Chapter 20
Endocrine Disorders
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20-1
Objectives
20-2
Glucose
• Glucose
– Sugar
– Basic fuel for body cells
– Level of sugar in the blood
must remain fairly constant
20-3
Glucose Regulation
20-4
Pancreatic Cell Function
Pancreatic
Cells
Hormone
Released
Hormone
Function
Alpha
Glucagon
Stimulates cells in the liver
to break down stores of
glycogen into glucose;
increases blood sugar
Beta
Insulin
Helps glucose enter body
cells to be used for
energy; decreases blood
sugar
Delta
Somatostatin
Inhibits release of insulin
and glucagon
20-5
Insulin
• Insulin
– Helps transport glucose from the blood
into cells where glucose is stored or used
as fuel
20-6
Types of Diabetes Mellitus
Diabetes
Type
Type I
Other Names
• Insulin-dependent
diabetes mellitus
(IDDM)
• Juvenile diabetes
• Noninsulindependent diabetes
mellitus (NIDDM)
• Adult-onset diabetes
Gestational Diabetes during
pregnancy
Type II
Possible Causes
•
•
•
•
Usually unknown
Viral infection
Injury to pancreas
Immune system
disorder
Insulin resistance
and relative insulin
shortage
Changes in body
metabolism due to
pregnancy
20-7
Type 1 Diabetes Mellitus
• Little or no insulin is produced by beta
cells in the pancreas
– Buildup of glucose in the blood
– Body’s cells are starved for glucose
• Usually begins during childhood or
young adulthood
20-8
Common Signs and Symptoms
• “Three polys”
– Polyuria
• Increased urination
– Polydipsia
• Increased thirst
– Polyphagia
• Increased appetite
• Abdominal pain
with vomiting
• Fruity breath odor
• Blurred vision
• Tiredness
20-9
Treatment
• Usually requires
treatment with insulin
• Some patients also
require treatment with
oral medication
20-10
Type 2 Diabetes Mellitus
• Most common type of diabetes
• Usually affects people older than 40
years of age
• Caused by a combination of insulin
resistance and relative insulin shortage
20-11
Type 2 Diabetes Mellitus
• Major causes of insulin resistance
– Obesity
– Genetics
– Sedentary lifestyle
– Stress
20-12
Gestational Diabetes
• Develops during
pregnancy
• Treatment
– Special diet
– Regular, moderate
exercise
– Daily blood glucose testing
20-13
Complications of Diabetes Mellitus
• Changes in the retina that can lead to
blindness
• Kidney damage
• Nerve damage
– Can lead to loss of sensation and pain
• Circulatory disorders
20-14
Hypoglycemia
• Lower-than-normal blood sugar level
– Less than 70 mg/dL in adults
• Most common diabetic emergency
• Symptom onset is sudden
– Minutes to hours
20-15
Hypoglycemia
Signs and Symptoms
Early
Late
•
•
•
•
•
•
•
•
•
•
•
•
•
Sweating
Palpitations
Increased heart rate
Tremors
Pale color
Hunger
Headache
Nervousness
Confusion, irritability
Tiredness
Staggering walk
Visual disturbances
Cool, pale, clammy
skin
• Fainting
• Seizures
20-16
• Coma
Hypoglycemia
• The blood sugar level may become too
low if the diabetic patient:
– Has taken too much insulin
– Has not eaten enough food
– Has overexercised and burned off sugar
faster than normal
– Experiences significant physical or
emotional stress
20-17
Hyperglycemia
• Higher-than-normal blood sugar level
• Gradual onset
– Hours to days
20-18
•
•
•
•
•
Hyperglycemia
Signs and Symptoms
Altered mental
• Dry skin
status
• Abdominal pain
Kussmaul
• Nausea and/or
respirations
vomiting
Sweet or fruity
• Increased heart
(acetone) breath
rate
odor
• Normal or slightly
Loss of appetite
decreased blood
Thirst
pressure
• Weakness
20-19
Diabetic Ketoacidosis (DKA)
• Severe, uncontrolled hyperglycemia
– Usually over 300 mg/dL
• Usually occurs in people who have type
1 diabetes
– May also occur in type 2 diabetes
• DKA is also called diabetic coma
20-20
Hyperglycemia
• The blood sugar level may become too
high when the diabetic patient:
– Has not taken his insulin or oral diabetic
medication, or has taken an incorrect dose
– Has eaten too much food that contains or
produces sugar
– Has lost a large amount of fluid, such as
through vomiting
– Experiences physical or emotional stress
that affects the body’s insulin production
20-21
Patient Assessment
• Scene size-up
• Primary survey
20-22
Patient Assessment
• Establish patient priorities
• Determine the need for additional
resources
• Make a transport decision
14-23
Patient Assessment
• Secondary survey
– SAMPLE history
– OPQRST
– Physical exam
• Focused exam if patient responsive
• Rapid medical assessment if unresponsive
14-24
Emergency Care
•
•
•
•
•
•
•
•
Stabilize the spine if trauma is suspected
Assess need for oral or nasal airway
Suction as necessary
Give oxygen
Remove or loosen tight clothing
Maintain body temperature
Perform a blood glucose test
Give oral glucose per protocol if patient can
swallow
• Transport
• Perform ongoing assessments
20-25
Performing a Blood Glucose Test
• Purpose
• Indications
– Unresponsive patient, cause unknown
(any age group, including trauma)
– Known diabetic patient with signs and
symptoms
– Patients with altered mental status, cause
unknown (including trauma)
– Special situations
20-26
Performing a Blood Glucose Test
20-27
Performing a Blood Glucose Test
[Insert skill drill 20-1 step 2]
20-28
Performing a Blood Glucose Test
[Insert skill drill 20-1 step 3]
20-29
Performing a Blood Glucose Test
[Insert skill drill 20-1 step 4]
20-30
Oral Glucose
• If approved by medical direction, you
may give oral glucose to a patient who:
– Has an altered mental status
– Has a history of diabetes controlled by
medication
– Is able to swallow
20-31
Giving Oral Glucose
[Insert skill drill 20-2 step 1]
20-32
Giving Oral Glucose
[Insert skill drill 20-2 step 2]
20-33
Giving Oral Glucose
[Insert skill drill 20-2 step 3]
20-34
Giving Oral Glucose
[Insert skill drill 20-2 step 4]
20-35
Questions?
20-36