ENDOCRINE DISEASES AND CONDITIONS

Diabetes

Type I or Type II

Type I Type IIJuvenile diabetes Most common form of

diabetesUsually diagnosed in children and young adults

Millions diagnosed and many unaware they have it

Body will not produce insulin

Either the body does not produce enough insulin or the cells ignore the insulin

Only 5% of diabetics are a type I

Symptoms – Type I

Frequent urination

Unusual thirst

Extreme hunger

Unusual weight loss

Extreme fatigue and irritability

Symptoms – Type II

Any of the type I symptoms

Frequent infections

Blurred vision

Cuts and bruises that are slow to heal

Tingling or numbness in the hands or feet

Recurring skin, gum or bladder infections

Prevention

Type II can be prevented or delayed

Lead a healthy lifestyle

Change your diet

Increase your physical activity

Maintain a health weight

Myths

• Diabetes is not that serious of a disease

• If you are over weight you will eventually develop type II diabetes

• Eating too much sugar can cause diabetes

• People with diabetes must eat special foods

• People with diabetes cannot eat carbs or sugars

• It is ok to eat as much fruit as you want because it is healthy

Diabetic Ketoacidosis (DKA)

Insulin deficiency and excessive stress hormone

Typically in Type I but can be in Type II

Elevated glucose promotes osmotic diuresis and dehydration

• Stress hormones stimulate free fatty acids which cause a release of ketones

• Causes decreased myocardial contractility and cerebral function

• Usually brought on by infection and stress

Interventions

• Gradually return to normal metabolic balances

• FSBS and notify the MD of the results

• 2 large bore IV’s• NS at a rate of 1 liter per hour• O2 and maintain ABC’s• Insulin drip per protocol• Monitor patient every 5-15 minutes

until stable• Closely monitor intake and output• Cardiac monitor

Hyperglycemic Hyperosmolar Nonketotic Coma (HHNC)

• Occurs in type II• Profound dehydration from elevated

glucose and osmotic diuresis• No ketones-not enough insulin to start

the process• Can be caused by infection, stroke or

sepsis• High mortality rates

Interventions

• FSBS and notify the MD of the results• May require intubation• 2 large bore IV’s• NS 1 liter over 1 hour• Insulin drip per protocol• Monitor the patient every 5-15

minutes until stable• Closely monitor the intake and output• Cardiac monitor

Hypoglycemia

• Serum glucose drops below 50• Below 35-the brain cannot adequately

extract oxygen• Results in hypoxia and eventually

coma• Any person with an altered level of

consciousness should be considered to have low glucose until proven otherwise

Interventions

• O2 and maintain ABC’s• FSBS and notify MD of results• If alert and oriented x3, give oral

glucose solutions (oj, milk, etc. )• Establish IV• ½ to 1 amp of 50% dextrose (D50) per

MD’s orders• Monitor the mental status closely• Monitor the FSBS every 15-30 minutes• Order a meal tray STAT• Cardiac Monitor

References

American Diabetic Association

Emergency Nursing Core Curriculum, ENA

Fundamentals of Nursing, Potter and Perry