Adult 1- Endocrine
True or False: Oversecretion of adrenocorticotropic hormone (ACTH) or the growth hormone results in Grave's disease.
False. Grave's disease = Hyperthyroidism.
Most complications arise from hypo- or hyperglycemia?
Hyperglycemia
What is the most common complication in all people with diabetes?
Hypertension
Emergency Measures
If the patient cannot swallow or is unconscious: - An injection of *1 mg glucagon* can be given either subcutaneously or intramuscularly (type 1 diabetics should have this in an emergency kit). May take as long as 20 minutes to regain consciousness. A concentrated source of carb followed by a snack should be given to the patient on awakening to prevent recurrence of hypoglycemia. - 25 to 50 mL of *dextrose 50% in water* (D50W) may be administered IV. Effect seen within a minute. Very thick liquid, hard to inject, and very irritating to veins.
What lab value should you look at to differentiate between type 1 and type 2 diabetes?
Insulin! With type 1 insulin will be low; with type 2 insulin will be high.
Manifestations of Adrenocortical Insufficiency
Muscle weakness; anorexia; GI symptoms; fatigue; emaciation; dark pigmentation of the mucous membranes and skin, especially of the knuckles, knees, and elbows; hypotension; low blood glucose, low serum sodium, high serum potassium; apathy, confusion, emotional lability.
What type of insulin can be given IV?
Regular
____________ disease is more prevalent in patients with type 1 diabetes, and ____________ complications are prevalent I'm older patients with type 2 diabetes.
Type 1 = kidney disease (microvascular). Type 2 = cardiovascular complications (macrovascular).
The Adrenal Glands
*Adrenal Medulla*- - Functions as part of the autonomic nervous system. - Releases catecholamines: epinephrine and norepinephrine. *Adrenal cortex*- - Glucocorticoids: cortisol. - Mineralocorticoids: aldosterone. - Sex hormones: androgens (male sex hormones).
Other Dietary Concerns
- *Alcohol*: lowers blood sugar = increases likelihood of hypoglycemia, especially concerning Type 1 diabetics. Should be consumed in moderation (1 drink/day or women and 2/day for men), should be consumed with food. - *Nutritive and nonnutritive sweeteners*: nutritive sweeteners contain calories and include fructose, sorbitol, xylitol. Nonnutritive sweeteners have minimal or no calories and include saccharin, nutrasweet. There is some concern about the use of artificial sweeteners with type 2 diabetics since the body thinks it's getting something sweet, so insulin levels rise. - *Misleading food labels*: foods labeled "sugarless" or "sugar free" may still provide calories equal to those of the equivalent sugar-containing products if they are made nutritive sweeteners.
Alpha and Beta Cells
- *Alpha cells*: produce glucagon, which increases blood sugar. - *Beta cells*: produce insulin, which decreases blood sugar. Released in response to high blood sugars, acts quickly (3-5 minutes).
Management of Hypoglycemia
- *Check blood glucose first before giving food for symptoms!!* - Give 15g of a fast-acting, concentrated carbohydrate (liquids are best). — three or four glucose tablets. — 4-6 oz of juice or regular soda. - Retest blood glucose in 15 minutes; retreat if less than 70 mg/dL or if symptoms persist more than 10-15 minutes and testing is not possible. - Once blood glucose is above 70, provide a snack with protein and carbohydrate (unless the patient plans to eat a meal within 30-60 minutes).
Clinical Manifestations of Diabetes
- *Depends on the level of hyperglycemia*. - The "three P's": polyuria (pee), polydipsia (thirst), polyphagia (hunger). - Fatigue, weakness, vision changes, tingling or numbness in hands or feet, dry skin, skin lesions or wounds that are slow to heal, recurrent infections. - Onset of type 1 may be associated with sudden weight loss.
Planning and Interventions for Patients with Cushing Syndrome
- *Goals* may include: decreased risk of injury, decreased risk of infection, increased ability to carry out self-care activities, improved skin integrity, improved body image, improved mental function, and absence of complications. - *Interventions*: encourage foods high in protein, calcium, and vitamin D; have patient wear a medical alert ID; restrict fluid and sodium; administer diuretics if appropriate. - See chart 52-12 on page 1539 about patient education.
Complications of Insulin Therapy
- *Local allergic reactions*. - *Systemic allergic reactions*. - *Insulin lipodystrophy*: localized reaction, can be atrophy or hypertrophy. Rotate sites to prevent. - *Resistance to injected insulin*. - *Morning hyperglycemia*: May be caused by several factors: dawn phenomenon, the Somogyi effect, and insulin waining. More on next slide.
Long-Term Complications of Diabetes
- *Macrovascular*: result from changes in medium to large blood vessels; accelerated atherosclerotic changes, coronary artery disease, cerebrovascular disease, and peripheral vascular disease. - *Microvascular*: characterized by capillary basement membrane thickening; diabetic retinopathy, and nephropathy (kidney disease). Albumin in urine is among the earliest signs of KD. - *Neuropathic*: peripheral neuropathy, autonomic neuropathies (constipation/diarrhea, bladder- urinary retention, cardiac), hypoglycemic unawareness, sudomotor neuropathy, sexual dhsfunion.
Classifications of Diabetes
- *Prediabetes*: impaired glucose tolerance or impaired fasting glucose. A1C 5.7-6.4. - *Type 1 Diabetes*: previously known as "juvenile" or "insulin-dependent" diabetes. Characterized by the destruction of pancreatic beta cells, usually autoimmune. (More in future slide). - *Type 2 Diabetes*: involves insulin resistance and impaired insulin secretion More commonly linked with lifestyle factors. (More in future slide). - *Latent Autoimmune Diabetes of Adults (LADA)*: progression of autoimmune beta cell destruction in the pancreas is slower than in types 1 and 2 diabetes (More in future slide). - *Gestational Diabetes*: glucose intolerance with its onset during pregnancy. Hyperglycemia develops because of placental hormones, which causes insulin resistance. 18% of pregnancies. - *Diabetes Associated with other Conditions or Syndromes*: pancreatic diseases, hormonal abnormalities, medications such as corticosteroids and estrogen-containing preparations. Refer to table 51-1 on page 1458.
Medical Management of Hyperthyroidism
- *Radioactive Iodine Therapy*: destroys thyroid cells. - *Medications*: propylthiouracil and methazole, sodium or potassium iodine solutions, dexamethasone, beta-blockers. - *Surgery*: subtotal thyroidectomy.
Interventions for Patients with Adrenocortical Insufficiency
- *Risk for fluid volume deficit*: monitor for s/s of fluid volume deficit, encourage fluids and foods, select foods high in sodium, administer hormone replacement as prescribed, monitor daily weight + I&O. - *Activity intolerance*: avoid stress and activity until stable; perform all activities for the patient when in crisis; maintain a quiet, nonstressful environment; measures to reduce anxiety. - *Patient education*: chart 52-10 on page 1536.
Tetany, Chvostek and Trousseau Sign
- *Tetany*: general muscle hypertonia, with tremor and spasmodic or uncoordinated contractions occurring with or without efforts to make voluntary movements. - *Chvostek sign*: a sharp tapping over the facial nerve just in front of the parotid gland and anterior to the ear causes a spasm or twitching of the mouth, nose, and eye. - *Trousseau sign*: carpopedal spasm is induced by occluding the blood flow to the arm for 3 minutes with a blood pressure cuff.
Method of Insulin Delivery
- *Traditional subcutaneous injections*: two preparations (U-100 and U-500, they should not be kept in the same area). - *Insulin pens*: Small (150-300 units) prefilled insulin cartridges that are loaded into a penlike holder. Disposable needle is attached to the device. Can be wasteful d/t priming the needle. - *Jet injectors*: deliver insulin through the skin under pressure in an extremely fine stream. Alternative to needle injections. - *Insulin pump*: continuous subcutaneous insulin infusion that involves the use of a small, externally worn device that closely mimics the functioning of the normal pancreas. Only rapid-acting insulin is used in the pump, provides a small basal dose continuously. - *Future Insulin delivery*: implantable pumps, oral sprays, capsules, skin patch.
Hypothyroidism
- A disorder caused by a thyroid gland that is slower and less productive than normal. - Slows everything down: lethargy, weight gain, constipation, bradycardia, cold intolerance, heavy period, hair loss. - Myxedema coma is a rare life-threatening condition. It is the decompensated state of severe hypothyroidism in which the patient is hypothermic and unconscious. - Tx: thyroid replacement hormone. Administer in the morning- 1 hour before meal. - See chart 52-4 on pages 1516-17 for Nursing Interventions.
Hyperthyroidism
- A form of thyrotoxicosis resulting from an excessive synthesis and secretion of endogenous or exogenous thyroid hormones. - Most common causes: Graves' disease (autoimmune disorder), toxic multinodular goiter, and toxic adenoma. - Affects women eight times more than men.
Diabetes
- A group of diseases characterized by increased levels of glucose in the blood (hyperglycemia) resulting from defects in insulin secretion, insulin action, or both. - One third of cases are undiagnosed. - Prevalence is increasing. - Minority populations and older adults are disproportionately affected.
Hypoglycemia
- Abnormally low blood glucose level (below 50-60 mg/dL); caused by too much insulin or oral hypoglycemic agents, excessive physical activity, and/or not enough food. - *Adrenergic symptoms (mild)*: sweating, tremors, tachycardia, palpitations, nervousness, hunger. - *Central nervous system symptoms (moderate)*: inability to concentrate, headache, confusion, memory lapses, slurred speech, drowsiness. - *Severe hypoglycemia*: disorientation, seizures, loss of consciousness, death.
Assessment of the Patient with Cushing Syndrome
- Activity level and ability to carry out self-care. - Skin assessment: trauma, infection, breakdown, bruising, edema. - Changes in physical appearance and patient responses to these changes. - Mental function and Emotional status: mood, response to questions, awareness of environment, and level of depression. - Medications: steroids.
Role of the Nurse in Nutritional Therapy
- Be knowledgeable about dietary/carb management. - Communicate important information to the dietician or other management specialists. - Reinforce patient understanding (do not assume that they know!). - Support dietary and lifestyle changes.
Hypoparathyroidism
- Caused by an abnormal parathyroid development, destruction of the parathyroid glands (surgical removal or autoimmune response), and vitamin D deficiency. - Results in increased blood phosphate and decreased blood calcium.
Hyperparathyroidism
- Caused by the overproduction of parathormone by the parathyroid glands and is characterized by bone decalcification and the development of renal calculi (kidney stones) containing calcium. - Primary hyperparathyroidism occurs two to four times more often in women. - Treatment: surgical removal of abnormal parathyroid tissue, hydration therapy, increase mobility.
Manifestations of Cushing Syndrome
- Central-type obesity with "Buffalo hump", heavy trunk and thin extremities. - Skin is thin and fragile, ecchymoses (bruises) and striae. - Weakness and lassitude, sleep disturbances. - Muscle wasting and osteoporosis. - Hypertension. - "Moon face", acne. - Infection, slow healing. - Virilization in women, loss of libido, mood changes. - Increased serum sodium, decreased serum potassium.
Meal Planning
- Consider food preferences, lifestyle, usual eating times, and cultural and ethnic background. - Review diet history; and the need for weight loss, gain, or maintenance. - Calculate caloric requirements and consider calorie distribution throughout the day. — 50-60% carbohydrates (emphasize whole grains), 20-30% fat (limiting saturated fats to 10% and less than 300mg cholesterol), 10-20% protein (encourage consumption of nonanimal sources of protein- legumes, whole grains), and increase fiber. - Refer to table on the next slide for an example exchange list.
Dietary Management Goals
- Control of total caloric intake to attain or maintain a reasonable body weight (BMI of 25 or less). - Control of blood glucose levels. - Normalization of lipids and blood pressure to prevent heart disease. - To prevent, or at least slow, the rate of development of the chronic complications of diabetes.
Blood Glucose Monitoring
- Cornerstone of diabetes management. - Self-monitoring of blood glucose (SMBG) has dramatically altered diabetes care. - SMBG is a method of capillary blood glucose testing in which the patient pricks their finger and applies a drop of blood to a test strip that is read by a meter. - Diabetics should check their blood glucose before every insulin injection (usually 3-4 times a day).
Nursing Diagnoses for Patients with Adrenocortical Insufficiency
- Disturbed body image - Self-care deficit r/t weakness, fatigue, muscle wasting, altered sleep patterns. - Risk for injury r/t weakness. - *Risk for fluid volume deficit* - Activity intolerance and fatigue - Risk for infection - Knowledge deficit
Risk Factors for Type 1 Diabetes
- Early onset (< 30 years old). - *Familial/Genetic predisposition*. - Possible immunologic or environmental (viral or toxins) factors.
Exercise precautions
- Exercise lowers blood sugar levels; insulin must be adjusted. - Blood glucose normal decreases with exercise; patients on exogenous insulin should eat a 15g carbohydrate snack before moderate exercise to prevent hypoglycemia. - Be aware of the potential for postexercise hypoglycemia. - Need to monitor blood glucose levels!
Diagnostic Findings with Diabetes
- Fasting blood glucose ≥ 126 mg/dL. - Casual glucose ≥ 200 mg/dL. - A1C ≥ 6.5%. Refer to the table on the next slide.
The Parathyroid Glands
- Four glands situated in the neck and embedded in the posterior aspect of the thyroid gland. - Parathormone (parathyroid hormone) regulates calcium and phosphorus balance. — Increased parathormone elevates blood calcium by increasing calcium absorption from the kidney, intestine, and bone. — Parathormone lowers phosphorus level.
Glycemic index
- How much a given food increases the blood glucose level compared with an equivalent amount of glucose. - Combining starchy foods with protein- and fat-containing foods slows their absorption and lowers the glycemic index. - Raw or whole foods tend to have a lower responses than eating chopped, puréed, or cooked foods. - Eating while fruit instead of drinking juice decreases the glycemic index, because *fiber* slows the absorption. - Adding food with sugars to the diet may result in a lower glycemic index if these foods are eating with foods that are more slowly absorbed.
Addisonian Crisis
- Hypotension, cyanosis, fever, nausea, vomiting, and signs of shock (rapid, weak pulse; tachypnea; pallor; extreme weakness; hypotension). - Pallor, headache, abdominal pain, diarrhea, confusion, restlessness. - The stress of surgery or dehydration resulting from the preparation for diagnostic tests or surgery may precipitate an addisonian or hypotensive crisis. - Treatment: IV administration of fluid, glucose, electrolytes (esp sodium), replacement of mission steroid hormones, and vasopressors.
Thyroid Disorders
- Hypothyroidism - Hyperthyroidism - Thyroiditis - Goiter - Thyroid Cancer
Medical Management of Adrenocortical Insufficiency
- Immediate treatment is directed toward combating circulatory shock: restoring blood circulation, administering fluids and corticosteroids, monitoring vital signs, and placing the patient in a recumbent position with the legs elevated (as pictured). - Hydrocortisone is administered by IV, followed by D5W. - Vasopressors may be required if hypotension persists.
Insulin Therapy
- In type 1 diabetes, exogenous insulin must be given for life because the body loses the ability to produce insulin. - In type 2 diabetes, insulin may be necessary on a long-term basis to control glucose levels if meal planning and oral agents are ineffective or when insulin deficiency occurs. - Because the insulin dose requires by the individual patient is determined by the level of glucose in the blood, accurate monitoring of blood glucose levels is essential (SMBG).
Type 1 Diabetes
- Insulin-producing beta cells in the pancreas are destroyed by a combination of genetic, immunologic, and environmental factors. - Results in decreased insulin production, increased glucose production by the liver, and fasting hyperglycemia. - Acute onset. Affects 5% of adults with diabetes.
The Thyroid Gland
- Largest endocrine gland. - Produces three hormones: thyroxine (T4), triiodothyronine (T3), and calcitonin. - Iodine is contained in thyroid hormones. - TSH from the anterior pituitary controls the release of thyroid hormone. - The main function of thyroid hormone is to control cellular metabolic activity. - T3 is more potent and rapid-acting than T4. - Calcitonin is secreted in response to high plasma calcium level and increases calcium deposit in bone (thereby decreasing levels).
Exercising with Diabetes
- Lowers blood glucose and reduces cardiovascular risk factors. - Aids in weight loss, easing stress, and maintaining a feeling of well-being. - *Type 1*: exercise at the same time each day, exercise when glucose is high *not* when insulin is peaking, eat a 1 carb choice snack before, and watch for post-exercise hypoglycemia (1 hour after). - *Type 2*: standard recommendation- 30 minutes, 5 times a week of moderate exercise. Don't have to worry as much about insulin and food.
Functions of Insulin
- Moves glucose from the blood into muscle, liver, and fat cells. - Transports and metabolizes glucose for energy. - Stimulates storage of glucose in the liver and muscle (in the form of glycogen). - Signals the liver to stop the release of glucose. - Enhances storage of dietary fat in adipose tissue. - Accelerates transport of amino acids into cells. - Inhibits the breakdown of stored glucose, protein, and fat. - Can be endogenous and/or exogenous.
Manifestations of Hyperthyroidism
- Nervousness; rapid pulse; heat intolerance; tremors; skin flushed, warm, soft, and moist; exophthalmus (abdominal protrusion of one or both eyeballs); increased appetite; weight loss; elevated systolic BP; cardiac dysrhythmias.
Assessment of Patients with Adrenocortical Insufficiency
- Note any illness or stressors that may precipitate problems. - Fluid and electrolyte status. - Vital signs and orthostatic blood pressure. - Note signs and symptoms related to adrenocortical insufficiency: weight changes, muscle weakness, fatigue. - Medications: steroids. - Monitor for signs and symptoms of Addisonian crisis.
Risk Factors for Type 2 Diabetes
- Obesity. - Age (usually > 30 years old). - Previously identified fasting glucose or impaired glucose tolerance. - Hypertension > 140/90 mmHg. - HDL < 35 mg/dL or triglycerides > 250 mg/dL. - History of gestational diabetes or babies over 9 pounds.
Adrenocortical Insufficiency (Addison Disease)
- Occurs when the adrenal glands are damaged and cannot produce sufficient amounts of cortical hormones. - Addison disease = autoimmune. - Therapeutic use of corticosteroids is the most common cause of adrenocortical insufficiency (Should be weaned off to prevent this). - *Diagnostic tests*: early-morning serum cortisol and plasma ACTH (adrenocorticotropic hormone).
Hypercalcemic Crisis
- Occurs with extreme elevation of serum calcium levels (> 13 mg/dL). - Results in neurologic, cardiovascular, and kidney symptoms that can be life-threatening. - Treatment: — Rapid rehydration with large volumes (200 mL/hr) of IV isotonic saline fluids (NS). — Combination of calcitonin and corticosteroids is administered in emergencies to reduce the serum calcium level by increasing calcium deposition in bone.
Glands of the Endocrine System
- Pituitary - Thyroid - Parathyroid - Adrenal - Pancreatic islets - Ovaries and Testes
Endocrine System
- Plays a vital role in orchestrating cellular interactions, metabolism, growth, reproduction, aging, and response to adverse conditions. - Closely linked with the nervous and immune systems. - Involves the release of chemical transmitter substances known as hormones. - Regulated by a negative feedback mechanism: when the hormone concentration increases, further production of that hormone is inhibited, and vice versa.
The Pituitary Gland (Hypophysis)
- Referred to as the master gland because of the influence it has on secretion of hormones by other endocrine glands. - *Anterior pituitary*: follicle-stimulating hormone (FSH), luteinizing hormone (LH), prolactin, adrenocorticotropic hormone (ACTH), thyroid-stimulating hormone (TSH), growth hormone (GH). — Hyper: Cushing Syndrome, Gigantism, Acromegaly. — Hypo: Dwarfism, Panhypopituitarism. - *Posterior pituitary*: vasopressin/antidiuretic hormone (ADH), oxytocin. - 95% of pituitary tumors are benign. - Surgery: hypophysectomy.
Cushing Syndrome
- Results from *excessive* adrenocortical activity, commonly caused by the use of *corticosteroid medications* (patients that are post-transplant; have COPD, rheumatoid arthritis, and other autoimmune conditions). - Diagnostic tests: — *Serum cortisol*: usually higher in the morning (6-8 am) and lower in the evening (4-6pm). This variation is lost in patients with Cushing syndrome. — *Urinary cortisol*: requires a 24-hour urine collection. Will be 3x the normal range. — *Low-dose Dexamethasone suppression tests*: a dose of this steroid is given at night, and then plasma cortisol levels are checked in the morning.
Nursing Diagnoses for Patients with Cushing Syndrome
- Risk for injury d/t fluid overload. - Risk for infection. - Self-care deficit. - Impaired skin integrity. - Disturbed body image. - Disturbed thought processes.
Latent Autoimmune Diabetes of Adults (LADA)
- Subtype of diabetes in which progression of autoimmune beta cell destruction in the pancreas is slower than in types 1 and 2 diabetes. - Not insulin dependent in the initial 6 months of disease onset. - Clinical manifestations of LADA shares the features of types 1 and 2 diabetes. - This emerging subtype has led some to propose the diabetes classification scheme should be revised to reflect changes in the beta cells in the pancreas.
Manifestations of Hypoparathyroidism
- Tetany; numbness, tingling, and cramps in the extremities; stiffness of hands and feet; bronchospasm, laryngeal spasm, carpopedal spasm; dysphagia; anxiety, irritability, depression, delirium; ECG changes.
Medical Management of Diabetes
- The main goal is to normalize insulin activity and blood glucose levels to reduce the development of complications. - The ADA now recommends that all patients with diabetes strive for an A1C less than 7% to reduce their risk of complications. - Diabetes Management has five components: nutritional therapy, exercise, monitoring, pharmacologic therapy, and education.
Manifestations of Hyperparathyroidism
- The patient may have no symptoms or may experience signs and symptoms resulting from involvement of several body systems. - Apathy, fatigue, muscle weakness, nausea, vomiting, constipation, hypertension, and cardiac dysrhythmias may occur. - Demineralization of bones, decreased nerve and muscle excitability, cardiac issues.
Thyroid Diagnostic Tests
- Thyroid stimulating hormone (TSH) - Serum free T4 (thyroxine) - T3 and T4 - T3 resin uptake - Thyroid antibodies - Radioactive iodine uptake - Fine-needle aspiration biopsy - Thyroid scan, radioscan, or scintiscan - Serum thyroglobulin
Causes of Morning Hyperglycemia
- To determine the cause, the patient must be awakened once or twice during the night to test blood glucose levels. - Testing at bedtime, at 3 a.m., and on awakening provides information that can be used to make adjustments in insulin to Avoid morning hyperglycemia.
Type 2 Diabetes
- Two main problems are insulin resistance (decreased tissue sensitivity to insulin) and impaired insulin secretion. - Affects 95% of adults with diabetes. Onset is commonly over age 30 years old, however incidence is increasing children d/t diabetes. - Slow, progressive glucose intolerance. May go undetected for years.
Educating Patients in Insulin Self-Management
- Use and action of insulin. - Symptoms of hypoglycemia (future slide) and hyperglycemia (next slide). Plus required actions. - Blood glucose monitoring. - Self-injection of insulin: into the subcutaneous tissue with the use of special insulin syringes. - Storing Insulin: vials not in use should be refrigerated. For vials in use, if it will be used up within 1 month, it may be kept at room temperature. The patient should be instructed to always have a spare vial. - Insulin pump use. - Use of correction insulin ("sliding scale"). - See criteria for determining effectiveness of self-injection of insulin education on chart 51-8 on page 1481.
Corticosteroid Therapy
- Used extensively for adrenal insuffiency and are also widely used in suppressing inflammation and autoimmune reactions, controlling allergic reactions, and reducing the rejection process in transplantation. - Medications: end in "-sone" or "-lone". - Patient education (see next slide): — Timing of doses (early morning, 7-8 am). — Need to take a prescribed, tapering is required when discontinuing or reducing therapy to prevent adrenal insufficiency. — Potential side effects and measures to reduce side effects.
Oral Antidiabetic Agents
- Used for patients with type 2 diabetes who require more than diet and exercise alone. - Patients are usually started on Metformin. - A combination of oral drugs may be used. - Major side effect: hypoglycemia! - Nursing Interventions: monitor blood glucose for hypoglycemia and other potential side effects. - Patient education: *not* a substitute for diet and exercise. Metformin should be stopped 48 hours prior to and for 48 hours after the use of contrast agent (d/t risk for acute kidney injury and lactic acidosis).
Insulin Regimen
- Vary from 1 to 4 injections per day. - Usually a combination of a short-acting Insulin and a longer-acting insulin. - There are two general approaches to insulin therapy: conventional (simplify regimen as much as possible) and intensive (achieve as much control over blood glucose levels as possible). - Table 51-4 on page 1470 describes several insulin regimens and the advantages + disadvantages of each.
Management of Hypoparathyroidism
-Increase serum calcium level to 9—10 mg/dL. -Calcium gluconate IV. -May also use sedatives such as pentobarbital to decrease neuromuscular irritability. -Parathormone may be administered; potential allergic reactions. -Environment free of noise, drafts, bright lights, sudden movement. -Diet high in calcium and low in phosphorus. -Vitamin D.
How many grams of carbohydrates equal 1 carb choice?
15
Fasting Blood Glucose should be _________.
70-100 mg/dL
What category of insulin is rapid acting? A. Humalog B. Humalog R C. Humalog N D. Glargine (Lantus)
A. Humalog
When should people start getting their TSH checked?
At age 35, and then every 5 years after.