GLUCOSE REGULATIONConcept 12

Goals for This Concept PresentationDefine and describe the concept.Notice risk factors for impaired glucose regulation.Recognize when an individual has compromised glucose regulation.Provide appropriate nursing and collaborative interventions to optimize glucose regulation.

Definition and DescriptionGlucose regulation is the process of maintaining optimal blood glucose levelsThe ultimate end result of glucose metabolism is cellular use of glucose for energy (adenosine triphosphate [ATP]) synthesis

Key TermsCollaborative Learning #1 In your learning group, discuss the meaning of the listed key terms and the link of each term to the concept definition.GlycogenolysisCounterregulatory hormonesInsulin resistanceGluconeogenesis

Scope of Concept

Categories of Glucose RegulationHypoglycemiaState of insufficient or low blood levels, defined as less than 70 mg/dLHyperglycemiaState of elevated blood glucose levels, defined as more than 100 mg/dL in a fasting state or 140 mg/dL when not fasting

Risk Factors Risk for impaired glucose regulationAgeRacial and ethnic groupsFamily history LifestyleMedical risk factors Selected medications

Individual Risk FactorsCollaborative Learning #2In your learning group, create a list of individual risk factors and health conditions associated with impaired glucose regulation, and include a rationale. Indicate if the risk factor is modifiable.

Risk Factors and Health ConditionsRationaleModifiable(Yes or No)

Review of Endocrine SystemAnatomy and Physiology Anterior pituitary glandPancreasAdrenal glandsPosterior pituitary gland

Physiologic Processes: Maintaining Glucose BalanceHormone to lower glucoseInsulinCounterregulatory hormones to raise glucose GlucagonCortisolProblems arise when hormones are deficient or excessive or when production is not balanced with the blood glucose need

Consequences: HyperglycemiaShort-term consequences Inadequate glucose reaching the cellsDehydrationLong-term consequencesEnd-organ disease due to microvascular damageRetinopathyNephropathyPeripheral neuropathyMacrovascular angiopathyHypertensionCardiovascular and peripheral vascular disease

Consequences: HypoglycemiaIrritabilityFatigueMental confusion Seizures UnconsciousnessPotentially leads to cellular death

Assessment: HistoryCurrent medicationsPersonal or family medical history markersCentral obesityDiabetesHypertensionCardiovascular diseaseCancerReview of symptoms

Assessment: ExaminationAnthropometric measurementsBody mass indexWaist-to-hip ratio

Recognizing Impaired Glucose RegulationCollaborative Learning #3In your learning group, create a list of common symptoms and clinical findings associated with hypoglycemia and hyperglycemia. Discuss the symptoms and findings from a physiologic perspective.

Symptoms and SignificanceClinical Findings and SignificanceHyperglycemiaHypoglycemia

Common Diagnostic TestsGlucose screeningAssess antibodies to confirm type 1 diabetes mellitusLipid analysisMicroalbuminuriaC-reactive protein

Clinical Management:ScreeningLaboratory tests Hemoglobin A1cCholesterolMicroalbuminuriaScreening to detect complicationsBlood pressureDental, foot, and eye examinations

Clinical Management: Collaborative InterventionsEducation about glucose regulationNutrition therapyPattern management: monitoring meal-related blood glucose valuesPharmacologic agentsOral hypoglycemic agentsInsulin

Interrelated Concepts