pharm care endocrine dm
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- what are hormones?
- endogenous chemicals that are produced locally and act in different parts of the body
- how do hormones maintain homeostasis?
- they stimulate or inhibit biological responses
- how is hormone concentration controlled?
- negative feedback
- an endocrine disorder is an _________ in physiological functions
- imbalance (deficiency or excess hormones)
- what are the 4 endocrine tets and what disease is each used to test for?
-
plasma hormone concen (thyroid)
integrity of feedback mechanism (thyroid)
plasma substance concen (DM)
measurement of physiological effect (DI) - what does the integrity of feedback mechanism test tell you about the thyroid & anterior pituitary
- the thyroid is functioning properly but the anterior pituitary is not
- what are the 3 general locations within the body?
-
intravascular
intracellular
extracellular - insulin is produced as a result of?
- hyperglycemia (insulin is the only substance that brings down blood sugar)
- what are the 7 roles of insulin in the body?
-
1. stim glucose uptake
2. promote glucose storage (glycogenesis)
3. inhibits glycogenolysis
4. enhances fat storage (lipogenesis)
5. inhibits lipolysis
6. decr ketogenesis
7. inhibits gluconeogenesis - glycogenesis
- storage of glucose as glycogen in muscle & liver
- gylcogenolysis
- breakdown of glycogen (inhibits production of glucose from liver & muscle)
- lipogenesis
- fat storage
- lipolysis
- break down / mobilization of fat for energy
- ketogenesis
- breakdown of fatty acids to ketone bodies
- gluconeogenesis
- formation of glucose from non carb sources (amino acids)
- what are the 4 counteregulatory hormones that control glucose levels
-
glucagon
epinephrine
cortisol
growth hormone - where is glucagon produced?
- alpha cells of the pancreas
- what effect does glucagon have on glucose homeostasis?
-
glycogenolysis
glucose synthesis - what efect does epi have on glucose homeostasis
-
glycogenolysis
glucose synthesis - what effect does cortisol have on glucose homeostasis
- gluconeogenesis
- what effect does growth hormone have on glucose homeostasis?
- inhibits uptake of glucose
- what are the physiological effects of insuline defiency?
-
impaired glucose uptake (muscle)
impaired glycogenesis (liver)
impaired insulin induced supression of gluconeogenesis & glycogenolysis - what are the 9 effects of a total lack of insulin in the body (type I DM)
-
1. incr blood glucose concen
2. incr osmolarity (polyuria & polydipsia)
3. dehydration & electrolyte abnormalities
4. incr lipolysis
5. glycerol incr blood glucose even further
6. ketogenesis
7. ketonemia, acidosis, ketonuria
8. kussmaul breathing
9. ketoacidosis can lead to coma & death - what is kussmal breathing
-
rapid, deep, labored breathing
trying to compensate for acidosis - 8 s/s of type I diabetes
-
hyperglycemia
polyuria
polydyspia
polyphagia
dehydration
acidosis
kassmaul breathing
hypokalemia - what is type II diabetes?
- a relative lack of insulin & insulin resistance
- what are the 4 s/s of type II diabetes?
-
hyperglycemia
polyuria
polydypsia
dehydration - what may be a cause of hypogylcemia?
- over-treatment with antidiabetic drugs
- what are the 7 s/s of hypoglycemia
-
hunger
sweat
nervous
sleepy
anxious
clumsy
bg < 70mg/dL - what are the microvascular long term complications of DM?
-
retinopathy
neuropathy
nephropathy (renal) - what are the macrovascular long term complications of DM?
-
cerebral vascular
coronary artery
peripheral vascular disease - what are the 4 tests to assess glucose control?
-
fasting plasma glucose
oral glucose tolerance test
gycosylated hemoglobin
fructosamine - which test is the best indicator of glucose homeostasis?
- fasting plasma glucose
- what does the fasting plasma glucose test measure?
- the ability of endogenous or exogenous insulin to prevent fasting hyperglycemia (trough levels more reproducible)
- is FPG used to screen or diagnose?
- screen
- how is the FPG test conducted
-
must fast for 8 hours
venipuncture
use seperator tube, add sodium floride, or refrigerate - FPG normal range, prediabetes range, & diagnosis range
-
normal < 110mg/dL
pre > 100 to <126mg/dL
diagnose >126mg/dL (on 2 occasions) - in an FPG test, the first reading is considered a _________ while the second is a __________
-
screening
diagnosis - what are some causes of abnormal lab results in the FPG test
-
improper collection
improper storage - the american diabetic association recommends sreenings for:
-
those >45 yo (every 3 yrs)
>25kg/m2 + dyslipedemia, vascular disease, polysystic ovarian disease - what are the 5 possible results of a diagnostic test
-
confirm suspected diagnosis
differentiate among possible diagnoses
determine severity of disease
detect recurrence of disease
monitor therapy - when is the OGT test used?
-
when a patient has s/s
when FPG suggests prediabetes - what does the OGT test tell you?
-
the body's ability to secret insulin
body's response to insulin action - OGT test normal range, prediabetes range, provisional dx range, & confirm dx range
-
nl <140mg/dL
pre >140-200mg/dL
pro >200mg/dL
confirm + raised FPG - how is OGT test conducted
-
overnight fast
75g oral glucose dose
taken over 5 min
samples taken between 0-2hr
sodium floride tube or assay immedietly - what can cause an abnormal OGT test result?
-
improper collection
improper storage
malnourished
consume inadequate carbs
bedridden
alcohol
medication that causes hypergylcemia
coffee
smoking - does the gycosylated hemoglobin test monitor short or long term control of glucose?
- long term (2-3months)
- which subfraction of Hb is used in the gycosylated hemoglobin test?
- A1C
- calculation for mean daily plasma glucose
- 10*(A1C + 4)
- what is the reference range for the gycosylated hemoglobin test?
-
>7% suggets poor glucose control
up to 20% for persistent hyperglycemia - what is the specimen for the GH test?
- RBC (Hb) not plasma or serum
- what can cause abnormal gycosylated hemoglobin test results?
-
false elevation (uremia, chronic alcohol intake, hypertriglyceridemia, pregnancy)
falsely lowered (pregnancy, hemolysis) - what can't the GH test be used to screen for gestational diabetes?
- pregnancy can cause false elevations & depressions
- what is the reference range for the GH test?
- varies with assay method
- how often shouild a patient with good glycemic control get a GH test? a person with poor control?
-
1-2 times a year
4 times a year - when is the fructosamine test used?
- for acute cases - to see how a patient is doing
- reference range for the fructosamine test?
- <285 umol/L (can vary)
- where does the specimen come from for the fructosamine test?
- serum or plasma b/c using glycosylated proteins
- what can cause an abnormal lab result in the fructosamine test?
-
falsely elevated (serum Hb concen >100mg/dL, serum bilirubin >4mg/dL, serum ascorbic acid >5mg/dL, methyl dopa & Ca dobesilate)
falsely lower (obesity)