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Endocrine System Diseases and Disorders 287
Hyperthyroidism
■ Description. Hyperthyroidism occurs when the thy
roid gland secretes excessive T
3
and T
4
. This condition
is also known as overactive thyroid and is a type of
thyrotoxicosis.
■ Etiology. The cause of hyperthyroidism can be idio
pathic (unknown), but there are several known causes
of hyperthyroidism, including tumors or adenoma
(AD-eh-NO-ma; adeno = gland, oma = tumor), hered
ity, excessive dietary intake of iodine (found in sea
weed and liver), and taking too much thyroid hormone
medication.
The most common cause is an autoimmune condi
tion called Graves’ disease. In this condition, antibodies
stimulate the thyroid, leading to glandular hypertrophy.
Graves’ disease commonly affects young women.
■ Symptoms. No matter the cause, the thyroid gland
becomes enlarged and produces a characteristic goiter
(GOI-ter), a noticeable protrusion of the thyroid gland
(Figure 14-4). Overproduction of T4 increases metabo
lism, leading to symptoms of tachycardia, nervousness,
hyperactivity, weakness, and excessive excitability. The
individual has a tremendous appetite but loses weight
to the point of extreme thinness. Diarrhea is common
because T
4
speeds up peristalsis of the gastrointestinal
tract. High metabolic rate causes high heat production,
leading to excessive sweating and an intolerance to heat.
The skin can be moist, and the individual might have
extreme thirst due to this water loss.
Courtesy of Mark L. Kuss
Figure 14-4 Goiter.
One very distinguishing characteristic of hyper
thyroidism is a stare in the eyes due to exophthalmos
(ECK-sof-THAL-mos; abnormal protrusion of the eye
balls) (Figure 14-5) from edema in the tissues behind
the eyes. It can be so severe that the eyelids will not
close. Unfortunately, this condition might not totally
resolve when the hyperthyroidism is corrected.
■ Diagnosis. A diagnosis is made based on history and
physical examination and is confirmed with blood tests.
An elevated thyroid-stimulating hormone is usually all
that is needed to confirm the diagnosis.
■ Treatment. Hyperthyroidism can be treated with
medication, radiation of the thyroid, or surgical removal
of all or part of the gland. If the entire gland receives
eradication radiation or is surgically removed, hormone
replacement medication will be needed for the life of
the individual.
A sudden, life-threatening exacerbation of all
symptoms of hyperthyroidism is called thyroid storm.
This condition can occur in an individual with severe
hyperthyroidism or during the immediate postoperative
period following a thyroidectomy (ectomy = excision or
removal of). Symptoms of thyroid storm include severe
tachycardia with heart rates reaching 200 beats per
minute, tachypnea, and loss of temperature regulation
characterized by a rapid and steady increase in body
temperature. Emergency medical intervention must be
initiated to save the individual’s life.
■ Prevention. There are no general preventive measures
for hyperthyroidism, but people who smoke are more
likely to develop Graves’ disease and ophthalmopathy
than people who do not smoke.
Figure 14-5 Exophthalmos in Graves’ disease.
288 Chapter 14
Simple Goiter
■ Description. Simple goiter is an enlargement of the
thyroid gland. It occurs as the thyroid attempts to pro
duce adequate amounts of T
4
.
■ Etiology. Causes of goiter include:
■ A family history of goiter incidence.
■ Eating large amounts of goitrogenic (goiter
producing) foods that inhibit production of
thyroid hormone. These include soy, peanuts,
peaches, spinach, turnips, cabbage, Brussels
sprouts, seaweed, and millet.
■ Regular use of medications that affect thyroid pro
duction, including lithium and propylthiouracil.
■ Iodine deficiency is rare in the United States due
to the use of iodized table salt, but some people in
other parts of the world have iodine deficiency.
■ Symptoms. This condition usually affects females and
can be asymptomatic until the thyroid gland enlarges to
the point of forming a noticeable mass at the front of the
neck. If the gland is extremely enlarged, it can cause pres
sure on the trachea and esophagus and cause dyspnea
and dysphagia (dys = difficulty, phagia = swallowing).
The main symptom is a swollen thyroid gland. The size
can range from a single small nodule to a large neck lump.
■ Diagnosis. A physical examination including pal
pation (feeling the enlarged thyroid gland) and blood
tests, ultrasound, and fine-needle biopsy help confirm
the diagnosis.
■ Treatment. Treatment includes administration of
potassium iodide initially, followed by increasing iodine
in the diet with iodized salt. If the cause is related to
goitrogenic foods or drugs, avoidance of these often
leads to cure. If the goiter is unresponsive to treatment,
surgery might be needed to reduce the size of the gland.
Treatment is aimed at stopping the enlargement of the
gland, but it will not reduce the current size of the
gland. Surgery also might be needed to improve phys
ical appearance and decrease difficulty with breathing
and swallowing.
■ Prevention. Monitoring dietary intake of goitrogenic
foods and medications, along with ensuring adequate
intake of iodine, helps prevent some types of goiter.
Hypothyroidism
■ Description. Hypothyroidism is the decrease in nor
mal T
4
production.
Advanced hypothyroidism in an adult is called
myxedema (MICK-seh-DEE-mah). Myxedema com
monly occurs in middle-aged women.
Hypothyroidism in infants is rare in the United
States. It is caused when any part of the fetus’s thyroid
fails to develop properly. Congenital hypothyroidism
is called cretinism. It can lead to mental and physical
growth challenges in the infant and young child.
■ Etiology. There are two fairly common causes of
hypothyroidism. The first and most common natu
ral cause is an autoimmune disorder called Hashimo
to’s disease. This condition occurs most frequently in
women. It is believed that lymphocytes react with thy
roid tissue, leading to destruction of the thyroid gland
tissue. This loss of tissue leaves the thyroid unable to
produce adequate amounts of thyroid hormone.
The second cause is the result of medical treat
ments. Often, treatments to cure hyperthyroidism lead
to destruction of part or all of the thyroid gland, leading
to hypothyroidism.
In underdeveloped countries, congenital hypothy
roidism is more common and is due to an iodine defi
ciency during the mother’s pregnancy.
The symptoms, diagnosis, and treatment plan for
hypothyroidism are quite similar regardless of the
cause.
■ Symptoms. Symptoms of hypothyroidism are the
opposite of those for hyperthyroidism. The affected
individual is fatigued, drowsy, and sensitive to cold tem
perature; has thin nails and brittle hair; and gains exces
sive weight. The individual becomes sluggish, affecting
both mental and physical abilities. An individual with
myxedema can exhibit all these symptoms as well as a
characteristic swelling or bloating of the facial tissue,
thickened tongue, and puffy eyelids.
Children with hypothyroidism are dwarfed with a
short, stocky body build and a protruding tongue and
abdomen. The face is abnormal, with a broad nose, puffy
eyelids, and small eyes. Sexual organs fail to develop
(Figure 14-6). Muscle growth is slowed to the point that
the child is unable to stand or walk. The earlier this condi
tion is discovered, the better the prognosis. For this reason,
many states mandate a thyroid blood test on newborns.
■ Diagnosis. Diagnosis is confirmed by review of symp
toms along with thyroid hormone blood test, including
T
4
, T
3
, and free T
4
index (FTI).
■ Treatment. This condition responds well to treatment
with thyroxine hormone replacement. Symptoms usu
ally disappear after a few months of treatment.
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Endocrine System Diseases and Disorders 289
Figure 14-6 A person with Cretinism.
■ Prevention. Most cases of hypothyroidism in the
United States are caused by Hashimoto’s thyroiditis and
cannot be prevented.
Parathyroid Gland Diseases
Parathyroid glands regulate blood calcium levels. Most
of the body’s calcium (approximately 99%) is stored
in the bones, but the remaining 1% circulates in the
blood. Blood calcium plays a vital role in blood clotting
and muscle contraction, thus affecting heart function.
If blood calcium levels drop, parathyroid hormone
(parathormone, PTH) increases the level by increasing
calcium absorption in the digestive tract, releasing cal
cium from bone stores, and saving calcium excretion in
urine. When blood calcium levels are restored to nor
mal, parathormone is no longer released. Like other
endocrine glands, most endocrine diseases of the para
thyroid are related to hypersecretion or hyposecretion.
Hyperparathyroidism
■ Description. Hyperparathyroidism is a condition of
overproduction of parathormone by one or more of the
four parathyroid glands.
■ Etiology. Over secretion is usually due to a glandular
tumor or idiopathic hyperplasia of the gland. Excessive
parathormone production causes excessive blood cal
cium levels called hypercalcemia (hyper = excessive, calc
= calcium, emia = blood).
■ Symptoms. As previously discussed, this calcium is
pulled from the bones, leading to bone weakness and
spontaneous fractures. Hypercalcemia also leads to
kidney stones because the urinary system—under the
influence of parathormone—retains calcium, further
increasing blood calcium levels. The digestive system
increases absorption of calcium, leading to abdominal
pain, vomiting, and constipation. Hypercalcemia also
leads to hyperactivity of cardiac muscle, thus causing
arrhythmias.
■ Diagnosis. Blood tests for parathormone levels assist
with diagnosis.
■ Treatment. Treatment of hyperparathyroidism is
directed at the cause. Removal of a tumor or removal
of the parathyroid glands might be necessary. Only
half of one parathyroid gland is necessary to main
tain normal parathormone levels. Other treatments
include diuretics to increase urine output, thus forcing
excretion of calcium, and limiting dietary intake of cal
cium. Prognosis is generally good with adequate treat
ment, although cardiac arrest can occur with severe
hyperparathyroidism.
■ Prevention. There is no known way to prevent pri
mary hyperparathyroidism.
Hypoparathyroidism
■ Description. Hypoparathyroidism is a decrease in the
normal amount of parathormone secreted, which leads
to abnormally low blood calcium levels.
■ Etiology. This condition is usually the result of surgi
cal removal of all parathyroid glands in an effort to treat
hyperparathyroidism or following a thyroidectomy.
■ Symptoms. Low blood calcium levels (hypocalce
mia) cause irritability to muscles, called tetany. Tetany
should not be confused with the infectious disease teta
nus (lockjaw). The tetany associated with hypoparathy
roidism affects the face and hands primarily, causing
uncontrolled contraction of these muscles.
■ Diagnosis. Physical examination reviewing for symp
toms, along with blood tests revealing low blood calcium
level and low parathyroid hormone level, aid in diagno
sis. Testing for hypocalcemia and hypoparathyroidism
may also include checking for Chvostek’s (VOHS-tecks)
and Trousseau’s (true-SOHs) signs (Figure 14-7).
290 Chapter 14
(A)
(B)
Figure 14-7 Tetany of the hand and face: (A) Positive
Chvostek’s sign. Tapping over facial nerve causes facial
muscle spasm. (B) Positive Trousseau’s sign. Pressure to
nerves and vessels of upper arm causes muscle spasm.
■ Treatment. Treatment with calcium and vitamin D,
which controls absorption of calcium from the gastro
intestinal tract, will cure the problem.
■ Prevention. There are no preventive measures for
hypoparathyroidism.
Adrenal Gland Diseases
The adrenal glands, also called the suprarenals because
they sit atop the kidneys, have two distinct parts that
function quite differently. The inner part, called the
medulla, releases two hormones, epinephrine (adrena
line) and norepinephrine, when stimulated by the ner
vous system. These hormones have a direct effect on the
vascular system and are known as fight-or-flight hor
mones. The cortex, or outer part of the adrenal gland,
is controlled by the pituitary gland’s release of ACTH.
The adrenal cortex secretes several hormones.
■ Mineralocorticoids The primary hormone is
aldosterone, which regulates salt balance.
■ Glucocorticoids The primary hormone is cortisol
(cortisone), or hydrocortisone, which regulates car
bohydrate metabolism.
■ Sex hormones The primary ones are androgens
and estrogens, which provide male and female
characteristics, respectively. Males and females
have both of these androgenic sex hormones.
Cortisone is a hormone frequently used to treat
inflammatory diseases such as arthritis because it acts
as an anti-inflammatory agent. Cortisone does not cure
the inflammatory condition; it only relieves the inflam
mation and the associated pain. Prolonged use of corti
sone is avoided whenever possible because it has some
detrimental side effects including hypertension, ulcers,
puffy face (called moon face), and drowsiness. The
anti-inflammatory properties of cortisone reduce the
body’s inflammatory response. This alteration in the
immune system can mask the symptoms of an infec
tion, allowing it to go unnoticed until it is in advanced
stages. This side effect of prolonged cortisone use can
be potentially life-threatening.
Hyperadrenalism
Hyperadrenalism is the over secretion of hormones
by the adrenal cortex. The specific forms of hyper-
adrenalism depend on which hormones are secreted
in excess. Three syndromes identified with hyper-
adrenalism are Conn’s, Cushing’s, and androgenital
syndromes.
Conn’s Syndrome
■ Description. Conn’s syndrome, also called hyperaldo
steronism, is due to an overproduction of aldosterone, a
mineralocorticoid that plays an important role in main
taining blood volume pressure and electrolyte balance.
It affects people between ages 30 and 50 and is more
common in women than in men.
■ Etiology. This form of hyperadrenalism is most often
due to an adrenal cortex tumor.
■ Symptoms. Symptoms include hypokalemia (low
potassium levels), alkalosis (increased blood pH), and
hypertension.
■ Diagnosis. Conn’s should be suspected in those with
hypertension that is resistant to standard treatment.
Diagnosing Conn’s is important because it represents
a cause of hypertension that might be curable. Blood
testing for the two hormones that play a role in stimulat
ing aldosterone is helpful and includes aldosterone and
rennin testing. Positive testing reveals high aldosterone
and low rennin levels.
■ Treatment. Removal of the tumor usually leads to a
good prognosis.
■ Prevention. There is no known prevention for most
causes of hyperaldosteronism.
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Endocrine System Diseases and Disorders 291
Cushing’s Syndrome
■ Description. Cushing’s syndrome is due to an over
production of the cortisol glucocorticoid.
■ Etiology. Cushing’s syndrome might be caused by a
tumor on the pituitary gland or on the adrenal cortex.
Prolonged administration of large doses of glucocorti
coid steroids (cortisone) will also cause this syndrome.
■ Symptoms. Classic symptoms include a round,
moon-shaped face and a buffalo hump on the upper
back. Other symptoms include fatigue, weakness, poor
wound healing, a rotund abdomen with pencil-thin
arms and legs, hypertension, and striae (stretch marks)
on the skin (Figure 14-8).
■ Diagnosis. A blood test to measure cortisol levels and
MRI to view tumors aid in diagnosis.
■ Treatment. Surgical removal of the tumor or the adre
nal cortex may correct the condition. Lifetime hormone
therapy to replace this hormone is then needed. Cush
ing’s syndrome may develop in individuals receiving
long-term glucocorticoid steroids. These individuals
need to be carefully monitored for symptoms of Cush
ing’s syndrome.
■ Preventable. Cushing’s syndrome may be prevented
by early detection and treatment of the associated
symptoms.
Androgenital Syndrome
■ Description. Androgenital syndrome is due to an
overproduction of sex hormones by the adrenal cor
tex. It is also known as adrenal virilism (masculin
ization or feminization), depending on the excessive
hormone.
■ Etiology. Androgenital syndrome is hereditary. Most
of these conditions involve excessive, or hypersecretion
of, androgen.
■ Symptoms. Increased androgen leads to premature
sexual development in boys, also called precocious
(early development) puberty. In girls, overproduction
of androgen leads to excessive hair growth on the legs,
chest, and abdomen; an enlarged clitoris; a deepened
voice; and amenorrhea (ah-MEN-oh-REE-ah; a = with
out, menorrhea = menses).
If adrenal feminization occurs due to excessive
estrogen production, girls experience premature sex
ual development (precocious puberty). Boys with an
overproduction of estrogen experience gynecomastia
(GUY-neh-koh-MAS-tee-ah; excessive breast develop
ment), testicular atrophy, and decreased libido.
Virilism in women leads to symptoms of hirsutism
(HER-soot-izm), or abnormal hair on the face and
body; decreased breast size; and amenorrhea.
Figure 14-8 Cushing’s syndrome. (A) Individual affected with Cushing’s syndrome. (B) Same individual after treatment.
292 Chapter 14
■ Diagnosis. Physical exam of symptoms and blood
testing for elevated ACTH aid in diagnosis.
■ Treatment. Treatment of adrenal cortex tumors usu
ally involves surgical removal of the tumor.
■ Prevention. Because this is a hereditary disease, it is
not preventable.
Other Diseases of the Adrenal Glands
Hypoadrenalism
■ Description. Hypoadrenalism, Addison’s disease,
is an uncommon undersecretion of hormones by the
adrenal cortex.
■ Etiology. Causes of Addison’s disease include an auto
immune disorder, tumor of the pituitary gland, tubercu
losis, and prolonged steroid hormone therapy. As much
as 90% of the adrenal cortex can be destroyed before
hyposecretion occurs.
■ Symptoms. Symptoms of Addison’s disease can be mild
to life-threatening. Lack of mineralocorticoids allows
depletion of sodium, leading to diarrhea and dehydration.
Deficiency in glucocorticoids affects blood sugar levels,
leading to hypoglycemia (HIGH-poh-gly-SEE-me-ah;
hypo = decreased, glyc = glucose, emia = blood). Increased
ACTH levels by the pituitary lead to a hyperpigmenta
tion, or increased skin coloring, ranging from yellow to
dark brown. This increased skin color affects the palms,
elbows, scars, and skin folds and the areola of the nipples.
■ Diagnosis. Diagnosis is based on medical history,
symptoms, physical examination, and blood tests,
including cortisol and ACTH.
■ Treatment. Treatment includes a combination of
glucocorticoids and mineralocorticoids to replace the
adrenal insufficiency.
■ Prevention. There are no guidelines for preventing
Addison’s disease.
Pancreatic Islets of Langerhans
Diseases
The pancreas is both an exocrine and endocrine gland.
As an exocrine gland, it secretes digestive juices through
ducts into the digestive system. As an endocrine gland,
it secretes two hormones—insulin and glucagon—
directly into the blood. Both of these hormones are
secreted by specialized tissue called islets of Langerhans
that are scattered throughout the pancreas; however,
insulin and glucagon have an antagonistic relationship.
Insulin lowers blood sugar, whereas glucagon raises it.
The overall effect of these hormones maintains a nor
mal blood sugar level (80-120 mg/dl).
When blood sugar levels rise, for instance after a
meal, insulin is secreted. Insulin assists in moving sugar
out of the blood and into the tissues, thus decreasing
the blood sugar level (Figure 14-9). Without adequate
insulin, the blood sugar level rises, and the tissues are
depleted of sugar.
Figure 14-9 Effect of insulin on blood sugar. Insulin assists in moving sugar out of the blood and into the tissues, thus
decreasing blood sugar levels. Think of insulin as “offering a hand” in pulling blood sugar levels down.
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Endocrine System Diseases and Disorders 293
Sugar, or glucose, is the primary source of energy
for all tissue cells. Without glucose, cells must burn
fats and proteins for energy. When tissue cells burn
fat and protein, they produce a waste product called
ketones. Ketones are picked up by the blood to be
filtered and excreted by the kidneys. Acetone, a part
of this ketone waste, is excreted by the respiratory
system, giving the affected individual a fruity- or
sweet-smelling breath. This condition of having
ketones in the blood, breath, and urine is called keto
sis. Chemically, a large part of ketones is acidic in
nature, which leads to metabolic acidosis, or a low
pH, in the body tissues. For this reason, ketosis is
often called ketoacidosis.
When carbohydrates or sugars are eaten, the extra
sugar, the amount not needed for immediate energy, is
stored, primarily, in the liver as glycogen. If blood sugar
levels drop, for instance during exercise, the pancreas
secretes glucagon. Glucagon circulates in the blood and
stimulates the liver to release glycogen in the form of
glucose, thus raising the blood sugar to normal.
Diabetes Mellitus (DM)
■ Description. DM, commonly known simply as diabe
tes, is the most common major disease of the endocrine
pancreas.
■ Etiology. DM is a chronic disease affecting car
bohydrate, or sugar, metabolism due to inadequate
production of insulin by the pancreatic islets of
Langerhans.
■ Symptoms. Diabetes is characterized by symp
toms of polyuria (excessive urination), polydipsia
(excessive thirst), and polyphagia (excessive eating).
Glycosuria (GLYE-koh-SOO-ree-ah; glyco = glyco
gen or sugar, uria = urine), or the spilling of sugar
in the urine, is also a common symptom. The exces
sive sugar in the blood, known as hyperglycemia
(hyper = excessive, glyc = glycogen or glucose, emia =
blood), causes the kidney to filter out part of the excess,
resulting in glycosuria. Hyperglycemia indicates that
sugar is not being pulled into the tissues, and cells are
using fat for energy, resulting in the formation of ketones
(the waste product of fat metabolism). Ketones can be
found in the blood and urine and smelled on the breath.
There are two types of DM:
Type 1
Formerly known as insulin-dependent diabetes mel-
litus (IDDM) or juvenile-onset diabetes. This form of
diabetes is the most serious and usually occurs quite
suddenly. It affects children and young adults before
age 25 and requires daily injections of insulin. Insu
lin must be injected because digestive juices would
destroy oral forms. Type 1 is thought to be caused by
an autoimmune disorder. The tendency for the dis
ease also is thought to be genetically inherited. The
immune system, when triggered by a virus or some
other stressor, develops antibodies and begins warring
against the islets of Langerhans, thereby destroying
the insulin-secreting cells. Affected individuals gen
erally do not secrete any insulin, making regulation
Berberine for
Hyperglycemia
Complementary and Alternative Therapy
B
erberine is a powerful antioxidant that can be extracted from several different plants.
It is yellow-colored and is in a class of compounds called alkaloids. Berberine has
been used for centuries in traditional Chinese medicine to treat or prevents various dis
orders. In several studies, it has been shown to lower cholesterol, promote optimal blood
pressure, boost brain health, improve digestion, strengthen immune health, and protect
liver, kidney, and pancreatic function. Berberine has also been studied for it metabolic
benefits in combating hyperglycemia in type 2 diabetes. It has been shown to be as effec
tive a pharmaceutical medicines for lowering blood glucose levels. The side effects have
been minimal, which is a plus for its use. There are concerns for the long-term use of
berberine so further studies are indicated before recommendations for its use are made.
Source: Adams (2020)
294 Chapter 14
Healthy Highlight
Using Steroids
Therapeutically
■ Anabolic steroids are synthetic derivatives of testosterone that have anabolic
(tissue-building) effects. These drugs were initially used by athletes to increase strength
and endurance, but because of their potential for abuse, steroids have been placed in
the Controlled Substance Act in category C-III. General uses include treatment for
chronic infections, some types of anemia, extensive burns, and severe trauma.
■ Use of steroids to enhance athletic performance is not recommended and has been banned
in professional athletics. Serious irreversible side effects occur with long-term use of ste
roids and include kidney damage, increased risk of liver tumors, and increased risk of heart
disease. Long-term steroid users exhibit increased irritability and aggressive behavior. In
women, masculinization occurs as evidenced by hirsutism, menstrual difficulties, male
pattern baldness, and a deepening of the voice. Men experience a decrease in testosterone
production, leading to testicular atrophy, decrease in sperm production, and impotence.
Individuals taking steroids need to follow the following recommended guidelines:
■ A well-balanced diet, including adequate proteins and carbohydrates, should be
followed during steroid therapy.
■ Never share steroid medications with others.
■ Do not stop taking these medications abruptly. A scheduled weaning regimen
should be determined and monitored by a qualified physician.
Healthy Highlight
What You Need
to Know About
Type 2 Diabetes
and Taking Dietary
Supplements
A
ccording to the National Center for Complementary and Integrative Health
(NCCIH), studies are being conducted on the use of dietary supplements to treat or
prevent type 2 diabetes. At this time, the Center recommends that individuals live a healthy
lifestyle, keep their weight down, and use conventional medical care to control their dia
betes. They have not found scientific evidence that dietary supplements are beneficial in
treating type 2 diabetes. The Center recommends individuals follow these guidelines:
■ Follow a healthy diet, participate in physical activity, and use blood glucose testing
for managing diabetes.
■ Be aware that many supplements have side effects that could be harmful to the kidneys.
■ Chromium has neither been shown in the research to prevent diabetes, nor control
glucose levels.
■ Magnesium may or may not be beneficial for managing diabetes. Benefits have been
found in some research studies but it is inconclusive at this time. However, individuals
with lower magnesium levels may have a higher risk of developing diabetes.
■ There is no research base that demonstrates that herbs or other dietary supplements
such as omega-3, alpha-lipoic acid, or cinnamon are beneficial in controlling diabetes.
■ Individuals should talk to their health care providers before taking any dietary supple
ments for diabetes. It could be particularly harmful for pregnant or nursing women,
or children.
Individuals with type 2 diabetes should follow the prescribed medical regimen prescribed
by their health care providers. Deviating from this could cause serious health care issues.
Source: Modified from the National Center for Complementary and Integrative Health (2021)
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Endocrine System Diseases and Disorders 295
of blood glucose levels quite difficult. Individuals with
type 1 must:
■ Follow a strict diet.
■ Monitor blood sugar levels on a regular basis.
■ Administer the needed amounts of insulin.
Exercise and stress can alter insulin needs and must
be considered as part of the treatment plan.
Type 2
Formerly known as noninsulin-dependent diabetes
mellitus (NIDDM) or adult-onset diabetes. This is the
more common form of DM. Until recently, this type of
diabetes was seen primarily in obese women over age
40, but due to the dramatic increase in childhood and
adolescent obesity, the trend is changing. Obesity has
led to a dramatic increase in the incidence of type 2 dia
betes among children and adolescents over the past two
decades. The Centers for Disease Control and Preven
tion (2021 reports that:
■ Nearly 14 million children and teens in the United
States are overweight to obese.
■ Obesity affects one in five children and adolescents.
These drastic increases raise concern about the future
of Americans’ health. It is well known that obesity
increases the risk of many diseases, including type
2 diabetes.
This form of diabetes is thought to be due to a
wearing out of the pancreatic islets of Langerhans.
It is believed that excessive carbohydrate consump
tion over the life of the individual places such a heavy
demand on the pancreas to produce the needed insu
lin that the pancreatic cells literally become exhausted,
and the resulting lack of insulin leads to type 2 dia
betes. Type 2 is usually controlled with diet, exercise,
and oral and/or injectable medications that stimulate
insulin secretion.
Complications of DM may be classified as immedi
ate or long term. Immediate and life-threatening com
plications of type 1 diabetes include diabetic coma and
insulin shock. Both of these complications occur as a
result of improper insulin administration, either too
much or not enough insulin. Diabetic coma can occur
as a result of not administering enough insulin or tak
ing in too many carbohydrates in the diet. Symptoms
of diabetic coma are those related to hyperglycemia and
include the following:
■ Polyuria
■ Polydipsia
■ Dehydration
■ Ketoacidosis
Diabetic coma usually progresses rather slowly.
The affected individual becomes lethargic and, if
untreated, slips into a coma. The individual in a coma
will have a slow deep-breathing pattern and fruity- or
sweet-smelling breath. The individual requires emer
gency medical treatment with insulin and intravenous
fluids.
Insulin shock occurs quite rapidly and is the result
of taking too much insulin, not eating enough food, or
participating in excessive exercise. The affected individ
ual becomes hypoglycemic with symptoms of:
■ Diaphoresis (sweating)
■ Light-headedness
■ Trembling
Complementary and Alternative Therapy
Luteolin to Maintain uteolin is a flavone and is found in some fruits and vegetables. It is considered to have
antioxidant, anti-inflammatory, anticancer, and neurological protecting effects. It is
oouco
s
e
found in celery, thyme, green peppers, chamomile tea, apples, and onions. It has been
Levels studied for its many health benefits, including its ability to assist in maintaining blood
glucose levels in type 2 diabetes. The conclusion of this study was that the potential for
luteolin or any other flavonoids being used for treatment of type 2 diabetes still needs
further research before recommendations are made.
Source: Sangeetha (2019)
296 Chapter 14
Without treatment, the affected individual pro
gresses quite rapidly into a state of confusion followed
by coma. Individuals in insulin shock need immediate
emergency medical treatment with intravenous glucose
to raise blood sugar levels (Table 14-2).
Long-term complications of diabetes usually
appear gradually after many years. With improper car
bohydrate metabolism, lipids or fats are pulled into the
bloodstream for cellular energy. This increase in lipids
in the vascular system leads to atherosclerosis.
Atherosclerosis leads to a variety of complications,
including myocardial infarction, cerebrovascular acci
dents or strokes, and peripheral vascular disease. The
poor circulation caused by peripheral vascular disease
is the cause of diabetic gangrene in the feet and legs,
which can lead to amputation, and poor wound healing.
Atherosclerosis also affects the vessels of the eyes
and kidneys. The retinas of the eyes become damaged,
causing diabetic retinopathy (retino = retina, opathy =
disease) and leading to blindness. Damage to the kid
ney leads to kidney failure, a frequent cause of death in
individuals affected with diabetes.
■ Diagnosis. Diagnosis is confirmed by a positive
history of symptoms along with blood glucose testing
including a three-hour glucose tolerance test. This test
starts with a baseline blood glucose test. Next the fasting
individual drinks a glucose-concentrated drink. Blood
testing is completed every hour after the drink is con
sumed to determine how quickly it is cleared from the
blood.
■ Treatment. Diabetes cannot be cured. Management
of the disease is dependent on education and a lifetime
commitment to following the treatment regimen of diet,
medication, and exercise. Frequently monitoring blood
glucose levels and controlling these are beneficial in
avoiding long-term complications.
The American Diabetes Association recognizes
HbA1C testing as a standard in medical care of dia
betes. This is a test that measures glycosylated hemo
globin in the blood and is a good indicator of diabetes
management.
Glycosylated hemoglobin is formed when the
hemoglobin component of the blood is exposed to high
glucose levels. Once the hemoglobin is glycosylated, it
remains that way for the duration of the red blood cells’
two- to three-month life. A high level of glycosylated
hemoglobin indicates that the blood glucose levels of
the individual have been high during the previous two
to three months.
The higher the HbA1C, the greater the risk of
developing complications such as eye disease, kid
ney disease, nerve damage, heart disease, and stroke.
TABLE 14-2 Emergency Treatment of Diabetic Coma or Insulin Shock
Step 1: Determine a Need for Intervention
Unfortunately, it is usually difficult to determine whether an affected individual is suffering from diabetic coma or insu
lin shock, especially if found in a comatose state. The best rule to follow in this case is, “when in doubt—sugar” Raising
an already elevated glucose level is not as life-threatening as allowing the blood sugar level to remain low or to drop even
further.
Step 2: Administer Glucose
If the individual is still alert, drinking fruit juice with sugar added can be effective in raising blood sugar level. If juice is not
available, candy of any type will help. If the individual is unconscious and emergency medical assistance is not available,
turn the individual on his or her side and place table sugar or hard candy in the lower cheek of the mouth to help raise
blood sugar. Emergency medical assistance should be sought immediately.
Additional Important Information
Individuals with diabetes should wear a diabetic alert tag and should carry some type of carbohydrate treat with them at all
times for use during a hypoglycemic reaction. If an incident occurs, the tag alerts the medical responder or other individ
uals aiding the person that he or she is diabetic and, thus, could be having a hypoglycemic or hyperglycemic reaction. This
saves time between assessing the victim for probable cause of the problem and treating the person. The diabetic alert tag
also helps those who are assisting the individual to recognize the fruity breath of a hyperglycemic diabetic as ketone breath
rather than mistaking it as alcohol breath. Allowing a hyperglycemic individual to “sleep it off” can be a fatal mistake.
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