ENDOCRINE SYSTEM
on milk let down) and prolactin (in charge on
Important function of your endocrine system is
the production of your hormones -> (these are
chemical transmitter substances that regulate
and integrate body functions)
-endocrine system plays a vital role in your
nervous system and your immune system in
such a way that the products produced by your
nervous system specifically your
neurotransmitters could also act as a hormone
that could happen a specific organ of our body
-immune system also produces hormones and
the hormones produced by other organs may
also impact the immune system in a way that it
can depress or stimulate the immune system.
*Endocrine glands secrete the hormones to the
bloodstream exocrine gland secrete the
hormones that they produce to the epithelial
surface or the GI tract the surfaces of your
stomach and referring to the parietal cells which
produces the acid in the stomach it's referred to
as an exocrine gland
*In endocrine gland a very good example would
be your pancreas your pancreas produces your
insulin (produced by the pancreas)
Gastrointestinal system pancreas also produces
your amylase and lipase the amylase and lipase
produced by pancreas
PITUITARY GLAND as previously mentioned is
divided into two anterior pituitary and posterior
pituitary gland (secretes different kind of
hormones), posterior pituitary gland is referred to
as neural hypothesis.
=Hypophysectomy – removal of pituitary gland
POSTERIOR PITUITARY GLAND
There are only two hormones or primary
hormones secreted and that is oxytocin which
acts on the breast and uterine wall and
vasopressin (antidiuretic hormone- it tries to stop
your urination by doing water retention)
Hormones produced in your ANTERIOR
PITUITARY GLAND would include the following
is TSH (thyroid stimulating hormone) lead to the
production of your t3 and t4 (potent hormones
produced by your thyroid gland)
Hormone in BREAST- oxytocin (one in charge
milk production)
GROWTH HORMONE- bone muscles and
organs, excess growth will lead to gigantism,
deficit of growth hormone will lead to dwarfism.
FUNCTION AND REGULATION OF
HORMONES
Rapid action of the nervous system is balanced
by the slower hormonal action.
Neurotransmitters tend to act rapidly and this is
balanced by the slower hormonal action.
NEGATIVE FEEDBACK MECHANISM
Whenever a certain substance in the body would
decrease, is intended to maintain equilibrium of
the hormones and the chemicals in our body.
DISTURBANCES IN GLUCOSE METABOLISM
Disease that you're most familiar of is your
diabetes so you know that your diabetes is the
increase of your blood sugar in the blood so
disturbances in glucose metabolism 
ENDOCRINE FUNCTIONS OF PANCREAS
Islet of Langerhans
Alpha cells which produces glucagon
Beta cells which produces insulin
Delta cells which produces somatostatin
INSULIN
*insulin is being released if there is an increase
in blood sugar levels
*is released to the bloodstream in two rates:
Basal rate (released in small amounts, however
the release is continuous)
Bolus rate (released in larger amounts and these
larger amounts is usually in response to a
stimuli)
If we eat, the tendency is for the insulin to
increase your pancreas would produce
increased insulin
in such a way that the glucose would move from
the blood going towards the muscle liver and the
fat cells that is the way for the body to utilize the
glucose in the blood. (In other words with the
lack of insulin the glucose in our bloodstream will
not be utilized)  YES if patient is having NPO simply for the
FUNCTIONS OF INSULIN
*It transports and metabolizes carbohydrates for
energy so it transports and metabolizes sugar
for energy 
*It stimulates storage of carbohydrates in the
liver and muscle in the form of your glycogen
* signal the liver to stop the release of glucose  *if your patient would ask if they can fast for let's
*enhances storage of dietary fat as adipose (bad
to use protein and fats as energy
GLUCAGON
*is released in response to a low blood sugar
levels (this is negative feedback mechanism on
the work)
Glycogenolysis it is the process where in the
liver produces glucose through the breakdown of
glycogen then 8 to 12 hours without food
gluconeogenesis would commence
Gluconeogenesis the liver forms glucose from
the breakdown of non-carbohydrate substances
including your amino acids.
*genesis it's the makeup okay it's the formation
of your glucose (came from amino
acids=glucagon)
SOMATOSTATIN would inhibit the release of
both your insulin and glucagon (the action of
your somatostatin would be to delay the nutrient
absorption by the GI tract)
HYPOGLYCEMIA – excess in INSULIN deficit in
GLUCAGON
HYPERGLYCEMIA – excess in GLUCAGON
deficit in INSULIN
DIAGNOSTIC STUDIES
-to diagnose or confirm the presence of diabetes
FBS
*educate your patient that they need to be on
NPO for 8 hours
*common question will be an NPO can take
candy? of course that will be a big NO because
your candy would contain sugar
*if your patient will be asking can they take water
purpose of fasting laboratories
*but if your patient is placed on NPO because of
surgery that's the time that you need to place
your patient on NPO including your fluids (at risk
for aspiration)
*FBS lipid profile and uric acid (patient needs to
be on fasting eight hours)
say more than 24 hours that would be a big no-
no because that will be a false negative on their
result okay over-fasting will also not be
beneficial to your patient other than they are
fooling the laboratory result they might be
exposing their cells at risk for your complications
of diabetes if ever they have diabetes
RBS
*patient does not need to be on fasting
CBG
*normal values of is between 80 to 120 milligram
per deciliter
OGTT
*a certain amount of sugar will be administered
to the patient and after some time the patient's
blood sugar levels will be monitored, after 30
minutes 1 hour after 2 hours for us to check if
the insulin of patient is working if patient has
enough insulin regardless of the tablespoon of
sugar that you have administered to them they
will be able to balance their blood sugar levels
within certain periods of time
HBA1C (glycosylated hemoglobin)
common question would be do I need fasting if I
will undergo hba1c NO because hba1c would be
able to detect your compliance to medications
for the past two to three months and fasting for
two to three months is a no-no
HBA1C is able to monitor your blood sugar
control for the past two to three months hence it
is commonly used to evaluate effectiveness of
your OHA (oral hypoglycemic agents) and also
your insulin dosing okay if your patient is uh
having high levels of
HBA1C okay they need to change their
treatment or they need to have strong
adherence to the prescribed lifestyle to them
because remember the management on
diabetes is not all about OHA and insulin okay
management on diabetes would be on dietary
and lifestyle changes.

*checked the urine for glucose kidney has a

renal threshold of 160 to 180 milligram per
deciliter or others is 200 milligram per deciliter

*fat as a source of energy in other words there's

no more glucose or there's no more insulin that
could metabolize the glucose intake of your
patient hence the body is opting towards your fat
metabolism to be the energy source with that
ketones will be present in the urine

*the presence of the ketones in the urine would

signal your diabetic keto acidosis then you have

ULTRASOUND and CT scan are imaging

studies used to determine if there are presence
of abnormal masses in the pancreas that could
possibly lead to imbalance on the hormone
production from the pancreas
-also detect for the sequelae of your um
diabetes

- evaluate for structural changes on other organs

such as your thyroid
DIABETES MILLETUS
*metabolic disorder characterized by glucose
intolerance which is caused by an imbalance
between the supply and demand of your insulin
*there is a problem with metabolism primarily of
your glucose  *the destruction of your pancreatic islet cells,
*glucose intolerance meaning the body is not
tolerating the increased amount of glucose in the
blood because there is no insulin
*imbalance between your insulin supply and
demand
*Diabetes mellitus 3P’s, Diabetes Insipidus 2P’s
3 Types of DM
*Type 1 diabetes is also known as IDDM (insulin
dependent diabetes mellitus)
*Type 2 is non-insulin dependent  diabetes is the condition that we refer to as your
*Gestational diabetes if your patient has type 1
diabetes mellitus that would mean that your
patient may have an idiopathic type of diabetes
or an autoimmune type of diabetes between the
two types of diabetes it is your type one that is
usually detected in early stage and has
hereditary implications.
*Problem: in type 1 there is absence of insulin,
*in type 2 there is lack of insulin there is still
some insulin in type 2 however it's lacking to
support the metabolism of your glucose
*for gestational diabetes is among pregnant
patients due to the hormonal changes brought
about by pregnancy (there is an increase in
blood sugar levels of your pregnant patient the
concern is, if the gestational diabetes is not
managed and not coupled with lifestyle,
medication and dietary changes your patient
may progress towards your type 2 diabetes
mellitus)
Etiology: for the causes or possible causes of
diabetes
*possible autoimmune mechanism specifically
for juvenile diabetes or your diabetes mellitus
type 1
*second viral infection at an early age, the
presence of viral infection may possibly cause
autoimmune responses
*genetic implications, there is a strong
hereditary component especially for type 1
diabetes
islet of langerhans cells that produces your
insulin so with the destruction of the cell which
may be brought about by side effects of
chemotherapy or maybe excessive use of
alcohol
*patient is more likely to develop insulin
resistance due to the decrease of insulin and
increased levels of blood sugar then excessive
blood glucose levels that is related to your diet
perhaps the significant risk factor which can be
modified among our patients
*one problem that you can have in a patient with
diabetic keto acidosis
*once patient is undergoing diabetic ketoacidosis
you would know that the patient does not have
insulin in order to metabolize glucose hence
body opted for fat metabolism
*one of the function of your insulin is to prevent
the breakdown of your fat in this case there is no
insulin that can prevent the breakdown of your
fats because there is no insulin that can prevent
that breakdown fat would become ketones in our
bloodstream hence it would manifest as
ketoacidosis
so you now know that if your patient is
diabetic
*the common ABG problem that can occur to
your patient is metabolic acidosis and all the
signs are pertaining to
*coma
*respiratory problems related to your metabolic
acidosis
*ketoacidosis is already
considered to be an emergency which needs
to be managed promptly, might result to death of
*cell starvation, there is again enough glucose
however the body perceives that it is being
starved because the glucose could not be
properly metabolized remember our body does
not use glucose specifically but it is the ATP
that is derived from this glucose so
because of the starvation of the cells
the body would have
opt again for protein metabolism and by
opting to protein metabolism
amino acids would be there and then
liver
would form glucose through the amino
acids in the process referred to as
gluconeogenesis
and then there will be glycogenolysis
which is the breakdown of your glycogen
two
glucose hence look at that okay your
patient is forming glucose from amino
acids
and then breaking down glycogen to
become glucose
what happens there will be a worsening
of your hyperglycemia
so it becomes a sequila already that
worsens the hyperglycemia
of your patient due to this
what can possibly happen to our patient
so there will be metabolic changes
remember glucose is supposed to be the
main source of energy for our patients
but due to the decreased metabolism of
glucose the organs will not be able to
function properly
there will be fluid electrolyte
imbalance later on you will know
that polyuria and polydipsia is among
the manifestations of your diabetes
and then because of the acidotic state
of your patient your patient could also
have
problems with potassium now try to
recall
if your patient has acidosis what would
happen to the blood potassium levels
then changes in immunity and
inflammation
due to the increase in the blood sugar
levels the immune system of your patient
will be
impaired your patient will be at risk iv
infection in terms of inflammatory
responses
your patient would have decreased pain
perception
due to neuropathy in other words the
nerves of your patient are already
damaged in such a way that it is not
able to feel or
sense anything properly hence neuropathy
and then there will be changes in
oxygenation the change in oxygenation is
usually brought about by the acidotic
state of your patient
and then other than that may be caused
by infection
your patient is at higher risk for
hospital acquired infection due to the
presence of high glucose levels
changes in perception especially if your
patient is having your
honk okay your hyper osmolar non-ketotic
coma or your diabetic ketoacidosis
and then there will also be problems in
coordination
so in other words there are several
effects
on diabetes
and it is effect tend to become
multi-organ
okay there is involvement of several
organs
now what are the assessment findings so
there will be three p's
the three piece is summarized as
polyuria
polyphagia and polydipsia so polyuria
eating so a lot of eating and then you
have your poly
dipsha is drinking so increased
amounts of fluid intake
with that being said okay try
try to rationalize what do you think
among the three p's would occur first
okay among the three p's what would
occur
first think of cell starvation for you
to answer this question
once you've answered that question try
to figure out what occurs next
and what is the rationale why would it
occur and then what would be the third
okay so there is a proper order for the
three ps as the manifestation of
diabetes your patient would also become
easily
fatigue the easy fatigability on the
part of the patient
is also because of the lack of glucose
that is being metabolized
so because of this your muscles will not
be able to function properly
and then your body will perceive that
there is lack of energy
then poor wound healing is secondary to
the increase of sugar levels
again leading to infection and then also
related to
the changes on the blood vessels your
patient may have
poor circulation towards the affected
side hence
leading to poor wound healing so
oftentimes if you have seen patients who
have diabetic foot
it's one complication of diabetes so it
results to gangrene okay the infection
usually results to gangrene if not
managed early
and then there are patients who are
being amputated because of
ascending infection from the lower
extremity that's why wound care is very
crucial if we're talking about patients
with
diabetes
for the laboratories your patient would
have an increase of
your fasting blood sugar an increase of
your rbs
and then if your patient is on poor
medication control
your patient would have increase of your
hba1c
by the way as mentioned your hba1c is
used for medication compliance
as it can detect the blood sugar levels
or blood sugar control i mean
for the past two to three months so if
the patient is unable to reach the
percentage of hba1c which is being set
as target by the physician
meaning there needs to be a modification
of the therapy that the patient
is undergoing okay so the usual target
for a diabetic patient is to maintain an
hba1c of six to seven
percent let's talk about the therapeutic
management for a patient with
diabetes big word there is that there is
no cure for this
okay this is a lifetime lifestyle
disorder
our goal is just to control the blood
sugar levels of the patient
in other words uh if your patient has
type one diabetes mellitus
your patient needs to be maintained on
insulin therapy
for the lifetime or else your patient's
blood sugar levels would be very high
until your patient could have
complications
diet is important exercise will be there
monitoring meaning you expect your
patients to be on regular laboratory
monitoring
usually they are being monitored every
three to six months depending on their
response to the therapy
furthermore pharmacologic therapy is
there and then education
is important okay if you have noticed
pharmacologic therapies not the first
on the list okay because our focus is
lifestyle modification meaning diet and
activity is the one
which is uh considered to be the
cornerstone in the management of a
patient with
diabetes so diet is considered to be the
cornerstone for management
our plan is for the diet to be
consistent with the insulin resources of
the patient to achieve the ideal body
weight
if your patient have been newly
diagnosed with diabetes you don't tell
them to stop eating carbohydrates
or you don't tell them to reduce their
diet suddenly
a sudden reduction of diet for a patient
with diabetes might lead to hypoglycemia
which could be a possible cause also of
coma and complications to your patient
so when we talk about diet in diabetes
they need to have three regular meals
and then two snacks in a day
it does not mean that because they have
a sugar problem they need to skip meals
for their sugar to be controlled
okay what we would want is that the diet
is regulated but not reduced
or omitted reduction or omission of your
diet
is not beneficial for a patient with
diabetes
so this is the ada american diabetes
association recommendation for calorie
distribution
in the case of carbohydrates the
recommendation is 50 to 60 percent
for the fats the recommended
distribution is 30 to 35
whereas for proteins the recommendation
is 10 to 20
so fiber is recommended to be at 25
grams
daily okay so the diet prescription is
based on the patient's ideal body weight
in kilograms so you advise your patient
that you do not just copy the diet of
another patient because
usually the management for them is
individualized
okay then so these are the foods that
are not allowed for the patient with
diabetes
so usually your concentrated
carbohydrates are not recommended for
this patient
examples of which are table sugar can be
honey molasses then your caro syrup
then you have your jams and jelly pies
cakes cookies pastries
your regular soft drinks okay your soda
and then your candy coated
gum so these are concentrated
carbohydrates
then we have your diabetic exchange list
which is the most common tool for
nutritional management
so your diabetic exchange list would be
able to have
the equivalent of each food when it
comes to its serving
so it can save how many servings of rice
should you have in a meal
how many servings of chocolates can you
have in a day
okay and other than that so for the
exercise and activity plan our goal for
exercise
is to have to reach the 60 to 75 percent
of maximum heart rate for age
okay meaning we do not need the rigorous
exercises here we do not need
gym level exercises for this okay what
we are expecting is that the patient
will have activity
and this activity would be up to 75
of the maximum heart rate for age
meaning
we do not want our patient to be
tachycardic just because of the exercise
okay our recommendation is that this
exercise should be more
uh at least 20 minutes up to 45 minutes
in a week
or minimum i mean of three times a week
so again it's 20 to 45 percent
three times a week so the effects of
your exercise which should be regular
and moderate okay are as follows it is
expected to decrease your blood glucose
why so because the blood glucose level
metabolism i mean the blood glucose
metabolism tends to increase with
physical
activity furthermore your physical
activity is related to weight reduction
and maintenance also it increases your
insulin
sensitivity okay meaning it allows you
are little insulin to act on the glucose
on your bloodstream
it also decreases your blood pressure
and then decreases your stress and
tension so of course the usual benefits
of your exercise
so you advise your patient before the
exercise there should be a five minute
workout
and then they should check their blood
sugar usually you advise them to
bring their rescue candy okay which is a
high concentration of sugar
in such a way that if they will feel
hypoglycemic during the exercise
they will have a rescue candy that they
can take
after the exercise you would educate
them to include a five minute cool down
and then also to check the blood sugar
levels okay class if your patient is a
diabetic patient they are prone either
for hyperglycemia and hypoglycemia
the hypoglycemic episode is usually
brought about by the failure of your
patient to take their meals regularly
or probably because of the increase on
the use of your oral hypoglycemic agents
that's why in the use of your oral
hypoglycemic agents you need to be able
to take note of the time
okay the peak time of the action of the
drug for you to know
um in when is hypoglycemia more likely
to
occur then um we're talking about
monitoring glucose levels so we educate
our patient
on how to do the self-monitoring of
blood glucose
uh there are patients who would need
insulin dose adjustment depending on
their present blood sugar levels
so that's why we need to teach them on
how to monitor their blood glucose
also we educate our patients on the
signs and symptoms of hypoglycemia
in such a way that if our patient will
have signs and symptoms of hypoglycemia
they will be able to check for their
blood sugar levels
and then act on it
on the succeeding lecture we will be
talking about the pharmacologic
management for your
diabetes