1

2
*Pancreatic enzymes include
proteases, amylases, and lipases 
breakdown of proteins, starches and
fats
*primary endocrine cells referred to
as alpha, beta, and delta cells

*
 * 3

*Produces glucagon which

maintains N blood glucose level
(Glycogenolysis, Gluconeogenesis)
*Hypoglycemia  release of
glucagon
*Hyperglycemia inhibits glucagon
release.
 * 4

*secrete somatostatin
*which inhibit growth
hormone, thyroid-stimulating
hormone, insulin, glucagon,
and other gastrointestinal
(GI) hormones.
 * 5

*Produce insulin
*allows cells to be
permeable to glucose long
with amino acids,
potassium, magnesium and
phosphate
* 6

*an important
source of energy for
cells of our body.
*enters the cells 
metabolism 
energy
 7
*Disorder that causes
alterations in glucose
metabolism.

*
Classification: 9
1. Type 1 (IDDM): 5-10 %
-  production of insulin due to
destruction of beta cells.
- viral, or congenital
- Age of onset: before 30 yrs. old
- Usually thin at diagnosis
- inc. risk in production of ketone
bodies.
2. Type 2 (NIDDM): 90-95%
10
- insulin resistance and impaired insulin
secretion
- exact mechanism is unknown, genetics
may play a role
- Age of onset: usually over 30 y/o
- 80% are obese
- enough insulin to prevent
breakdown of fats.
 11
*
 12
Medical Mgt:
*Admin insulin
*Blood glucose and urine ketone monitoring
*Diet recommended at 55% carbohydrate, 15%
protein, 30% fat; no dietary foods used
*Stress management
*Exercise
*Hygiene-skin/foot care
 13
*
 14
*DIABETIC KETOACIDOSIS
*Type 1 DM
*Hallmark Sx:
*Dehydration
*Ketosis
*Metabolic acidosis
*Ketonuria
*Weakness, anorexia, vomiting, abdominal
pain, shock-like sx, altered mental status,
Kussmaul respi
 15
*Dx Test:
*>250 mg/dl
*Glycosuria
*↑ Serum osmolality and acidosis
*↑ BUN
*Hyperkalemia – initial
 16
Mgt:
*Monitor glucose level q1-2 hrs while
in continuous insulin infusion
*Monitor ABG for acidosis q15min
*Fluid replacement (NS)
*Administer rapid-acting insulin IV
*Monitor cardio, pulmo, neuro
system
17
18
 19
*HYPEROSMOLAR
NONKETOTIC COMA (HHNK)
*Type II DM

*S/Sx:
*Profound dehydration
*Shock-like symptoms
*Confusion, seizure, coma
HYPOGLYCEMIA 20
When blood sugar level drops rapidly.
Less than 60 mg/dl

S/Sx:
*Sweating *Anxiety
*Tremors *Slurred speech
*Blurred vision *Headache
*Hunger *Palpitations
*Weakness *Seizure
*Behavior changes *Coma
*Confusion
*Mgt: 21

*Identify cause
*<80 mg/dl – FAC
*Check ability to swallow
*4 oz. (½ cup) apple, orange or cranberry juice
*4oz cola or 8oz skim milk
*If unable to swallow – glucagon IM or D50 IV
 22
*ADH, also called vasopressin, is secreted
by the posterior pituitary gland in
response to increased osmolality.
*ADH regulates osmolarity by increasing
the water permeability to the collecting
ducts in the kidney.

*
 23
*caused by excessive release of
antidiuretic hormone (ADH).

*
 25
Serum Sodium Associated Symptoms
Levels

130 Impaired taste, anorexia,

dyspnea with exertion,
fatigue, dulled sensorium

120-130 mEq/L Severe gastrointestinal

symptoms including vomiting
and abdominal cramps

<115 mEq/L Confusions, lethargy, muscle

twitching, convulsions
*Mgt: 26
*Remove the cause
*Fluid restriction (500ml-1L/day)
*Diet: ↑ salt, ↑ CHON
*IV hypertonic saline – severe hyponat
*Weigh daily
*Manage thirst
*Protect from seizure
*Drugs
*Diuretic: Furosemide, Mannitol
*ADH inh: Lithium carbonate, Demeclocycline
 27

*deficiency in the production or

releases of ADH by the posterior
pituitary gland.

*
*S/SX: 29

*Polyuria *Dehydration
*Polydipsia *Changes in LOC
*Hypotension *Seizures
*Tachycardia *Constipation
*Weight loss
 30
Mgt:
*Remove the cause
*Fluid replacement
(oral and IV)
*Shock mgt
*Hormone replacement
 DRUG DOSE SIDE EFFECTS
Desmopressin Intranasal; Nasal congestion
31
(acetate) Parenteral Headache
Flushing
Hyponatremia

Vasopressin IM, SC, IV Sweating

(Pitressin) Tremor
Pounding in head
Nausea
Angina
↑ BP
Water intox
 32

*defined as a condition in which the

patient becomes both hypovolemic
and hyponatremic.

*
*Mgt: 33
*Fluid volume and Na replacement
*IV NSS or hypertonic (3%) solution
*Match with urine output
*Oral salt
**Gradual Na replacement
*pontine myelinolysis (loss of myelin
on the nerve fibers within the base of
the pons.)
*Monitor for seizure
*