hormones
ACTH is released from the anterior lobe of the pituitary gland
ACTH stimulates the release of cortisol from the adrenal cortex
What is the number 1 killer of people that have diabetes?
heart attack
what are physical activity recommendations when dealing with hyper/hypoglycemia
pre exercise BG > 100mg/dL
reduce prandial insulin
increase food intake
monitor BG
have sources of simple carbohydrates available
list examples of each and the peak time
rapid-acting drugs:
short-acting:
intermediate acting
long-acting
rapid-acting drugs: Aspart (Novolog)m, Lispro (Humalog)--> 1-3hrs
short-acting: Regular (Humulin R and Novolin R)--> 2-3 hours
intermediate acting: NPH --> 4-8 hours
long-acting: Glargine (Lantus) and Degludec (Tresiba)--> no peak but can last minimum 24 hours
what is DKA? what are s/s?
DKA is a result of insufficient insulin leading to increased BG
Kussmaul breathing (rapid and deep respirations to breathe off acid), lethargy, dehydration
what are the two disorders of the adrenal cortex?
Cushing's disease= excessive amount of glucocorticoids
Addison's disease= deficient glucocorticoids
_____ mimics decreased cardiac output, angina or an MI
hypoglycemia
cortisol is released from the _____ _____. What is its primary effect?
adrenal cortex
cortisol acts as an anti-inflammatory, decreases immune response and is responsible for a stress response
why are people with type 1 DM thin and why is type 2 DM associated with obesity?
type 1: sugar in the bloodstream but the body is unable to enter the cells due to lack of insulin; they may mimic individuals who are starved (irritable and fatigue)
type 2: some sugar is brought into the cells, which makes the body think that the excess sugar in the blood is for storage. Insulin may take this excess sugar and store as glycogen and/or fat in the tissues
s/s of someone with hyperglycemia
s/s of someone with hypoglycemia
hyper: polyuria, polydipsia, polyphagia, lethargy/fatigue, weight loss, blurred vision
hypo: BG < 70mg/dL, tremor, nervousness/anxiousness, diaphoresis, tachycardia, hunger, light-headedness, irritable, confusion and drowsiness
describe the oral agent Glucophage (metformin)...
1.____ glucose production in liver
2. ____ insulin sensitivity
3. ____ intestinal absorption of glucose
4. adverse effects?
5. advantages?
1. decrease
2. increase
3. decrease
4. N/V and diarrhea, decreases vitamin B12 levels, lactic acidosis
5. weight remains neutral and its inexpensive
what are the 3 types vascular disorders involved with the endocrine system and what they can lead to
microangiopathy--> occurs in diabetic retinopathy leading to blindness
macroangiopathy--> MI, CVA, PVD, intermittent claudication, obstruction can lead to non-healing ulcers
neuropathy--> ischemia can lead to peripheral neuropathy and incontinence due to nerves not being fed well
which disorder of the adrenal cortex can lead to DM? why?
Cushing's syndrome
People with Cushing's typically develop a "Buffalo Hump," as a result of the fatty deposits in the abdomen and back
metabolically-they are insulin resistance
Metformin and/or Glipizide are typically prescribed for patients with...
type 2 DM
Where is insulin secreted from? NE and epinephrine?
beta cells of islets of Langerhans; adrenal medulla
give the average values for and A1C, pre-prandial BG and post-prandial BG
what values are listed as contraindications for exercise?
A1C < 7%
pre-prandial 80-130 mg/dL
post-prandial < 180mg/dL
contraindications: if BG is < 60 mg/dL and greater than 300mg/dL
list some causes of hyperglycemia and hypoglycemia
hyper: underestimating CHO intake, high fat meal, missed or inadequate insulin, poor administration technique, overuse of injection site, less activity than usual
hypo: irregular timing of medications, incorrect dosing, overestimating CHO intake, increase physical activity, skipping/delaying meals
describe the oral agent Sulfonylureas-Glipizide (Glucotrol)
1._____ secretion of insulin from pancreas; good for type __DM
2. adverse effects and disadvantages
3. advantages
1. stimulates; type 2 DM
2. hypoglycemia and weight gain, high secondary failure rate
3. quick onset and inexpensive
hypoparathyroidism vs hyperparathyroidism
hypoparathyroidism: low serum calcium levels, spontaneous skeletal muscle contraction, affected cardiac muscle function leading to arrythmias
hyperparathyroidism: forceful cardiac muscle contraction, increased PTH leads to bone mineralization and osteoporosis...
what is metabolic acidosis?
why should PTs be cautious when working with patients who have hyperparathyroidism?
increased activity of the parathyroid gland= increased secretion of PTH= increased bone mineralization that can lead to osteoporosis increase risk for stress fractures
The posterior lobe of the pituitary gland releases _____. This hormone is responsible for increasing water reabsorption into the kidney.
Aldosterone is secreted from the ____ ______ and indirectly increases water reabsorption into the kidney by first increasing _____ absorption.
ADH
adrenal cortex; sodium
describe the process that leads up to diabetic ketoacidosis
DKA occurs mainly in type ___ DM
we eat food--> BG increases--> lack of insulin causes BG to remain high and the body remains in a low energy state. As a result, the body begins to burn fat too quickly, resulting in ketones and acid released as a byproduct--> ketoacidosis, coma and possible death
type 1 DM
how do we determine if an individual has hyper, hypo, dehydration or MI related symptoms?
take blood pressure
--low= cardiac issue
--if normal, give them a sugar tablet
if they are hypo--> their BG will rise
if they are hyper--> they are going to the hospital anyways rip
what are the other adjunct medications? what they also used for?
Gabapentin (Neurontin)--> diabetic neuropathy and other neuro diagnoses, fibromyalgia
Pregabalin (Lyrica) --> diabetic neuropathy and other neuro diseases, fibromyalgia
and Metoclopramide (Reglan)--> diabetic gastroparesis
hyperthyroidism is also known as.....
patients will have...
hyper= grave's disease
protruding and staring eyes, decreased blinking and decreased eye movement
true or false: cushing's syndrome can cause cardiac arrhythmias and heart failure
false; Addison's disease can lead to cardiac arrhythmias and heart failure
what's important for PTs to consider when working with patients who have a thyroid disease?
their metabolism changes, therefore the amount of energy they can produce and/or burn is altered and may affect exercise
Describe the difference between parathyroid hormone and calcitonin
PTH is secreted by the parathyroid gland and increases blood Ca2+ by stimulating bone demineralization and absorption into the GI
calcitonin is secreted by the thyroid gland and decreases the release of Ca2+ from the bone
compare type 1 and type 2 using these categories:
age of onset
cause
prevalence
progression
body habitus
treatment
type 1 type 2
age of onset childhood adult
cause insulin deficiency insulin resistance
prevalence 5-10% 90-95%
progression abrupt gradual
body habitus thin overweight
treatment exogenous insulin diet, exercise and/or oral medications and/or insulin
is hyperglycemia or hypoglycemia more commonly seen by PTs?
which one is more likely associated with a crisis?
hyperglycemia
hypoglycemia
Metformin and Glipizide are mostly used for which type of DM?
type 2
list s/s for
1. hyperthyroidism
2.hypothyroidism
1. heat intolerance, bulging eyes, increase SBP, muscle wasting, weight loss, increase diarrhea, tremors, increase HR
2. cold intolerance, dull-blank expression, extreme fatigue, muscle weakness and aches, constipation,
describe typical patient with Cushing's syndrome
round, puffy face, heavy trunk, wasting of limb muscles, fat at back of neck and fragile skin
idk
lol