enter the cell, and the cell cannot produce energy
onset usually happens from early childhood through the fourth decade of life.
Immune system destroys the ability of the pancreas to produce insulin
Patient must obtain insulin from an external source
Type one diabetes patients cannot survive without insulin
Most type one diabetics have an implanted insulin pump
The pump continuously monitors glucose levels and provides insulin
The pump limits the number of times patients have to check their fingerstick glucose levels
Pumps can malfunction and cause diabetic emergencies
Most common metabolic disease of childhood
New onset patient will show symptoms related to eating and drinking
Polyuria
Polydipsia
Polyphagia
Weight loss
Fatigue
Normal blood glucose is between 80-120 mg/dL
When glucose is unavailable to cells, the body turns to burning fat
This produces acid waste (ketones)
As ketone levels go up in the blood they spill into the urine
The kidneys cannot maintain acid-base balance.
Patient can get Kussmaul respirations
If metabolism and ketone production continue, diabetic ketoacidosis can develop.
Ketoacidosis may present as generalized illness plus
Abdominal pain
Body aches
Nausea
Vomiting
Altered mental status or unconsciousness
If not treated diabetic ketoacidosis can result in death
DKA patients' glucose is usually higher than 400mg/dL
Diabetes mellitus type 2
Caused by resistance to the effects of insulin at the cellular level
Obesity predisposes patients to type 2 diabetes
The pancreas produces more insulin
Insulin resistance can be sometimes improved by exercise and dietary modification
Oral medications are used to treat type 2 diabetes
Injectable medications and insulin are also used
Often diagnosed at yearly medical exam from complaints related to high blood glucose
Such as recurrent infection, change in vision, numbness in feet
Symptomatic hyperglycemia
Occurs when blood glucose is high
Patient has an altered mental status resulting from several combined problems
In type one diabetes- leads to ketoacidosis with dehydration and excess urination
In type two diabetes- leads to nonketotic hyperosmolar state of dehydration
If a patient has hyperglycemia for a protracted length of time consequences of diabetes may present
Wounds that do not heal
Numbness in hands and feet
Blindness
Renal failure
Gastric motility problems
When blood glucose levels in type two diabetes are not controlled it can lead to HHNS
Key signs and symptoms of HHNS
Hyperglycemia
Altered mental status, drowsiness, lethargy
Severe dehydration, thirst, dark urine
Visual or sensory deficits
Partial paralysis or muscle weakness
Seizures
Higher glucose in the blood causes excretion of glucose in urine
Increased fluid intake causing polyuria
Urine becomes dark and concentrated
Patient may become unconscious or have seizure activity due to severe dehydration
Symptomatic hypoglycemia
A patient's blood glucose level drops and must be corrected swiftly
Can occur in patients who inject insulin or take oral medications to stimulate the pancreas to make more insulin
When insulin levels remain high, glucose is rapidly taken out of the blood
If glucose levels fall, there may be an insufficient amount to supply the brain
The mental status of the patient declines
Patient may become aggressive or display unusual behavior
Unconsciousness and permanent brain damage can quickly follow
Common reasons for low blood glucose to develop
Correct dose of insulin with change in routine
More insulin than necessary
Correct dose of insulin without eating a sufficient amount
Correct dose of insulin and the patient developed an acute illness
Signs and symptoms of hypoglycemia
Normal to shallow or rapid respirations
Pale, moist skin
Diaphoresis
Dizziness, headache
Rapid pulse
Normal to low blood pressure
Altered mental status
Anxious or combative behavior
Seizure, fainting, or coma
Weakness on one side of the body
Rapid changes in mental status
Hypoglycemia is quickly reversed by giving the patient glucose
Without glucose, the patient can sustain permanent brain damage
Emergency medical care for diabetic emergencies
Giving oral glucose: there are three types of oral glucose: rapidly dissolving gel, large chewable tablets, liquid formulation
Contraindications of giving oral glucose
Inability to swallow and unconscious
Reassess frequently and transport
The presentation of hypoglycemia
Seizures
Consider hypoglycemia or underlying condition
Ensure airway is clear
Place patient on side
Put nothing in the patients mouth
Have suctioning equipment ready
Provide oxygen or artificial ventilations for inadequate breathing or cyanosis
Transport promptly
Altered mental status
May be caused by diabetes complications
Use AEIOU-TIPS
Always suspect and check for hypoglycemia in a patient with altered mental status
Ensure airway is clear
Be prepared to provide artificial ventilations, and prepare suction for if patient vomits
Provide prompt transport
Patients with altered mental status can lose gag reflex
Vomit or tongue can obstruct airway
Place patient in lateral recumbent position
Carefully monitor airway
Make sure suction is available