MED-SURG: ENDOCRINE CONDITIONS ✔ Indicates:

Ototoxicity (CN
VIII)
ENDOCRINE HORMONE #1
✔ DISCONTINUE
1) ANTIDIURETIC HORMONE (ADH)
medication
❒ Retains water
✔ NOTIFY physician
❒ Posterior Pituitary gland produces it
b) K+ SPARING DIURETICS
✔ Spironolactone
ADH CONDITIONS:
(Aldactone)
A. Syndrome of Inappropriate
✔ Amiloride (Midamor)
Antidiuretic Hormone (SIADH)
✔ Triamterene (Dyrenium)
❒ INCREASE ADH levels
❖ Hyperkalemia (>5 mg/dL)
❒ INCREASE fluid RETENTION
❖ Diet: Limit Potassium
❒ Fluid volume EXCESS (FVE)
Intake
❒ CAUSES:
c) THIAZIDE DIURETICS
a) Lung Cancer
✔ Hydrochlorothiazid
✔ Lung tumors also
e
produces ADH (ectopic
❖ Hypokalemia (<3.5
release)
mg/dL)
❒ SIGNS & SYMPTOMS: related to
❖ Hypercalcemia (>10.5
FVE
mg/dL)
1) HEART:
❖ Diet:
a) HYPERtension
a) High Potassium
b) TACHYcardia (Compensatory
a. Avocado
mechanism)
b. Banana
✔ To pump out excess water
c. Cantaloupe
2) BLOOD:
d. Spinach
a) HemoDILUTION
e. Oranges
b) DECREASE serum osmolality
f. Tomatoes
(<285)
g. Nuts
✔ (N) osmolality:
h. Potato (Baked)
● 285-295
b) Low Calcium
mmOsm/kg
a. AVOID Dairy
c) DECREASE Hematocrit
Products
✔ (N) Hct (MEN): 38-48%
❖ CONTRAINDICATION
(<38%)
a) History of renal
✔ (N) Hct (WOMEN):
stones
36-45% (<36%)
2) DIET:
d) DECREASE Sodium Levels
a) LIMIT oral fluid intake
(<135 mg/dL)
b) INCREASE Sodium Diet
✔ At risk: SEIZURES
3) MONITOR FOR:
3) KIDNEYS:
a) Vital Signs
a) DECREASE urinary output
b) Intake and Output
(oliguria)
c) Weight (BEST indicator for
b) Urine CONCENTRATION
fluid balance)
c) INCREASE urine specific
4) EFFECTIVENESS: LOSES
gravity (>1.030)
weight
✔ (N) urine specific gravity:
● 1.010-1.030
5) SEIZURE PRECAUTIONS:
d) DARK-YELLOW urine
a) Non-stimulating
e) NOT edematous
environment (Private
4) Weight GAIN
room)
b) Limit visitors
❒ MANAGEMENT:
c) Dim lights
1) DOC: Diuretics
d) AVOID Television, radio,
a) LOOP DIURETICS (K+
Cellphones, laptops
Waster)
e) PRIORITY: During
✔ Furosemide (Lasix)
Seizure
✔ Bumetanide (Burinex)
a. POSITION: Side-lying
❖ Hypokalemia (<3.5
✔ To drain secretions
mg/dL)
✔ To maintain open
❖ Diet: High Potassium
airway
a. Avocado
b. PLACE Pillow under
b. Banana
the neck/head
c. Cantaloupe
✔ Prevent the head in
d. Spinach
hitting the floor
e. Oranges
c. NEVER Restrain
f. Tomatoes
d. NEVER Insert anything
g. Nuts
inside the mouth
h. Potato (Baked)
❖ Watch Out For: Tinnitus
B. Diabetes Inspidus (DI)
❒ DECREASE ADH levels
❒ DECREASE fluid RETENTION b. Chest pain/Angina
❒ Fluid volume DEFICIT (FVD) c. MI
✔ Leads to: DEHYDRATION d. Stroke
❒ CAUSES: ✔ WATCH OUT FOR: Nausea &
a) COMMON: Hypohysectomy Vomiting and Headaches
(removal of pituitary gland) ❖ Indicates WATER
✔ Absent Pituitary Gland INTOXICATION
✔ Absent production of ADH ❖ STOP medication
b) Brain tumor temporarily
c) Brain Injury 2) DIET:
d) Brain Infection (Meningitis, a) INCREASE oral fluid intake
Encephalitis) b) LIMIT Sodium Diet
✔ 3) MONITOR FOR:
❒ SIGNS & SYMPTOMS: related to a) Vital Signs
FVD b) Intake and Output
1) HEART: c) Weight (BEST indicator for
a) HYPOtension fluid balance)
b) TACHYcardia (Compensatory 4) EFFECTIVENESS: GAINS
mechanism) weight
✔ To pump out oxygenated 5) SKIN CARE:
blood to the rest of the a) Moisturizers
organs
2) BLOOD:
e) HemoCONCENTRATION ENDOCRINE HORMONE #2
f) INCREASE serum osmolality 2) GROWTH HORMONE (GH)
(>295) ❒ FUNCTION:
✔ (N) osmolality: a) Stimulates growth
● 285-295 b) Stimulate the liver to produce
mmOsm/kg sugar
g) INCREASE Hematocrit ❒ Long Bones has epiphyseal plate
✔ (N) Hct (MEN): 38-48% ✔ Open until 18 years old
(>48%) ✔ Growth occurs before 18
✔ (N) Hct (WOMEN): years old or before the closing
36-45% (>45%) of the epiphyseal plates
h) INCREASE Sodium Levels ❒ Posterior Pituitary Gland produces it
(<135 mg/dL)
GH CONDITIONS:
3) KIDNEYS: A. Gigantism
a) INCREASE urinary output ❒ INCREASE GH levels
(polyuria) ❒ ONSET: LESS THAN 18 years old
b) Urine DILUTION (epiphyseal plates are still OPEN)
c) DECREASE urine specific ❒ CAUSES:
gravity (<1.010) a) Pituitary Gland Tumor
✔ (N) urine specific gravity: ❒ SIGNS & SYMPTOMS:
● 1.010-1.030 1) EARLIEST: Changes in
d) CLEAR urine Appearance (Permanent)
4) SKIN: 2) Enlargement of the:
e) DRY Skin a) Forehead
f) POOR skin turgor b) Nose
5) NEURO c) Lips
a) EXCESSIVE Thirst d) Tongue (Macroglosia)
(Polydipsia) e) Larynx (Deepened voice)
✔ Earliest indicator of f) Hands
dehydration g) Feet
6) Weight LOSS 3) INCREASE in Height
4) Organomegaly
❒ MANAGEMENT: 5) Enlargement of the:
1) DOC: Antidiuretics a) Cardiomegaly
a) Vasopressin ✔ WOF: S3 & S4 heart
b) Desmopressin sounds
c) Lypressin ✔ Immediately notify
✔ INCREASE ADH levels physician
✔ INCREASE fluid RETENTION b) Hepatomegaly
✔ Synthetic ADH hormones c) Splenomegaly
✔ ROUTE: Intranasal ✔ Causes abdominal
✔ TAKEN: PRN or As necessary enlargement
✔ INDICATION to take: 6) INCREASE cholesterol levels
develops THIRST ✔ GH stimulates liver to
❖ CAUSES: sugar
Vasoconstriction ✔ Liver converts fats to
❖ CONTRAINDICATIONS sugar
a. CAD
 ✔ The conversion will c. HYPOglycemia
increase cholesterol in ⮚ WOF:
the blood 1. Hunger
✔ At risk: CVD & CVA (earliest sign)
7) Weight GAIN 2. Dizziness
✔ Can cause joint pain 3. Headaches
due to weight 4. Cool clammy
B. Acromegaly skin
❒ INCREASE GH levels d. CSF leakage
❒ ONSET: MORE THAN 18 years old ⮚ Complains fluid
(epiphyseal plates are CLOSED) drainage on the
❒ CAUSES: NOSE (Rhinorrhea)
a) Pituitary Gland Tumor ⮚ Complains fluid
❒ SIGNS & SYMPTOMS: drainage on the
1) EARLIEST: Changes in EARS (Otorrhea)
Appearance (Permanent) ⮚ Collect fluid and
2) Enlargement of the: send for analysis
a) Forehead ⮚ MANAGEMENT:
b) Nose ✔ Complete
c) Lips Bed rest
d) Tongue (Macroglosia) e. Development of DI
e) Larynx (Deepened voice) ⮚ WOF:
f) Hands 1. Polyuria
g) Feet 2. Polydipsia
nd
3) Organomegaly 2) 2 Option: MEDICATIONS
4) Enlargement of the: a) DOC: Optreotide (Sandostatin)
a) Cardiomegaly ✔ Blocks production and release
✔ WOF: S3 & S4 heart of GH levels
sounds ✔ ROUTE: SubQ (Abdominal
✔ Immediately notify area)
physician ✔ WOF: Abdominal pain
b) Hepatomegaly ❖ Indicates: Gallbladder
c) Splenomegaly complications
✔ Causes abdominal ❖ DISCONTINUE
enlargement medication
5) INCREASE cholesterol levels
✔ GH stimulates liver to ENDOCRINE HORMONE #3
sugar 3) THYROID HORMONE (TH)
✔ Liver converts fats to ❒ Thyroid Gland:
sugar ✔ Butterfly-like organ
✔ The conversion will ✔ LOCATION: trachea
increase cholesterol in ✔ Highly vascular
the blood ✔ FUNCTION: releases the:
✔ At risk: CVD & CVA a. T3 (Triiodohtyronine)
6) Weight GAIN 1) Regulates metabolism
✔ Can cause joint pain b. T4 (Thyroxine)
due to weight 2) Regulates heat
production
MANAGEMENT OF GH CONDITIONS: ❒ Parathyroid Glands:
1) SURGERY: Transphenoidal ✔ At the back of the thyroid gland
Hypohysectomy ✔ FUNCTION: Calcium balance
❒ CLOSED brain surgery
❒ LOCATION of incision site: beneath TH CONDITIONS
the upper lip A. Hyperthyroidism
❒ POST-OP MANAGEMENT: ❒ HYPERactivity of the thyroid gland
a) POSITIONING: ❒ INCREASE T3 and T4 levels
Semi-fowler’s ❒ DECREASE TSH levels
✔ HOB elevated 30-45
degrees
✔ With head & neck in ❒ CAUSES:
NEUTRAL position a) Grave’s Disease (Autoimmune)
✔ Prevents INCREASED ✔ HYPERstimulation of the
ICP thyroid gland
b) MONITOR ❒ SIGNS & SYMPTOMS:
COMPLICATIONS: 1) INCREASE T4: INCREASE heat
a. Bleeding production
⮚ WOF: Frequent a) HYPERthermia (Fever)
swallowing ✔ Administer antipyretics
b. Increase ICP ✔ Provide TSB
⮚ WOF: decrease ✔ AVOID aspirin
LOC − contains iodine
(Restlessness)
 − further enhances ✔ MANAGEMENT:
thyroid hormones 1. Administer
a) Provide COOLING artificial tears
blanket 2. Use eyeglasses
b) HEAT intolerance 3. Tape eyelids at
a) Provide COOL bedtime
environment 4. STOP smoking
(air-conditioned) (can further drying
2) INCREASE T3: INCREASE the eyes)
metabolism in body functions f) Thyromegaly (Goiter)
a) HEART: ✔ Difficult of Breathing
a. HYPERtension ⮚ Elevate HOB
b. TACHYcardia ✔ Difficulty of swallowing
✔ Administer ⮚ Provide SOFT diet
Beta-blockers (“-olol” ❒ DIAGNOSTICS:
medications) a) INCREASED T3 and T4 serum
⮚ Can cause levels
BRONCHOSPASM b) DECREASED Thyroid stimulating
⮚ Contraindications hormones
: ❒ MANAGEMENT:
1. Asthma a) Radioactive Iodine Therapy (RAI)
2. COPD ✔ Administration of 1 dose of
✔ Monitor vital signs Iodine 131 (PO)
✔ WOF: Cardiac ✔ PURPOSE: destroy the
dysrhythmias overactive thyroid gland
b) NEUROLOGICAL: ✔ SIDE EFFECTS:
a. Insomnia a. Hypothyroidism
b. DECREASE LOC ✔ PREVENTION of
(Restlessness) Hypothyroidism:
c. Irritability a. Take Levothyroxine for
❖ Provide LIFE
NON-STIMULATING b) 2nd Option: SURGERY (Total
environment thyroidectomy)
c) GI: ✔ Removal of thyroid gland
a. INCREASE appetite ✔ DECREASE production of T3
b. Weight LOSS and T4 (Hypothyroidism)
❖ DIET: ❖ PREVENTION of
1. INCREASE Hypothyroidism:
calories a. Take Levothyroxine for
2. INCREASE CHO LIFE
3. INCREASE ✔ DECREASE PTH levels
CHON (Hypoparathyroidism)
4. Small frequent
feedings ✔ PRE-OP MANAGEMENT:
c. Diarrhea with a. Administer Lugol’s
abdominal cramping Solution (decrease
✔ INCREASE vascularity of thyroid
peristalsis gland)
✔ INCREASE − MUST be diluted
motility with juice
❖ DIET: (improves taste)
1. LOW Fiber − TAKE it with straw
2. AVOID caffeinated (prevent
products discoloration of
3. AVOID smoking teeth)
4. AVOID alcohol − Prevent BLEEDING
5. AVOID spicy − Prevent THYROID
products STORM
d) MENSTRUATION: (Thyrotoxicosis)
a. DECREASE menses ✔ POST-OP MANAGEMENT:
(oligomenorrhea) a. POSITIONING:
✔ Due to DECREASE Semi-fowler’s
estrogen ✔ HOB elevated 30-45
e) EYES: degrees
a. Exophthalmos (severe ✔ With head & neck in
bulging of eyes) NEUTRAL position
✔ Difficulty closing of ✔ Prevents NECK
eye lids EDEMA
✔ At risk: b. Monitor
1. Injury Complications:
2. Drying 1. Bleeding
3. Blindness
 ⮚ Assess the back c) Provide extra blankets
of head/neck for d) Provide jackets
dampness 2) DECREASE T3: DECREASE
2. HYPOcalcemia metabolism in body functions
⮚ S/Sx: known as a) HEART:
TETANY a. HYPOtension
❒ Nausea and b. BRADYcardia
vomiting ✔ Monitor vital signs
❒ Tingling b) NEUROLOGICAL:
(lips/fingers) a. HYPERsomnia
❒ Muscle b. Lethargic
cramps c) GI:
❒ Trousseau’s a. DECREASE appetite
Sign (Anorexia)
❒ Chvostek’s b. Weight GAIN
Sign ❖ DIET:
❒ Stridor 1. LIMIT calories
(wheezing 2. DECREASE CHO
upon 3. DECREASE
inhalation) CHON
⮚ MEDICATION: c. Constipation
Calcium ✔ DECREASE
gluconate peristalsis
⮚ BEDSIDE ✔ DECREASE
Equipment: motility
Trache Set ❖ DIET:
1. HIGH Fiber
2. INCREASE oral
fluid intake
3. Laxatives
d) MENSTRUATION:
a. INCREASE menses
(Menorrhagia)
✔ Due to INCREASE
estrogen
e) EYES:
3. Laryngeal Nerve a. Myxedema (periorbital
Damage edema)
⮚ Hoarseness f) Thyromegaly (Goiter)
of the voice a. The pituitary gland
(temporary) compensates the
⮚ ASSESS: destroyed thyroid
talk for the gland, resulting
patient enlargement of the
c) 3rd Option: MEDICATIONS thyroid gland
❒ DOC: Antithyroid b. Still it cannot produce T3
Medications (blocks T3 and and T4 hormones
T4) ✔ Difficult of Breathing
a. Propylthiouracil (PTU) ⮚ Elevate HOB
✔ WOF: Sore throat ✔ Difficulty of swallowing
❒ Indicates ⮚ Provide SOFT diet
agranulocytosis
❒ Indicates infection ❒ DIAGNOSTICS:
❒ DISCONTINUE a) DECREASE T3 and T4 serum
medication levels
b. Methemazole b) INCREASE Thyroid stimulating
B. Hypothyroidism hormones
❒ HYPOactivity of the thyroid gland ❒ MANAGEMENT:
❒ DECREASE T3 and T4 levels a) DOC: Thyroid Medications
❒ INCREASE TSH levels (increases T3 and T4)
❒ CAUSES: a. Levothyroxine (PTU)
a) Hashimoto’s Thyroiditis ✔ TAKEN: Morning before
(Autoimmune) meals
✔ Destroys the thyroid − It can cause insomnia
gland − For better absorption
❒ SIGNS & SYMPTOMS: ✔ AVOID
1) DECREASE T4: DECREASE ❒ Cabbage
heat production ❒ Cauliflower
a) COLD intolerance ❒ Carrots
a) Provide WARM ❒ Cute radish
environment ❒ Cute strawberry
b) Provide extra clothing ❒ Cute spinach
 −
This BLOCKS T3 and d)Moon Face
T4 e)Buffalo Hump
✔ WOF: Chest pain f)Truncal Obesity
− WITHHOLD the next g)Stretch marks
dose h)Easy bruising
− NOTIFY physician i)TEMPORARY changes in
appearance
ENDOCRINE HORMONE #4 j) Depression (Suicidal)
4) ADRENAL HORMONE (AH) k) HYPOkalemia
❒ ADRENAL GLAND: ⮚ Causes muscle
✔ LOCATION: upper portion of cramps
kidneys ⮚ DIET: HIGH Potassium
✔ 2 PARTS: 4) INCREASE Androgens
a) Adrenal Medulla (Inner) a) HIRSUTISM (EXCESS body
a. Epinephrine hair)
b. Norepinephrine ❒ MANAGEMENT:
− To stimulate SNS 1) SURGERY: Adrenalectomy
(Removal of adrenal gland)
b) Adrenal Cortex (Outer) ✔ At risk: ADDISONIAN
a. Glucocorticoids CRISIS
− Sugar production ✔ PREVENTION of Addisonian
b. Mineralocorticoids Crisis:
(Aldosterone) a. Take steroids
− Salt retention & UNILATERAL BILATERAL
Potassium ADRENALECTOMY ADRENALECTOMY
excretion (Complete)
c. Androgens (Male sex 2 years taking Steroids for LIFE
hormones) steroids
− For body hair ✔ POST-OP MANAGEMENT:
a. Monitor Vital signs
AH CONDITIONS of ADRENAL CORTEX: b. WOF: Hypotension,
A. Cushing’s Disease Tachycardia &
❒ Tumor in the adrenal cortex Tachypnea
✔ Tumor INCREASES the − These are S/Sx of
glucocorticoids, Addisonian Crisis
mineralocorticoids and − Administer IV
androgens hydrocortisone
❒ SIGNS & SYMPTOMS
1) INCREASE Glucocorticoids B. Addison’s Disease
a) HYPERglycemia ❒ Autoimmune destruction of the
⮚ Polyuria adrenal gland
⮚ Polyphagia ❒ DECREASES glucocorticoids,
⮚ Polydipsia mineralocorticoids and androgens
❖ Monitor blood sugar levels ❒ SIGNS & SYMPTOMS
2) DECREASE immune system 1) DECREASE Glucocorticoids
✔ Neutropenic precautions b) HYPOglycemia (<60 mg/dL)
a. AVOID crowded places CONSCIOUS/ALERT UNCONSCIOUS
b. AVOID FRESH foods Offer snacks Administer IV D50/50
(contains live organisms Offer juice or soda Administer IM
can cause infection) Glucagon
3) INCREASE Mineralocorticoids:
INCREASE Aldosterone 2) DECREASE Mineralocorticoids:
❖ DIET: DECREASE Aldosterone
a. LIMIT Sodium a) HYPOnatremia
b. LIMIT oral fluid intake ⮚ DECREASE fluid
❖ MONITOR: RETENTION
a. Vital Signs ⮚ Fluid Volume DEFICIT
b. Intake and Output b) HYPOtension
c. Weight c) TACHYcardia
❖ Provide SAFE environment d) TACHYpnea
❖ SUICIDE PRECAUTIONS e) Dry skin
(one-on-one monitoring) f) POOR Skin turgor
g) INCREASE melanin
− TEMPORARY
Bronze-colored skin
(Pathognomonic sign of
a) HYPERnatremia Addison’s disease)
⮚ INCREASE fluid h) Weight LOSS
RETENTION l) HYPERkalemia
⮚ Fluid Volume EXCESS ⮚ Causes muscle
b) HYPERtension weakness and
c) Edema heaviness
 ⮚ DIET: LOW Potassium ✔ TAKEN: Morning with or
❖ DIET: after meals
a. INCREASE Sodium − Are known GI irritant
b. INCREASE oral fluid
− Must be FULL
intake
❖ MONITOR: stomach
a. Vital Signs ✔ Contains sodium:
− WOF: Hypotension, HYPERnatremia
Tachycardia, − Causes edema
Tachypnea ✔ Contains glucose:
b. Intake and Output HYPERglycemia
c. Weight − Monitor Sodium and
❖ SKIN CARE: Use moisturizers Glucose levels
3) DECREASE Androgens ✔ Causes OSTEOPOROSIS
a) TEMPORARY Hair LOSS − At risk: FRACTURES
(alopecia) − Implement SAFE
❒ MANAGEMENT: environment
1) DOC: Steroids ✔ DECREASE immune system
− Neutropenic
TYPE 1 TYPE 2 precautions
(AUTOIMMUNE) a. AVOID crowded
places
INSULIN NON-INSULIN
b. AVOID FRESH
DEPENDENT DM DEPENDENT DM
foods (contains
live organisms
ABSENCE OF INSULIN
can cause
INSULIN DEFICIENCY
infection)
✔ Upon DISCONTINUATION:
Pancreas cannot CELLS are
TAPER dose (prevent shock)
produce insulin d/t to RESISTANT to Insulin
Immune cells (T cells)
attack the Beta Cells Insulin Resistance
AH CONDITIONS of ADRENAL MEDULLA:
GLUCONEOGENESIS NO A. Pheochromocytoma
(Liver converts GLUCONEOGENESIS ❒ Tumor in the adrenal medulla
protein/fats into sugar) ✔ INCREASE epinephrine and
BODY TYPE: BODY TYPE: norepinephrine (catecholamines)
✔ INCREASE SNS stimulation
THIN FAT ❒ SIGNS & SYMPTOMS:
JUVENILE CHRONIC 1) HYPERtensive Crisis
⮚ COMPLICATIONS: CVD,
(for Older Stroke
Adults/Obese) 2) HYPERglycemia
IDIOPATHIC LIFESTYLE 3) HYPERmetabolism (weight LOSS)
OBESITY 4) HYPERhidrosis
(unknown cause) 5) Headaches
(Sedentary life, eating ❒ MANAGEMENT:
sugary foods, 1) DOC: Phentolamine mesylate
hypertension, etc.) ✔ BLOCKS epinephrine and
MANDATORY TO NOT MANDATORY norepinephrine
TAKE INSULIN TO TAKE INSULIN 2) DIET:
MANAGEMENT a) INCREASE calorie
INSULIN INITIALLY: Oral b) INCREASE CHO
(LIFELONG) Hypoglycemic Agents c) INCREASE CHON
(Metformin) d) AVOID caffeinated products
DIET e) AVOID deep abdominal
(Can cause palpation
EXERCISE hypoglycemia) − Might compress the
tumor
TEMPORARY − Thus, INCREASES
INSULIN catecholamines
If there is: f) AVOID contact sports
a) Illness 3) SURGERY (if needed):
b) Infection Adrenalectomy (Removal of
c) non-healing adrenal gland)
wounds ✔ At risk: ADDISONIAN
CRISIS
d) HHNS
✔ PREVENTION of Addisonian
Crisis:
a. Take steroids
DIET
UNILATERAL BILATERAL
EXERCISE ADRENALECTOMY ADRENALECTOMY
(Complete)
 2 years taking Steroids for LIFE ❖ This increases insulin
steroids absorption (risk of
✔ POST-OP MANAGEMENT: hypoglycemia)
a. Monitor Vital signs
b. WOF: Hypotension, TYPE EXAMP ONSE PEAK DURATIO
Tachycardia & LE T N
Tachypnea (max.
− These are S/Sx of effect) (total
Addisonian Crisis effect of
− Administer IV Hypo-gly insulin)
hydrocortisone cemic
A. Diabetes Mellitus effect
❒ CHRONIC disorder of impaired RAPI LISPRO 10-15 30 2-4 HR
carbohydrates, proteins and lipid D MINUTE
metabolism ASPAR S
❒ Due to: T
a) Deficient of Insulin
b) Absence of Insulin GLULISI
❒ SIGNS & SYMPTOMS: NE
1) HYPERglycemia Eat within 15 minutes after
a. POLYURIA administration
− d/t osmotic diuresis SHO REGUL ½-1 2-3 HR 4-6 HR
b. POLYDIPSIA RT AR HR
− d/t cellular (clear)
dehydration ONLY insulin that can be given via IV
c. POLYPHAGIA
− d/t cellular starvation
2) WEIGHT CHANGES: INTE NPH 2-4 6-8 HR 16-20 HR
a) Type 1 DM: Weight LOSS R- (Neutral HR
− d/t gluconeogenesis MEDI Protami
b) Type 2 DM: Weight GAIN ATE ne
3) Blurring of Vision Hagedor
✔ Early development of cataract n)
4) Acanthosis nigricans
✔ COMMON in type 2 DM Humuli
5) At risk: UTI nN
6) Slow Wound Healing NEVER given at BEDTIME
❒ DIAGNOSTICS:
1) Fast Blood Sugar Test in 3 LON LENTE 6-8 NONE 20-30 HR
consecutive days G HR
✔ CONFIRMATORY test GLARGI
✔ >126 mg/dL in 3 NE
consecutive days: (+) DM
2) HbA1C (Glycosylated DETEMI
Hemoglobin) R
✔ To determine the mean SAFEST given at BEDTIME
glucose level for the
last 3 months
✔ To determine whether
the DM is well
controlled or not ✔ MIXING OF INSULIN:
✔ (N) = <7% (Well a) Regular (Clear)
controlled) b) NPH (Cloudy)
✔ (ABN) = >7% (Poorly ❖ STEPS:
controlled) 1) Inject AIR the NPH
❒ MANAGEMENT (Type 1 DM): 2) Inject AIR the
1) INSULIN REGULAR
✔ ROUTE: SubQ 3) ASPIRATE REGULAR
✔ SITES: 4) ASPIRATE NPH
a) Abdominal region
b) Upper outer arm ❒ MANAGEMENT (Type 2 DM):
c) Outer thigh (lateral) 1) Oral Hypoglycemic Agents
d) Gluteal (OHAs)
✔ DEGREE: ✔ Teratogenic to Pregnant
a) Thin = 45 degrees women
b) Obese = 90 degrees a) Biguanides
✔ ROTATE injection sites ⮚ E.g. Metformin
− Prevent lipodystrophy ⮚ Decreases glucose
✔ AVOID: production in the liver
a) Massage ⮚ Cannot cause
b) Put cold compress hypoglycemia (does no
c) Exercise the injection site release insulin)
⮚ WOF:
 a. Lactic Acidosis f) Kussmaul’s ❒ 800-1200 mg/dL of
⮚ HOLD metformin for 24 Respirations blood sugar
hours ❒ Accumulation of
− If patient will receive
❒ 400-600 mg/dL of excess glucose in
contrast (e.g. MRI with
contrast, CT scan with blood sugar the blood
contrast) ❒ Due to absent of (HYPERGLYCEMIC)
− Prevent kidney damage insulin, glucagon ❒ Blood thickens due
b) Sulfonylureas is secreted. to excess glucose
⮚ E.g. Glimeperide, ❒ Glucagon resulting increase
Glipizide, Gliclazide metabolizes fats blood pressure
⮚ Stimulates insulin release
for glucose (HYPEROSMOLAR)
from pancreas
⮚ WOF: (Gluconeogenesi ❒ The glucose CAN
a. Hypoglycemia s) enter in the cell,
2) DIET: ❒ The more it resulting cell satiety.
a) CALORIE RESTRICTED metabolizes fats, ❒ If there is Cell
b) BALANCED diet more ketones it satiety, the pancreas
a. 1 meal:
produces. does not produce
− 50% Carbohydrates
− 30% Fats glucagon, resulting
− 2% Proteins no fat breakdown
c) If patient becomes ILL: and NO KETONE
⮚ Eat and drink fluid as usual formation
3) EXERCISE: (NONKETOTIC)
✔ Improves insulin utilization
✔ LOWERS glucose level MANAGEMENT
✔ LOWERS cholesterol level FOR DEHYDRATION
✔ LOWERS triglyceride level
✔ Improve circulation Fluid replacement (0.45%)
a) REGULAR EXERCISE: For Glucose
− Same time of exercise
− Same amount of IV Regular Insulin
exercise If glucose (DKA/HHNS) have reached 250
− 3 times per week mg/dL:
− 30 minutes per session
− BEFORE and AFTER STOP 0.45% NaCl
Exercise:
✔ EAT! START D5W
− If glucose is >250
For DKA:
mg/dL or (+) ketones in
urine:
IV Sodium
✔ DO NOT
Bicarbonate
EXERCISE
(to treat acidosis)
✔ Indicative of
DKA or HHNS

DIABETIC HYPERGLYCEMIC
KETOACIDOSIS HYPEROSMOLAR
(DKA) NONKETOTIC
SYNDROME (HHNS)
❒ Due to
accumulation of ❒ Common in type 2
EXCESS DM
KETONES ❒ Gradual
❒ Common in type ❒ CAUSE:
1 DM a) Illness
❒ Sudden b) Infection
❒ CAUSE: missed c) Stress
insulin dose ❒ S/SX:
❒ S/SX: a) Glucose of >600
a) Glucose of mg/dL
>250 mg/dL b) Polyuria
b) Polyuria c) Dehydration
c) Dehydration d) Neurological
d) Ketosis Deficits
(Acidosis) e) Decrease of LOC
e) Abdominal
pain