Endocrine Part 1

1. A 46 year old male with a h/o hypertension has fasting blood glucose of 118 and hemoglobin A1C was 6.3%, glucose tolerance of 2 hours is 199 during annual follow up visit. What education should the nurse provide?

How to monitor glucose and self test. How to administer insulin and what s/s of hypoglycemia are.

Instruct the patient that they will start on oral hypoglycemic medication and caution the s/s of hypoglycemia

Diagnosis of Diabetes

́Fasting blood glucose (FBG) > or = to 126mg/dL

́Two hour Oral Glucose Tolerance Test (OGTT) > or = to 200 mg/dL

́Random Blood Sugar (RBS) 200mg/dL with classic symptoms of diabetes

́HbA1C 6.5% or higher

The patient is prediabetic, and at an increased risk for developing Type 2 DM.

With prediabetes it takes about 10 years for Type II DM to develop.

Prediabetes is defined as impaired glucose tolerance and impaired fasting glucose or both. Fasting blood glucose results between 100 mg/dL (5.56 mmol/L) and 125 mg/dL (6.9 mmol/L) indicate prediabetes. A diagnosis of impaired glucose tolerance is made if the 2-hour oral glucose tolerance test (OGTT) results are between 140 mg/dL (7.8 mmol/L) and 199 mg/dL (11.0 mmol/L).

Explanation

Diagnosis of Diabetes

́Fasting blood glucose (FBG) > or = to 126mg/dL

́Two hour Oral Glucose Tolerance Test (OGTT) > or = to 200 mg/dL

́Random Blood Sugar (RBS) 200mg/dL with classic symptoms of diabetes

́HbA1C 6.5% or higher

The patient is prediabetic, and at an increased risk for developing Type 2 DM.

With prediabetes it takes about 10 years for Type II DM to develop.

Prediabetes is defined as impaired glucose tolerance and impaired fasting glucose or both. Fasting blood glucose results between 100 mg/dL (5.56 mmol/L) and 125 mg/dL (6.9 mmol/L) indicate prediabetes. A diagnosis of impaired glucose tolerance is made if the 2-hour oral glucose tolerance test (OGTT) results are between 140 mg/dL (7.8 mmol/L) and 199 mg/dL (11.0 mmol/L).

2. Select all the leading complications of diabetes, SATA

Cause of new cases of blindness

End stage renal disease

Lower leg amputation

Pancreatic cancer

́#1 cause of new cases of blindness, end-stage renal disease and non traumatic lower limb amputation

Explanation

́#1 cause of new cases of blindness, end-stage renal disease and non traumatic lower limb amputation

Submit

3. A woman who had gestational diabetes should not be concerned with developing diabetes because delivering the baby resolves the issue

True

False

While it’s true that delivering the baby will resolve the gestational diabetes but she should still be concerned with developing type 2 later in life.

An important teaching point is gestational diabetes applies to women that develop glucose intolerance during pregnancy – 63% chance of developing DM within 16 years

Explanation

While it’s true that delivering the baby will resolve the gestational diabetes but she should still be concerned with developing type 2 later in life.

An important teaching point is gestational diabetes applies to women that develop glucose intolerance during pregnancy – 63% chance of developing DM within 16 years

4. What is the primary action of insulin in the body?

Aids in the process of gluconeogenesis.

Enhances the transport of glucose across cell walls.

Decreases the intestinal absorption of glucose.

Stimulates the pancreatic beta cells.

Insulin, a hormone produced by the beta cells of the Islets of Langerhans in the pancreas. Insulin is secreted by these cells in response to the presence of food, and in particular, carbohydrates, which are broken down into glucose.

Promotes the transport of glucose from the bloodstream into the cells.

In particular, skeletal and adipose cells require insulin to unlock receptor sites, to allow the transportation of glucose into their cells to be used for energy.

Explanation

Insulin, a hormone produced by the beta cells of the Islets of Langerhans in the pancreas. Insulin is secreted by these cells in response to the presence of food, and in particular, carbohydrates, which are broken down into glucose.

Promotes the transport of glucose from the bloodstream into the cells.

In particular, skeletal and adipose cells require insulin to unlock receptor sites, to allow the transportation of glucose into their cells to be used for energy.

5. What is true about pre-diabetes? SATA

From impaired glucose tolerance

The beta cells do not produce insulin

They are at higher risks for diabetic ketoacidosis

From impaired fasting glucose

Pre diabetes is a asymptomatic, condition where individuals are at an increased risk for developing Type 2 DM, type 1 is more at risk for DKA.

Caused by impaired glucose tolerance (IGT), impaired fasting glucose (IFG), or both.

Explanation

Pre diabetes is a asymptomatic, condition where individuals are at an increased risk for developing Type 2 DM, type 1 is more at risk for DKA.

Caused by impaired glucose tolerance (IGT), impaired fasting glucose (IFG), or both.

Submit

6. Identify the critical point of insulin?

Stimulates protein uptake in skeletal muscles

Stimulates liver to convert glucose to glycogen

Stimulates uptake of fat in adipose tissue

Without insulin, protein and body fat are broken down

Every option is correct BUT the critical point is that without insulin the body needs energy (glucose) and will get energy from protein and body fat.

Necessary to supply glucose to the body’s tissue

Without insulin, body fat and protein are broken down

If inadequate amount of insulin produced to meet body’s needs, then exogenous source needed

Explanation

Every option is correct BUT the critical point is that without insulin the body needs energy (glucose) and will get energy from protein and body fat.

Necessary to supply glucose to the body’s tissue

Without insulin, body fat and protein are broken down

If inadequate amount of insulin produced to meet body’s needs, then exogenous source needed

7. Match the following

Fasting blood sugar lvl for a diabetic dx

HbA1C lvl for a diabetic diagnosis

Random blood sugar lvl for a diabetic dx

Normal random blood sugar lvl

Normal fasting blood sugar

29

•Lab testing will give a definitive diagnosis of DM

•Fasting BS –

•Norm is 70-99

•DM if >126 on at least two occasions

•Critical levels are <60 or >500

•NPO 8-12 hours (water is permitted)

•Random BS –

•Drawn anytime without prep

•Should be within norm range for both DM and non-DM (<200); >200=DM

Other tests to consider:

•2 hour plasma glucose (Glucose tolerance test) –

•Fasting level is drawn, then pt. drinks water with 75g glucose, then NPO

•Levels drawn at 30 minute intervals – 2 hours should return to norm (>200 = DM)

•Urine tests –

•Ketones (waste product of fat metabolism) – dip stick test; + indicates that body is using fat as a major source of energy

•Protein (indicates microvascular changes in kidney) & glucose – part of routine UA; both should be -

Explanation

29

•Lab testing will give a definitive diagnosis of DM

•Fasting BS –

•Norm is 70-99

•DM if >126 on at least two occasions

•Critical levels are <60 or >500

•NPO 8-12 hours (water is permitted)

•Random BS –

•Drawn anytime without prep

•Should be within norm range for both DM and non-DM (<200); >200=DM

Other tests to consider:

•2 hour plasma glucose (Glucose tolerance test) –

•Fasting level is drawn, then pt. drinks water with 75g glucose, then NPO

•Levels drawn at 30 minute intervals – 2 hours should return to norm (>200 = DM)

•Urine tests –

•Ketones (waste product of fat metabolism) – dip stick test; + indicates that body is using fat as a major source of energy

•Protein (indicates microvascular changes in kidney) & glucose – part of routine UA; both should be -

Submit

8. A patient who's HbA1C level was at 7.3% said to the nurse, "I don't understand why it's so high, I stopped eating sugary food and pop for a whole month?" What's the best response from the nurse?

“We will retest your HbA1C level as soon as possible”

Assess if the patient ate breakfast the morning before the test

“HbA1C test detects how well controlled your blood sugar has been over 2-3 months”

Explain that the level is just slightly elevated

the hemoglobin A1C test provides a measurement of glycemic control over the previous 2 to 3 months, with increases in the A1C reflecting elevated blood glucose levels. The hemoglobin A1C test has several advantages over the FPG test, including greater convenience because fasting is not required.

Explanation

the hemoglobin A1C test provides a measurement of glycemic control over the previous 2 to 3 months, with increases in the A1C reflecting elevated blood glucose levels. The hemoglobin A1C test has several advantages over the FPG test, including greater convenience because fasting is not required.

9. What best describes the cause of type 1 DM?

Too much glucose in blood causes desensitization of cells to take in glucose and become insulin resistant

The immune system destroys the cells that make insulin

Being obese

The liver does not release enough glycogen

Type 1 DM is an immune-mediated disease – active autoimmunity directed at the beta cells of the pancreas; these antibodies progressively decrease the effective circulating insulin level till no insulin is produced; occurs when there is 80-90% of the pancreatic beta cells destroyed.

Keep in mind that there are no preventative measures for type 1, can only prevent complications by exercise and diet

Explanation

Type 1 DM is an immune-mediated disease – active autoimmunity directed at the beta cells of the pancreas; these antibodies progressively decrease the effective circulating insulin level till no insulin is produced; occurs when there is 80-90% of the pancreatic beta cells destroyed.

Keep in mind that there are no preventative measures for type 1, can only prevent complications by exercise and diet

10. Select all that apply for type 1 diabetes signs and symptoms

Gradual onset

Rapid onset

Increase thirst

Increased eating

Weight gain

Increased frequency of infections

Clinical manifestations – rapid onset with acute manifestations

• 3Ps

Polyphagia (increased hunger)

Polydipsia (increased thirst)

Polyuria (increased urination)

Fatigue

Weight loss

More frequent infections

Family history

Peak incidence from 10-15 years old

Explanation

Clinical manifestations – rapid onset with acute manifestations

• 3Ps

Polyphagia (increased hunger)

Polydipsia (increased thirst)

Polyuria (increased urination)

Fatigue

Weight loss

More frequent infections

Family history

Peak incidence from 10-15 years old

Submit

11. What best describes the cause of type 2 DM?

The immune system destroys the cells that make insulin

Being obese

The liver does not release enough glycogen

Beta cell response to repeated hyperglycemia desensitizes their response to further high glucose levels; also liver and peripheral tissues may become insulin resistance; results in insulin resistance and impaired insulin secretion.

Insulin resistance is when cells in your muscles, fat, and liver don't respond well to insulin and can't easily take up glucose from your blood.

Experts believe obesity, especially too much fat in the abdomen and around the organs, called visceral fat, is a main cause of insulin resistance. A waist measurement of 40 inches or more for men and 35 inches or more for women is linked to insulin resistance.

Explanation

Beta cell response to repeated hyperglycemia desensitizes their response to further high glucose levels; also liver and peripheral tissues may become insulin resistance; results in insulin resistance and impaired insulin secretion.

Insulin resistance is when cells in your muscles, fat, and liver don't respond well to insulin and can't easily take up glucose from your blood.

Experts believe obesity, especially too much fat in the abdomen and around the organs, called visceral fat, is a main cause of insulin resistance. A waist measurement of 40 inches or more for men and 35 inches or more for women is linked to insulin resistance.

12. Select all the signs and symptoms of type 2 diabetes.

Gradual onset

Rapid onset

Increased thirst

Increased hunger

Tingling feet

Blurred vision

Clinical manifestations - gradual onset

• 3Ps

• Polyphagia (increased hunger)

• Polydipsia (increased thirst)

• Polyuria (increased urination)

Lack of energy

Blurred vision

Dry/itchy skin

Tingling of the feet

Sore heals slowly

Weight loss or gain

Explanation

Clinical manifestations - gradual onset

• 3Ps

• Polyphagia (increased hunger)

• Polydipsia (increased thirst)

• Polyuria (increased urination)

Lack of energy

Blurred vision

Dry/itchy skin

Tingling of the feet

Sore heals slowly

Weight loss or gain

Submit

13. What statement made by a patient with diabetes indicate that they need further education about health maintenance visits?

“I will make a doctor appointment every 3 months to check my heart, skin, meds, and lab”

“I see my ophthalmologist every 2 years with dilated eye exam”

“I never miss my yearly podiatrist appointments”

“I need to schedule an appointment with a dietitian since my blood sugar has been out of control”

•Health Maintenance Visits:

•Participate in a diabetic education program initially and as needed

•Ophthalmology visit yearly with dilated eye exam

•Dental exam/cleaning every 6 months

•PCP every 3 months for eval of CV status, skin integrity, meds, and labs •Yearly podiatry visit

Explanation

•Health Maintenance Visits:

•Participate in a diabetic education program initially and as needed

•Ophthalmology visit yearly with dilated eye exam

•Dental exam/cleaning every 6 months

•PCP every 3 months for eval of CV status, skin integrity, meds, and labs •Yearly podiatry visit