Nutrirional-Metabolic

Patterns / Responses to
Altered Endocrine
Function
Nursing Care of Clients with Endocrine
Disorders of the Pancreas
 ENDOCRINE SYSTEM
- Composed of ductless(endocrine)
glands that release their
hormones(chemical messages) directly
into the bloodstream; the hormones
regulate the activity of target cells or
organs
- Pituitary gland – AKA master gland;
controls most of the activities of the
other endocrine glands
- Hypothalamus – AKA master of the
master gland; controls most of the
endocrinal activity of the pituitary
gland;
 PITUITARY GLAND
• Size of a grape
• Hangs by a stalk from the
hypothalamus
• Protected by the sphenoid bone
• Has two functional lobes
• Anterior pituitary – glandular tissue
• 1. Growth hormone
• 2. Prolactin
• 3. Gonadotrophins- LH and FSH
• 4. Stimulating hormones and
trophic hormones: ACTH, TSH
• Posterior pituitary – nervous tissue
• Oxytocin
• Antidiuretic hormone (ADH)
 HYPOTHALAMUS
• Corticotropin-releasing hormone (CRH) – signals PG to release
ACTH
• Gonadotropin-releasing hormone (GnRH) – signals PG to
produce FSH and LH
• Thyrotropin-releasing hormone (TRH) – stimulates PG to produce
TSH
• Somatostatin – stops PG from releasing certain hormones like GH
and TSH
• Oxytocin – uterine contraction and lactation; love hormone
• Vasopressin – antidiuretic hormone; ^BP
PANCREAS
This retroperitoneal organ has both endocrine and exocrine functions
The endocrine function resides in the ISLETS of Langerhans
The islets have three types of cells- alpha, beta and delta cells
The ALPHA cells secrete GLUCAGON – allows glucose to enter the blood
The BETA cells secrete INSULIN – allows glucose to cross plasma membranes into cells
The DELTA cells secrete SOMATOSTATIN -
DIABETES MELLITUS
 DIABETES MELLITUS
• A group of metabolic diseases characterized
by elevated levels of glucose in the blood
resulting from defects in insulin secretion,
insulin action, insulin receptors or any
combination of conditions.
• A chronic disorder of impaired glucose
metabolism, protein and fat metabolism
 DIABETES MELLITUS
Basic Pathology
• Insulin problem (deficiency or impaired
action)
• Stimulus of insulin – HYPERGLYCEMIA
Insulin Metabolic Functions:
1. Transports and metabolizes GLUCOSE
2. Promotes GLYCOGENESIS
3. Promotes GLYCOLYSIS
4. Enhances LIPOGENESIS
5. Accelerates PROTEIN SYNTHESIS
 DIABETES MELLITUS
Basic Pathology
• RISK FACTORS:
• 1. Family History of DM
• 2. Obesity
• 3. Race/Ethnicity
• 4. Age of more than 45
• 5. History of IFG/IGT
• 6. Hypertension
• 7. Hyperlipidemia
• 8. History of Gestational DM
 Factors to Consider

Type 1 Type 2 Gestational

Previously known as Previously known as Diabetes Mellitus

Insulin Dependent Non-insulin diagnosed during
Diabetes Mellitus dependent Diabetes pregnancy
Mellitus
 DIABETES MELLITUS
TYPE 1
• Characterized by the destruction of the
pancreatic beta cells which results in the
lack/absence of insulin; aka IDDM/Juvenile DM
• Etiology:
• Genetic susceptibility

• Autoimmune response

• Toxins, unidentified viruses and environmental

factors
 DIABETES MELLITUS
TYPE 1
PATHOPHYSIOLOGY
Destruction of BETA cells→ decreased
insulin production → uncontrolled glucose
production by the liver→ hyperglycemia
→ signs and symptoms
 DIABETES MELLITUS
TYPE 1
PATHOPHYSIOLOGY
Destruction of BETA cells→ decreased
insulin production → uncontrolled
glucose production by the liver→
hyperglycemia → signs and symptoms
CLASSIC P’s
Polyuria
Polydipsia
Polyphagia
 DIABETES MELLITUS
TYPE 2
• Characterized by insulin resistance and
impaired insulin production/aka NIDDM
• Etiology:
• Unknown

• Probably genetic and obesity

 DIABETES MELLITUS
TYPE 2
PATHOPHYSIOLOGY
Decreased sensitivity of insulin receptor to insulin
→ less uptake of glucose → HYPERGLYCEMIA
Decreased insulin production → diminished insulin
action → hyperglycemia → signs and symptoms
BUT (+) insulin in small amount → prevent
breakdown of fats → DKA is unusual
 DIABETES MELLITUS
Gestational
• Any degree of glucose intolerance with its
onset during pregnancy
• Usually detected between 24-28th week
gestation
Blood glucose returns to normal after
delivery of the infant
NEVER administer ORAL HYPOGLYCEMIC
AGENTS to PREGNANT MOTHERS!
 DIABETES MELLITUS
ASSESSMENT
• Classic 3 P’s
• Fatigue
• Body weakness
• Visual changes
• Slow/poor wound healing
• Recurrent skin and mucus membrane functions
• Paresthesia, Infection
 DIAGNOSTIC TESTS
01 02 03
FBS >126mg/dl RBS >200 OGTT >200
Fasting Blood Sugar Random Blood Sugar Oral Glucose tolerance
test

04 05 06
HgbA1 Urine glucose Urine ketones
Glycosylated hemoglobin test
to monitor effectiveness of
management
 DIABETES MELLITUS
Diagnostic Criteria
• 1. Fasting Blood Glucose Test
• Measures the amount of sugar (glucose)
in the blood after fasting for at least
eight hours or overnight.
• equal to or greater than 126mg/dL
(7.0mmol/L) – the NV of 8 hour FBS: 80-
109mg/dL
• A level between 110 mg/dl to 126 mg/dl,
is significantand is defined as impaired
fasting glucose
 DIABETES MELLITUS
Diagnostic Criteria
• 1. Random Blood Glucose Test
• done without regard to meals or time of day
random blood glucose concentration that is
elevated (>200 mg/dl,) in the presence of
classic symptoms of diabetes such as
polydipsia, polyphagia, polyuria, and blurred
vision is diagnostic of diabetes mellitus of
any age
 DIABETES MELLITUS
Diagnostic Criteria
• 2. Oral Glucose Tolerance Test
• the test measures the plasma glucose response to 75g
of concentrated glucosolution at selected intervals,
usually 1 hour to 2 hours. Persons with diabetes lacks
the ability to respond to an increase in blood glucose
by releasing adequate insulin to facilitate storage,
blood glucose levels rise above the served in normal
people and remain elevated for long periods
• NV 1 and 2 hours post-prandial: 140mg/dL
 DIABETES MELLITUS
Diagnostic Criteria
• 3. HgbA1 or Glycosylated Hemoglobin Test
• Tests how well you are managing the diabetes
• Reflects average blood sugar level for the past 2-3
months
• Normal range is 4-6%
• Abnormal if >7% (indicates the need for a change in
diabetic treatment plan)
 DIABETES MELLITUS
Diagnostic Criteria
• 4. Urine tests
• Benedicts test – used to test presence of
reducing sugar
• Urine test for ketones - urine test to
determine if your blood glucose is
dangerously high and if you are producing
substances called ketones. Ketones are the
by-product of the fat burning process that
occurs in the absence of insulin. They can
be toxic in large amounts and cause a life-
threatening emergency condition
called ketoacidosis.
 DIABETES MELLITUS
ASSESSMENT
ASSESSMENT FOCUS:
• Vital Signs
• Client’s level of • Urine Output
knowledge • Activity
• Lab results • Diet
• Blood Sugar • Weight
• Skin • Fluid intake
• Blood Pressure
• Eyesight
 DIABETES MELLITUS
NSG DIAGNOSES
• 1. Self-care Deficit: potential self-care deficit related to physical impairments
or social factors
• 2. High Risk for Injury
• 3.Altered Nutrition: imbalanced nutrition related to imbalance of insulin,
food, and physical activity
• 4. Risk for Infection
• 5. Risk for Impaired Tissue Integrity
• 6. Knowledge Deficit: deficient knowledge about diabetes self-care
skills/information
• 7. Risk for Impaired Adjustment
• 8. Risk for Disturbed Sensory Perception
• 9.Compromised Family Coping
• 10. Anxiety- related to loss of control, fear of inability to manage diabetes,
misinformation related to diabetes, fear of diabetes complications
• 11.Risk for Fluid Volume Deficit- related to polyuria and dehydration
 DIABETES MELLITUS
NSG MANAGEMENT OF DM
• Nutritional Modification/Diet
• Regular exercise
• Regular Glucose monitoring
• Drug therapy
• Client education
• Ensure skin care esp. Foot care &
WOF signs of infection
 DIABETES MELLITUS
Nutritional Management
• 1.Review the patient’s diet history to
identify eating habits and lifestyle
• 2. Coordinate with the dietician in
meal planning for weight loss
• 3. Plan for the caloric intake distributed as
follows- CHO 50-60%; Fats 20-30%; and
Proteins 10-20%; Cholesterol consumption
should be restricted and limited to 300 mg or
less daily
• 4. Advise moderation in alcohol intake
• 5. Using artificial sweeteners is acceptable
 DIABETES MELLITUS
Exercise Management
1. Teach that exercise can lower the blood glucose level
2. Diabetics must first control the glucose level before initiating
exercise programs.
3. Offer extra food /calories before engaging in exercise
4. Offer snacks at the end of the exercise period if patient is on insulin
treatment.
5. Advise that exercise should be done at the same time every day,
preferably when blood glucose levels are at their peak
6. Regular exercise, not sporadic exercise, should be encouraged.
7. For most patient, WALKING is the safe and beneficial form of
exercise
 DIABETES MELLITUS
Glucose Monitoring
• 1. Self-monitoring of blood glucose (SMBG) enables the patient to
adjust the treatment regimen to obtain optimal glucose control
• Most common method involves obtaining a drop of capillary blood
applied to a test strip.
• The usual recommended frequency is TWO-FOUR times a day.
• When is it done?
• Peak action time of the medication to evaluate the need for
adjustments
• Evaluate BASAL insulin → test before meals
• To titrate bolus or regular and lispro → test 2 hours after meals
• To evaluate the glucose level of those taking ORAL
hypoglycemics → test before and two hours after meals
 DIABETES MELLITUS
Drug Therapy
• Type 1 DM – main drug: Insulin
• Type 2 DM – main drug: Oral
Hypoglycemic Agents

• Lecture video to be posted this

weekend
 DIABETES MELLITUS
Complications
• Type 1 DM – Diabetic Ketoacidosis:
ketoacidosis and hyperglycemia
• Type 2 DM – Hyperosmolar
Hyperglycemic State: hyperglycemia
with no ketoacidosis

• Lecture video to be posted this

weekend