ENDOCRINE SYSTEM

Pituitary gland

ANTERIOR PITUITARY POSTERIOR PITUITARY

1. Growth hormone - Oxytocin
✓ Dwarfism (varones) Enanism - Vasopressin ADH
✓ Acromegaly. ✓ SIADH
2. Thyrotropin (TSH) ✓ Diabetes Insipidus (DI)
✓ Hyperthyroidism
✓ Hypothyroidism
3. Adrenocorticotropic (ACTH)
✓ Addison
✓ Cushing
4. FSH or follicle stimulant (menstruation)
5. Luteinizing (LH)

Sheehan ‘s syndrome = Hypopituitarism = todo ↓

➢ Woman who loses a large amount of blood in child bird or

➢ A severe decrease BP after labor can deprive the amount of oxygen of the
pituitary gland.

Assessment:

▪ Inability to breast feeding

▪ Amenorrhea (no menstruation)
▪ Inability to regrow shave public hair
▪ Slow mental function (hypotiroidism)
▪ Weight gain
▪ Low BP
▪ Low B6
▪ Cardiac dysrhythmias

Treatment
• Lifelong hormone replacement

DWARFISM (delicate features) ACROMEGALY (Coarse features)

- Decreased GH Cause= tumor in the hypophysis
- Assessment Delicate features
- height below normal • After 25 years old
Body proportion are normal • Increased GH
- Bone and tooth development delayed
- Sexual maturity and organs delayed Assessment
- Fine skin
1. Thickened lips
2. Increased head size
3. Lower jaw protrusion
4. Hyperglycemia

1
 Treatment 5. Enlarged feet and hands
6. Joint pain
1. Somatotropin – (6H) GH replacement 7. Deep voice
therapy until maturity (18 – 20 years old). 8. Coordination poor
9. Visual field changes
2. Gonadotropin chorionic
10. Liver, heart, lungs enlargement
3. Emotional support.
4. Testosterone replacement

Diagnostic = Increased GH

Treatment = OJO

Bromocriptine: is used to for neuroleptic

malignant, hyperthermia malignant and Parkinson.
Octreotide = Somatostatin) (stop grow)

Surgical Intervention (remove tumor)

- Trans nasal Hypophysectomy

Post – op - Intervention:

1. HOB = 30 (head at the midline) bc

expected ↑ ICP
2. Mustache dressing and nasal package will
be placed on the nose. (Halo sign)
3. Teaching = Client must be breath through
the mouth for 3-4 days after surgery.
4. Avoid activities that ↑ ICP

Complication

1-Diabetes Insipidus (too much urine)> 150 ml

(normal (30-50 in 1h)

2-Cerebro-Spinal fluid (leakage) = Call Dr

♦ Halo sign in mustache dressing

♦ Positive to glucose liquid

= Bedrest 30

3-Meningitis = neck stiffness, headache and fever

4-Expected ↓of sense of smell 4-6 weeks after

5-Avoid activities that ↑ICP *no cepillarse los

dientes 2 weeks after, solo enjuague y hilo
dental.
Nota: Acromegalia = crecen todos los órganos.

2
 Diabetes insipidus Syndrome inappropiated ADH
Cause = Brain Cause = ↑ADH
1. Hypophisectomy - Lung:
2. Head trauma 1. Small cell lung cáncer
3. Meningitis 2. Pneumonia
4. Brain tumor 3. Mecanical Ventilation
5. Lithium Therapy 4. TB
Assessment Assesment
1. Increased urinary output (poliuria) 1. Sign of increased fluid overload = CHF.
2. Increased thrist ✓ SOB
3. Polidipsia ✓ Crackle
Treatment ✓ Cough
1. IV fluid = 0.9 % Nacl 2. Decrease urinary Output
- Hypotonic solution choice (0,45 or ½) 3. Increased BP + tachycardia with bounding
2. Desmopressin (Oral or nasal solution) Goal: pulse
↓ Urinary output 4. Lethargy, decreased DTR
↓ thrist 5. Brain edema, LOC alteration, confusion,
Specific gravity ↑ ( 1005 -1030) seizure
LAB = En la orina todo alto y en el cuerpo todo bajo.
LAB = ✓ USG > 1030
- Urinary SG = less than 1005 ✓ Plasma urinary ↑
- Plasma urinary ↓
✓ Plasma osmolality ↓
- Plasma osmolality ↑
- Na ↑ ✓ Na ↓
- BUN ↑ ✓ BUN ↓
- Hematocrit ↑ ✓ Hematocrit ↓
- Capillary refill > 3 Treatment
Complication 1. Water restrinction (500-600ml in 24 hours.
1. SIADH 2. Diuretic (furosemide)
- Stop urinary output 3. IV fluid 3% Nacl
- Specific gravity = 1030 4. Demclocycline (antibiotic + antidiuretic
- LOL alteration, confusion propertie- primo de la tetracicline) lab check
= K (while administering)=
2. ↑ BP, MI, Cardiac dysrhythmias
Side effect
✓ Teeth discoloration
✓ Photosencibility
✓ No in children less than 9 years.
✓ No with milk
Goal
✓ Increase urinary output
✓ Decreased urinary specific gravity
✓ Improve LOC + diabetes Insipidus

3
 Thyroid

Hypothyroidism (tiene frio) Hyperthyroidism (tiene calor)

✓ Myxedema. Gravis disease (type of hyperthyroidism)
✓ Hashimoto thyroiditis (typo of =hyperthyroidism + exophthalmos
hypothyroidism)
• Decreased activity level

Diagnostic: Increased T3, T4 ↑, TSH ↓

Diagnostic T3, T4 ↓, TSH ↑ ✓ Uptake of iodine

Radioactive iodine

Less than 35 = OK
Assessment
More than 35 = hyperthyroidism
1. Increased sensitive to cold
2. Weight gain (basal metabolism ↓)
3. Dry skin
4. Decreased stimuli perception Assessment
5. Respiratory difficulty
6. Constipation 1. Hyperactivity
7. Alopecia 2. Increased sensitive to heat
8. Bradycardia 3. Increased temperature
9. Decreased sweating 4. Rest and sleep deprivation
10. Reproductive problems 5. Increased stimuli perception
11. Low cardiac output (hypotension, fatigue) 6. Weight loss
12. Peripheral edema 7. Diarrhea
13. Slow mental process (teaching: speech and 8. Diaphoresis
writing) 9. Tachycardia
14. Hypercholesterolemia 10. Increased BP
11. Cardiac dysthymia
12. Fine soft hair
Intervention hypothyroidism 13. Exophthalmos
14. Photophobia
1. Medical Alert Bracelet 15. Chest pain
2. No OTC medication 16. Mood swings.
3. Diet: high fiber, low carbohydrates.
4. Frequent rest periods between activities. GOITER classification
5. Teaching speech and writing. Grades
6. Maintain temperature 75° F ✓ O – No palpable, no visible (ultrasound)
✓ 1- Mass no visible with neck in normal position,
Medication but can be palpable when Pt swallowing (se
palpa por detras)
Levothyroxine = Take in the morning before 7:00
am with an empty stomach + plenty fluid.

Goal: normal functioning)

4
 ✓ 2- Mass is visible as swelling when the neck is in
Side effects the normal position, goiter is easily palpable and
✓ Hyperthyroidism. -Thyroid storm = is usually asymmetric
complication of levothyroxine
✓ Fever ↑1° F temp.
✓ ↑ Tachycardia
Intervention

1. ↓ Environmental stimulation. – restrict

Complication of hypothyroidism visitors.
2. Ensure that client has a fresh pitcher of ice
water at bed side
✓ Mixedema Coma
3. Change lines frequently, cold water shower
Triggers factors.
Medications
✓ Acute illness
1- Methimazole (contraindicate 1st trimester
✓ Surgery
pregnancy)
✓ Chemotherapy
✓ Stop thyroid replacement hormone
2- Propylthiouracil PTU
(levothyroxine)
✓ Use of sedative and opioids

S/E for both:

-↓WBC = Risk for infection – if fever or sore throat =
Assessment
call Dr.
Note: Med that ↓WBC = Clozapine Clozaril,
✓ LOC alteration, confusion, lethargy, coma. carbamazepine, and hyperthyroidism med.
✓ Respiratory failure (Respiratory Acidosis). (contraindicated in immunocompromised)
✓ Severe Hypotension -Liver toxicity
✓ Severe Hyponatremia -Hypothyroidism, (Myxedema coma)
If bradycardia call Dr.
✓ Severe Hypothermia
✓ Severe Hypoglycemia.

Intervention
3- Lugol Solution (oral liquid)
1. Patency airway
2. IV fluids 3% NaCl (hypertonic) -Use for shorth term (1-2weeks)
3. Levothyroxine IV
4. Glucose IV -1 week before thyroid surgery or
5. Steroids
-to treat thyroid storm
6. Monitor temperature every hour
✓ Cover with warm blanket S/E
7. Change position every 2 hours
8. Aspiration precaution. Teeth discoloration = use straw (same tetracycline)

Suction equipment at bed side. Metallic taste

Skin rash

Note: resume

5
Hypothyroidism = Myxedema 4- Ablation Therapy

- Radioactive Iodine -RAI 131

- No in pregnant woman
Hypothyroidism + Levothyroxine = Thyroid storm
- No in childbearing age
- Fasting overnight 8 – 12 hrs. before.
- Urine, saliva, semen, vomit = radioactive for 1
Hyperthyroidism = Thyroid storm week after (5-7 days)
- Flushing toilet twice for each voiding.
- Wash your hand with soap and water.
- Use gloves is any contact with secretions
Hyperthyroidism + PTU and Methimazole =
- During the first 6 – 8 weeks after radiation
Myxedema Coma
therapy.

Continuous with antithyroid medication using

methimazole or PTU.

- After that = levothyroxine lifelong (for

hypothyroidism)

5- Thyroid Surgery (thyroidectomy) (partial or

total) OJO

Post-surgical intervention and complication:

✓ Position semi fowler to fowler (30-45) HOB

✓ Avoid neck hyperextension
✓ Use a sandbag to support the neck or put one
hand behind the neck to support when walking.
✓ Use “Jaw thrust” Maneuver to airway
assessment.
✓ Hoarseness is expected during the first week
after surgery, if worsening or persisting more
than 1 week then call Dr.

Complication of the thyroidectomy.

- 1. Hypocalcemia = Emergency.
o Paresthesia's (numbness tingling
sensation on mouth or fingers)
o Chvostek.
o Trousseau

2. Laryngeal spasm (stridor)

Calcium Gluconate & Tracheostomy Set at bed

side.

3. Hemorrhage

6
 • Check behind the neck
• If respiratory distress call Dr
4. Thyroid storm

Triggers

• Stress
• Thyroid Manipulation
• Acute Illness
• Surgery
• Thyroid Surgery
• Stop antithyroid meds.

Assessment

• Fever or ↑1 F temperature
• Tachycardia (atrial Fib)
• Ansiety,
• tremors
• N/V
• Delirium,
• Agitation
• Zeusure.

Treatement

• ICU admission
• Colling blanket
• Lugol solution
• Antypyretic
• Propranolol (no in Asthma)
• PTU or methymazole IV
•

Pheochromocytoma (suprarenal Gland tumor)

▪ Bening tumor of the adrenal gland.

▪ Do not palpate
▪ Hypertension crisis (no MAOIS)

Assessment
1. Paroximal or sustained Hypertension (high BP)
2. Trobbing Headache.
3. Tachycardia and palpitation.
4. Flushing
5. Profuse diaphoresis- frequent bath with warm water
6. Heat intolerant

7
 7. Weight loss
8. Tremor
9. Hyperglicemia

Diagnostic
- Vanil mandelic Acid. (VMA) = 24 hours urinary collection
- Avoid 72h before the test.
o Coffee
o Bananas
o Vanilla
o Chocolate
- > 5/24h = positive for Tumor.
Treatment
1. Check for BP to prevent complications. (Risk for stroke or MI)
2. Medication = B-Blockers (LOL) to control BP
3. During crisis use Phentolamine(vasodilator) (choice) sino hay este, dar:
o Sodium nitroprusiate (es photosensitivity, use in ICU, blood pressure med potente, la luz lo
inactiva, si se pone green or red tienes que botarlo, para ponerlo el Pt tiene que estar en
cama y checarle la BP porque la baja mucho)
o Hydralazine (use in pregnancy)
o Niphedipine (choice for Autonomic dysreflexia)
4. Decrease enviromental stimulation
5. Restric visitor,
6. Bed rest
7. Do not palpate Abd sign bc increase BP
8. Diet: Low Na, avoid stimulant
a. High in calories, vitamins and minerals.
9. Frequently bath with warm water
10. Adrenalectomy

Nota importante: Phentolamine(vasodilator): use for extravasation of vasoconstrictor

Ex; epinephrine or dopamine, el antidote es phentolamine que se Administra subcutaneous.

Note: Wilms Tumor: No biopsy, No palpate bc metastases.

Conn’s Disease
= Primary hyperaldosteronism

Agua y sodio para mi y potasio para el toilet

No with digoxin bc digoxin is toxica when K is low
No with steroids bc decrease K
No with licorice (herb) bc decrease K or Ginseng
Lithium si se puede dar bc Na esta alto, y el es toxico cuando el Na es bajo.

Assessment
1. Increased Na
2. Fluid retention
3. Hypokalemia (U wave)
4. Cardiac dysrhythmias
5. Paresthesia = Tetany
6. Visual change
7. Glucose Intolerance

8
 Treatment
1. Administer K supplement
2. K sparring diuretics
• Spironolactone
• Triamterene
• Amyloride
3. Steroids
4. Glucocorticoid

ADDISON (addita florecita)(Stress) CUSHING

Decrease Steroids Too much steroids
- ↓ Cortisol - Increased cortisol
- ↓ Aldosterone - Increased aldosterone
Assessment Assessment
- K – Ca ↑ - Ca -- K ↓
- Skin hyperpigmentation or brown skin - Moon Face
discoloration. - “Buffalo Lump” (back)
- Tachycardia - ↑ weight (fluid retention)
- ↓ Weight - Gynecomastia
- Hypotension - Hirsutism (face and body hair)
- ↓ Na - Muscle wasting (buttocks, extremities)
- Lethargy, Fatigue - Abdominal stretch
- Muscles weakness - Easy bruising (Petechiae)
- ↓ Blood glucose - Healing retardation.
- Menstrual change - Dry skin
- Impotence in male - ACNE
- Osteoporosis (safety precautions) med: Alendronate
Diagnostic - Cataracts
ACTH Stimulation Test = (Confirmatory)
- Glaucoma
- 17 hydroxy corticosteroids - Immunocompromise
- 17 Ketosteroid. - High Risk for infection
- ↑ BP (hypertension)
Treatment.
- ↑ BG (hyperglycemia)
1. Avoid triggers to prevent Addisonian crisis.
• Stress
- ↑ Na (hypernatremia)
• Inadequate steroid replacement
Diagnostic
• Infection
Steroids ↑
• Surgery
Note: Stop suddenly, steroids also can cause
Intervention
Addisonian crisis, that’s why needed to increase 1. Diet
steroid in a surgery. • ↑ high protein
Diet • ↓ Low carbohydrate
- ↑ Na and Low K • ↓ Low Na
- Table salt ↑ (same in Lithium) • ↓ Calorie
- Salt sustitute ↓ bc is K • ↑ K, ↑ Ca
- High protein • Fluid Restriction

9
- ↑ Carbohydrates 2. Assist with ambulation
- Elimination of environmental hazards to prevent
- Wear a medical alert bracelet Osteoporosis.
- Lifelong steroid replacement Medication
- Fludrocortisone (Choice) Oral. 1. Aminoglutethimide
Sino hay pueden dar entonces : Prednisone 2. Hypophysectomy or Adrenalectomy

Complication Emotional support

- Addisonian Crisis The most physical changes are reversible with treat.

Assessment Post adrenalectomy care

• Hypotension + Tachycardia - Lifelong Steroids
• Epigastric pain - High risk for infection
• Severe headache - Risk for respiratory acidosis)
• Confusion (Acostarse sobre la herida 2-3 veces al dia para
• Hyponatremia severe
prevenir respiratory acidosis)
• Hypoglycemia severe
Treatment
Note: Cholecystectomy and nephrectomy or
1. IV fluids (Hypertonic solution 3%Nacl)
2. Hydrocortisone (IV) adrenalectomy cause respiratory acidosis, 2-3 times per
3. Fludrocortisone PO (pastillas only) day acuestate sobre la herida para prevenirlo.

Note: Isotonic Solution: misma cantidad de agua que de

Sodio
• Nacl 0.9%
• Ringer lactate
• 5% Dext in water
• 5% Dext in 0.225 Nacl
Hypotonic = un # < 1 Ex: ¼ Nacl, 0.225Nacl = H2O
Ex: near drowning in the Pacific Ocean.
Hypertonic = un # > 1 = Na
Ex: near drowning in fresh water.
Diabetes Mellitus
▪ Chronic disorder of impaired carbohydrate, protein and lipids metabolism
caused by deficiency of insulin or by increase peripheral resistance to insulin.

Type I Diabetes Type II Diabetes

- Absolute Insulin deficiency (B cell destruction) - Relative lack of insulin or increase peripheral
- More frequently in childhood before 30 years resistance.
old. - 80% = Obesity (abdominal)
- Insulin Dependent - Peak = 50 yrs.
Note: difference between diabetes mellitus and insipidus is polyphagia, that is for mellitus.

Metabolic syndrome
Acanthosis nigricans = Predisposition of 90% diabetes
1. Bbd Obesity
• Waist circumference + 40 inch for men, + 35 inches for women
• Apple shape

2. Hyperglycemia

10
 • Fasting glucose 70-110 = normal
• 110-125 Metabolic syndrome
• >126 = Diabetes

A1C = less than 5.6 = normal

➢ More than 6.5 = Diabetes
➢ 5.6-6.4 = Metabolic syndrome
7 for control value
Less than 7 se porto bien
More than 7 = Bad control

3. Systolic BP between 130-140

• Diastolic BP 85-90
More than 140-90 = Hypertension.

4. Hyperlipidemia
♦ Triglycerides > 150
♦ HDL cholesterol >50 = ok
♦ Less than 40 in Men and 50 in Women = mal

Assessment for Diabetes Mellitus.

1. Polyuria (increased urine)
2. Polydipsia (increased thirst)
3. Polyphagia (increased appetite)
4. Decreased weight
5. Hyperglycemia
6. Healing retardation
7. High risk for for vaginal Infection (Fungal)
8. Blurred Vision

Complication
Short Term Long Term
1. Hypoglycemia 1. Chronic Complication
2. Diabetes Ketoacidosis (Type 1)  Diabetes Retinopathy = legal blindness 20/200
3. Hyperosmolar non ketonic stage (Type II) (coma  Diabetes Nephropathy
hyperosmolar) Initially proteinuria = chronic kidney diseases
Lasting, = Renal insufficiency
 Diabetes Polyneuropathy = Diabetic foot
 Reproductive:
Impotence
Menstrual change
Dry vaginal

Hypoglycemia
- Blood glucose level falls below 70 mg/dl
o Mild less than 70
o Moderate less than 40
o Severe less than 20
Assessment
• Hunger
• Palpitation/ tachycardia

11
 • Drowsiness
• Nervouses
• “Quivering in abdomen”
• Jitteriness (infant) (newborn)
• Doble visión
• Headache
• Sweating
• Slurred speech
• Confusion
• Difficulty to arrouse
• Disorientation
• Seizure
• Loss of consesiouness

Treatment
- Carbohydrate replacement 15 – 20g of glucose
✓ ½ cup (4 – oz of fruit juice)
✓ ½ cup of regular soft drink
✓ 8 oz of skinny milk.
✓ 6 – 10 candies or live savers
✓ 4 cubes of sugar
✓ 4 teaspoons of sugar
✓ 3 graham crackers
✓ 6 saltines crackers
Le doy una de ellos nada mas and
- 15 minutes after check blood glucose,
- If continue hypoglycemic = repeat one more
- 15 after checking blood glucose again.
If hypoglycemia administers small snack of carbohydrates + protein.
- If 15 min after continuing hypoglycemia after small snack = Severe hypoglycemia.
-
Consciousness Unconsciousness
- Dextrose - Glucagon
- Repeat doses after 10 mins.

Nota: Tto de elección para la diabetes + HTN = priles. But if already renal failure = NO
PRILES (bc increased K)

Diabetes ketoacidosis (type of metabolic Hyperosmolar (Hyperglycemic nonketoic)

acidosis) (HTTS) Type II
Complication type I
Onset and Sudden Gradual
Precipitating Factors - Infection • Poor fluid intake
- Inadequate Insulin • Infection
Dose
- Surgery
Assessment

12
- Kussmaul respiration - Dehydration (more severe)
- Fruity breath Odor” - LOC Alteration, confusion, coma
- Epigastric Pain
- Sign of hyperglycemia
❖ Polyuria, polydipsia, polyphagia and loss
weigh
- Dehydration
- Tachycardia
- Dry and warm skin
Labs
- Serum glucose >300 – 600 (hyperglycemia) - Serum glucose > 600
- Plasma Osmolarity variable - Plasma Osmolality > 350 (severe
- Urine Ketones- positive dehydration).
- BUN increased > 20 - Urine ketones – negative
- Hematocrit increased 35% - K = increase
- K increased with acidosis - BUN Increased
- PH Acid↓ - Hematocrit Increased
- HCO3 ↓ = Metabolic Acidosis Do not administer Bicarbonate
Intervention (always cardia monitor)
1. IV fluids NaCl 0.9% or 0.45% NaCl (hypotonic) until blood glucose matches 250 to 300mg.
Add dextrose to IV fluid to prevent rebound Hypoglycemia
2. Administer insulin (R) IV (regular only) = IV bolus 5 – 10 units initially then continuous with
infusion in IV fluid.
3. Add K to the bag when K level = 3.5 to prevent rebound hypokalemia.

Diabetic Foot Care

1. Inspect your feet daily, especially between toes.

2. Wash your foot daily with lukewarm water and soap, then dry.
3. Apply moisturizing cream to your feet after bathing. Avoid between your toes.
4. Change into clean cotton socks daily.
5. Do not wear the same pair of shoes 2 days in a row, and wear leather or cloth,
no sandals, no open toes shoes.
6. Purchase your shoes later in the day.
7. Trim your nails straight across with a clipper. (Never curve, never soak your
feet.)
8. Use a mirror to see your feet If nobody can check them for you
9. Blister, corner, never treat at home.
10. Do not step into bathtub without checking the water temperature. Optimal
temp = 95F, Normal temp. = 110F.
11. Do. Not walk barefooted
12. Avoid smoking.
13. No hearing pads

Oral Hypoglycemic (only for type 2 diabetes)

13
 Biguanides Sulfonylureas Thiazolidinedione Meglitinide DPP-4 ∝ Glucosidase
Metformin No with Ginseng Tazones = CHF Glinide at the Inhibitors Inhibitors
Gli- at the end Gliptin at the
beginning end
Metformin Glyburide Pioglitazone Netaglidine Saxagliptin Acarbose
Mechanism Glipizide Rosiglitazone Repaglinide Sitagliptin Miglitol
action Glibenclamide Mechanism action Mechanism Linagliptin Mechanism action
Intestinal glucose Glimepiride -↓ liver glucose Action Mechanism -Reduce the rate
transport. Mechanism action production reducing - Same to Action digestive of
-Lower fasting fasting plasma and sulfonylurea) -Same to stretches.
plasma, blood improve insulin sulfonylurea - Delated
Do not cause glucose by receptors. -Cause -Delating absorption of
Hypoglycemia stimulate insulin Hypoglycemia gastric Empty. carbohydrate from
S/E production from β small intestine
Diarrhea/nausea Cell. S/E Cause
- ↓ weight CHF Hypoglycemia -Do not cause
-More lethal -Cause Contraindicated S/E Hypoglycemia
Lactic Acidosis hypoglycemics Fluid overload Pancreatitis -Give with the first
-Check renal S/E SIADH Liver toxicity bite of each meal
function before -No in Pts allergic
to sulfa. Note: Tazon lleno S/E
*Withhold -No with ginseng GI Disturbances
metformin 24 -No with alcohol Do not cause -Abdominal
hours before and To prevent hypoglycemia but discomfort
48 hours after disulfiram CHF symptoms -Diarrhea
any Dye exam. reaction. -vomiting
-weight gain -indigestion
Contraindicated
-In inflammatorily
bowel disease
(Chron Disease
and colitis)
-No if bowel
obstruction is
suspect

Insulin
Injection Site
1. Abdomen
2. Posterior Arm
3. Anterior Thigh
4. Hips
U – 100 syringes = 100 U in 1ml

Administration
Do not massage
Do not aspirate

14
 ✓ ≮ 45° or 90 if BMI >25 = Overweight or
obese
✓ Needle length = 0,5 – 0,6 – 5/8 inc.
✓ Needle gauge = 26 - 27

Note: 18=blood transfusion

22= IV regular

To prevent Lipodystrophy = Systematic Rotation

- Do not use the same site for more than 2 weeks period.
- ½ inch apart within anatomical area.
- Do not Heat, no exercises, no massage after insulin administration.

Storing Insulin
- Avoid exposure to extreme temperature.
- Should not be frozen or kept in direct sunlight.
- Can be refrigerated. Remove 1-2 hours before administered
- Administer at room temperature
- Never freezer
- The vial of Insulin will be used up in 1 month.
- During Illness = increased dose

Types of Insulin
1-Rapid Acting [Link] Acting- Regular [Link] Acting [Link] Acting
Only use in Emergency Isophane NPH (cloudy) Do not Mix
Lispro = Humalog Novolin (R) Novolin (N) Lantus
Aspart = Novolog Relion (R) Relion (N) Gargling
Glulisine = Apidra Humulin (R) Humulin (N)
Luis Alberto Garcia Safe in Pregnant
R= Peak before 12:00
ONSET- PEAK DURATION
Onset = 0.25min Onset = 0.50 hrs Onset = 1.5 hr - No peak
Peak = 1-3 hrs. Peak = 2 – 4 hrs Peak = 4 – 12 hrs -No Mix in the
Before 10:00 Before Noon = Between 2:00 – 8:00pm same syringe.
Duration = 3 -5 hrs 10:00am – 12:00pm Duration= 16 hrs -Same to basal
breakfast, at bed Duration= 5-7 h insulin, administer
side or ready, Can be mix Cloudy can mix with regular daily or twice daily.
If not in the room do Note: Peak = More risk for Duration = 24 hrs
not administer hypoglycemia

Mix Insulin
NR (Nancy Rodriguez) RN
Air Withdraw
1. Wash Hands
2. Gently Rotate NPH(cloudy) insulin bottle

15
 ✓ Do not shake = Swirl
3. Wipe tops of insulin vial with alcohol.
4. Draw back amount of air into the syringe that equal total dose
5. Inject air equal to NPH dose into NPH vial.
6. Remove Syringe.
7. Inject air equal to regular dose into regular vial.
8. Invert regular insulin bottle and withdrawal regular insulin dose.
9. Carefully withdrawal NPH dose.

Nota: Exenatide (Byelta) = Used for Type II diabetes (Subcutaneous), because it is not
an insulin. Follow up = a Type I Patient wants to get it

Insulin complication
1. Lipodystrophy
2. Down Phenomenon
3. Somogyi Phenomenon

- Down Phenomenon - Somogyi Phenomenon

Hyperglycemia (Pre- Breakfast)
Early in the morning 5:00 am 7:00am

Check at 2:00 – 3:00

If
- Normal Glycemia - Hypoglycemia
Or Hyperglycemia
Tto: Decrease Snack - Tto: Give snack at bet time
At bet time
- Increased insulin dose - ↓ Insulin dose NPH 4-10 pm

Insulin Pumps
1. Need check blood glucose apart.
2. Catheter Change every 2 – 3 days
3. Abdomen
4. Deliver a Continuous basal rate of insulin before each meal.

16