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