ADRENAL GLAND DISORDERS

ADRENAL GLAND DISORDERS

Two of the most common adrenal gland disorders, Addison’s disease and Cushing’s syndrome, result from imbalances of the adrenal cortical hormones.

Addison’s Disease

In Addison’s disease, the adrenal cortex is destroyed, resulting in low levels of the adrenal cortical hormones. Because the glucocorticoids play a role in protein metabolism, a person with Addison’s disease develops muscle weakness and atrophy. Dark discoloration of skin end disturbances in the body’s salt and water balance are also seen. The person may have hypertension as a result of the addison’s disease. A person with Addison’s disease may need assistance with walking and range of motion exercises.

Cushing’s Syndrome

Cushing’s syndrome results from excessive secretion of glucocorticoids. Cushing’s Syndrome can becaused by disorders of the pituitary gland that affect ACTH secretion or by disorders of the adrenal gland itself. Some people develop Cushing’s syndrome after taking high doses of steroid medications, such as hydrocortisone, for a long period of time. Because glucocorticoids help us to metabolize fat, people with Cushing’s syndrome tend to develop pocket of fat in the abdomen, on the back , and in the face. Increased facial hair is also common (Fig. 30-7). A person with Cushing’s Syndrome will have high blood glucose levels because one of the effects of glucocorticoids is to decrease the use of glucose by the tissues. Easy bruising of the skin and muscle weakness are also seen.

DIABETES

Diabetes mellitus results when the pancreas is unable to produce enough insulin. Diabetes mellitus can occus in people of all ages and races, but people between the ages of 65 and 74 years and people of African descent are affected most often. Diabetes mellitus is the most common of all endocrine gland disorders and is the seventh leading cause of death among the elderly. There are two types of diabetes mellitus, type 1 and type 2.

Type 1 Diabetes Mellitus

Type 1 diabetes mellitus is less common but much more severe than type 2 diabetes mellitus. Type 1 diabetes mellitus is caused by destruction of the insulin-producing cells of the pancreas. Also called juvenile diabetes, type 1 diabetes mellitus is the form of diabetes that most often affect children. Most people who have type 1 diabetes are diagnosed while they are children or young adults.

Insulin

Because the pancreas is unable to produce adequate amounts of insulin, a person with type 1 diabetes mellitus must receive daily injections of insulin. The insulin is injected into the subcutaneous layer of the skin, where it is absorbed by the bloodstream. Several types of insulin are available. The type of insulin differ in the speed at which they start working and how long they last in the body. Some of your patients or residents will receive only one injection of insulin each day, while others may receive two or three. Insulin can also be delivered continuously by a pump device (Fig. 30-8).

Monitoring blood glucose levels

People who are receiving insulin injections need to have their blood glucose levels monitored closely. Too much insulin causes hypoglycemia, a dangerous drop in blood glucose levels. Hypoglycemia  robs the brain of the glucose that is essential for it to function. Too little insulin results in hyperglycemia, or too much glucose in the bloodstream. If a person’s blood glucose level increases too much, he can enter a state called diabetic coma. If not treated, diabetic coma can lead to death.

Many devices are available to monitor blood glucose levels, and new ones are constantly entering the market as new technology is developed. Most devices for monitoring blood glucose levels use a drop of blood obtained from the person’s finger (Fig. 30-9A). The “finger stick” method of monitoring blood glucose levels is painful for the person  and can also expose the health care worker to bloodborne diseases. Make sure to wear gloves any time you are checking a person’s glucose level using this method. Noninvasive blood glucose monitoring devices are worn like a watch. Sensors measure the blood glucose level through the person’s skin, and the reading is displayed on the screen (see Fig. 30-9B). These devices are used in addition to regular finger stick monitoring.

Many people with diabetes monitor their own glucose levels and have been taught to adjust their insulin intake as needed, but some residents or patient may need help with monitoring their blood glucose levels. Different facilities will have different policies about who is responsible for blood glucose monitoring. You  may work in a facility that allows nursing assistants to perform the glucose monitoring. Make sure that you have been adequately trained in how to use the equipment and record your findings. Be aware of which glucose levels need to be reported to the nurse immediately.

Diet

It is very important for a person with diabetes to eat an adequate  amount of nutritious food, especially if the person is taking insulin. In addition to regular meals, snacks are served to help regulate the person’s blood glucose levels. A person with type 1 diabetes must it a diet with specific amounts of carbohydrates, sugars, fats, and proteins to react with the amount of injected insulin. If a person does not it at the recommended time after receiving her insulin, her blood glucose level can drop too low, resulting in condition known as insulin shock. This is why it is important to serve meals and snacks at the scheduled time, especially when your patient or resident is taking insulin (fig. 30-10). Also, if one of your patients or resident with diabetes refuses to at or only partially finishes his meal or snack, you should report this to the nurse immediately. Vomiting or being NPO for sugery or diagnostic testing can also affect a person’s glucose levels.

Type 2 Diabetes

Type 2 diabetes mellitus, sometimes reffered to as glucose intolerance, commonly occurs in overweight adults. In people with type 2 diabetes mellitus, the pancreas still produces some insulin, but the cells of the body are unable to respond to the insulin. This results in higher blood glucose levels because the body is unable to transport the glucose into the cells. Symptoms of type 2 diabetes mellitus may occur gradually and go undetected for a long time.

Type 2 diabetes is treated through diet, exercise, and the use of oral medications to increase the effectiveness of insulin. People with severe type 2diabetes may need to be treated with insulin injections, especially during times of illness or stress. Controlling the diet may be quite difficult, especially for the person who enjoys sweet. When caring for a person with type 2 diabetes, be sure to watch closely the amounts and types of food the person eats, just as you would for a person with type 1 diabetes.

Complications of Diabetes

Many organ systems can be affected by uncontrolled diabetes mellitus or either type. Low insulin levels increase the release of lipids (fats) into the bloodstream. The lipids then build up in the linings of the arteries, damaging them. Atherocsclerosis, high blood preasure, heart disease, kidney disease, and blindness (diabetic retinopathy: see Chapter 29) can result from the damaged blood veseels. In addition, peripheral nerve damage results from reduced blood flow to the neurons, causing diminished sensations in the arms and legs. Poor circulation to the feet and lower legs also increases the risk of infection and poor tissue healing in the event of injury.

Early detection of diabetes mellitus is essential for preventing complications. Once diabetes mellitus is diagnosed, there are many measures that can  be taken to keep the disease under control and minimize the person’s risk of developing complications. People who are overweight should try to lose the excess weight. In addition, exercising regularly, following the recommended diet closely, and taking prescribed meications correctly are also very important.