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The gland of the endocrine system most responsible for the body's response to stress:
"Master Gland" and why ?
Hypothalamus b/c it is the coordinating center for the nervous and endocrine responses to internal and external stimuli
This is caused by too little adrenocortical hormones:
These hormones are released by the intermediate lobe of the pituitary gland in response to stress, pain, transcutaneous stimulus and guided imagery:
Endorphins & Enkephalins
Explain the Diurnal pattern:
The pattern of the hypothalamus secretion of corticotropin releasing factor (CRF) in the PM with adrenocortical hormone peak around 0600-0900, and decreasing throughout the day until night time when the levels rise again.
Hormones are secreted directly into _______.
Hormones can react with receptors in 2 ways, name them:
- in the Cell Membrane
A long term assessment finding of increased adrenocorticotropic hormones :
Buffalo Hump from Cushing's syndrome
This temperature intolerance is associated with Hypothyroidism:
THis temperature intolerance is associated with HYPERthyroidism:
Diagnostic test for adrenal gland disfunction is the ____ test.
Sputum test - looks for elevated cortisol levels
Replacement therapy for Hypothyroidism :
- Levothyroxine / Synthroid
- Increases O2 consumption, respiration, heart rate, growth & maturation, and metabolism of fats, carbs, and protein
Prednisone may cause _______ in diabetic patients.
This system controls cellular activity that regulates growth and metabolism through the release of hormones:
process of biochemical reaction in the body cells needed to produce energy, repair cells and maintain life
Hormones regulate what functions in the body?
- Fluid & Electrolyte balance
- Gender differentiation
Insulin inhibits the breakdown of what 3 things?
- Stored Glucose
Name the 3 cell types of the islets of Langerhans:
What do Alpha cells release?
What do the Beta cells release?
What do Delta cells release?
Glucagon responds to what?
Low blood sugar- stimulates mobilization of glycogen from the liver to be broken down into glucose for energy.
The breakdown of glycogen from the liver into glucose
Define Gluconeogenesis :
The formation of glucose from non-carb substances
The spilling of sugar into the urine because the concentration of glucose in the blood is too high for complete reabsorption.
The breakdown of lipids in the liver and adipose tissue to free fatty acids (FFA) is called _____.
When metabolism shifts to breakdown of fats, a patient is at risk for what?
Increase ketone bodies leading to DKA diabetic ketoacidosis
What causes DKA?
Absence of Insulin to block the breakdown stored glucose and the production of new glucose from fat causing HYPERglycemia
In between meals and during periods of fasting what is released from the pancreas?
- Glucagon is released once BD is <70mg/dl -
- This prevents hypoglycemia in most people
Insulin functions to move ____ into what cells?
- Sugar/glucose into the liver, muscle, and fat cells -
- taking potassium with it
Beta cells regulate what ?
Insulin release regulated by blood glucose levels
What function does insulin serve with amino acids?
moves them into cells for protein synthesis
Name the 4 functions of Insulin:
- Move glucose into cells
- Prevent excess glycogenolysis
- Inhibit Lipolysis
- Moves amino acids into cells for protein synthesis
What body systems do NOT require insulin for glucose uptake?
- Renal tubules
Type I DM is cause by what?
- Destruction of beta cells by:
- Autoimmune (antibodies)
- Genetic Predisposition (Human Luekocyte Antigens)
- Environmental (viral Rubella) & Toxins (Nitrates)
Classic S/S of Type I DM:
- Hyperglycemia +
- Weight Loss
What causes Polyuria?
Elevated BS leads to Increased renal blood flow and decrease in osmolarity resulting in increased urine production/output because water is not reabsorbed by the tubules
Name the 3P's:
What causes Polydipsia?
Decreased intracellular volume with increased urine output leads to excessive thirst
Obesity contributes greatly to what type of diabetes?
- Type II
- Increased adipose tissue reduces receptor sites
- More Muscle = More receptor sites
Pre-diabetic patients have an increased risk for what because of impaired glucose tolerance?
When fats are used as a primary energy source the serum lipid levels rise and contribute to the accelerated development of __________.
What causes weight loss in Type I diabetes?
glucose is not available to the cells, so the body begins to breakdown Fat & Protein stores for energy
What causes Type II DM?
Combination of insulin resistance and inadequate insulin secretion to compensate.
Typical onset of Type II DM is when?
After 30 years of age, but may occur at any age
Type II DM clinical manifestations:
- Obesity & fatigue
- Poor wound healing
- Recurrent Infections
- Blurred Vision
Secondary DM may be caused by what?
- Medical condition (Cushing's or hyperthyroidisn)
- Drug induced (corticosteriods, thiazides, beta blockers, niacin)
Treatment for secondary DM:
- Check BS Q 6 hours
- change tubing Q 24 hours
- ALWAYS taper off TPN
How should diabetic patients exercise:
- daily same time, same amount
- Caution during hyperglycemic events (>250 no exercise)
Patient that experience exercise induced hypoglycemia should do what?
If taking insulin have a carb snack before and after exercise as well as before bedtime.
Short acting Regular insulin should be given when? name one
- Regular (Humalog R, Novolin R, or Iletin II R)
- 20-30 minutes before a meal
- May be taken alone or with a longer acting insulin
Name the rapid acting insulins:
- Lispro (Humalog)
- Aspart (Novolog)
- Glulisine (Apidra)
Name intermediate acting insulins:
- NPH (neutral protamine Hagedorm)
- (Humulin N)
Name the very long acting insulins:
- Glargine (Lantus)
- Detemir (Levemir)
Explain dawn phenomenon:
Fasting hyperglycemia without prior hypoglycemia
HOw do you treat dawn phenomenon?
Move dose of NPH from diner to bedtime - this provides longer coverage
What is the somogyi effect?
- Rebound hyperglycemia after hypoglycemia occurs
- Usually around 3am hypoglycemia occurs and the liver releases glucose causing a hyper state
How would you treat the somogyi effect?
Take a snack before bedtime AND/OR decrease NPH bedtime dose
How do the oral agents Sulfonylures & Secretagogues work?
Enhance/stimulate pancreas to secrete insulin
How do the Biguanides work?
Reduce/inhibit hepatic glucose production
What caution should be taken if a patient is taking a Biguanide oral agent?
D/C use prior to contrast dye testing and do not resume until contrast has been completely excreted from the body
Name a biguanide =
Name the Sulfonylureas:
- 1st generation: Diabenase (Chlorpropamise)
- 2nd genration: Amaryl / Glucotrol / Glynase