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PITUITARY GLAND
 Pituitary gland is a master gland.
* Located at the base of the brain.
* Directly affects the function of the other endocrine
glands.
* Promotes growth of body tissues.
* Influences water absorption by the kidney.
* Controls sexual development and function.
ADRENAL GLANDS
* Two small glands, one above each kidney.
* Regulates sodium and water retention.
* Affects CHO, fat and CHON metabolism.
* Influences development of sexual characteristics.
* The adrenal cortex synthesizes glucocorticoids and
mineralocorticoids.
* The adrenal medulla produces epinephrine and
norepinephrine.
THYROID GLAND
* Located anterior part of the neck.
* Controls rate of body metabolism and growth.
* Produces T4, T3 and thyrocalcitonin.
PARATHYROID GLANDS
* Located near the thyroid.
* Controls calcium and phosphorus metabolism.
* Produces parathyroid hormone.
PANCREAS
* Located posterior of liver.
* Influences CHO metabolism.
* Indirectly influences fat and CHON metabolism.
* Produces insulin and glucagon.
OVARIES
* Located in the pelvic cavity.
* Produce estrogen and progesterone.
TESTES
* Located in the scrotum.
* Contributes to the development of secondary
sex characteristics.
* Produce testosterone.
a

ÿ SH
Ɗ stimulates graafian follicle growth and estrogen secretion.
ÿ LH
Ɗ induces ovulation & development of corpus luteum and
stimulates testosterone secretion in men.
ÿ ACTH
Ɗ stimulates secretion of hormones from adrenal cortex.
ÿ TSH
Ɗ regulates secretory activity of thyroid gland.
ÿ GH
Ɗ stimulates growth of cells, bones, muscles and soft tissue.
ÿ Prolactin
Ɗ development of mammary glands & lactation
PPG:
ÿ ADH (Vasopressin)
Ɗ regulates water metabolism; helps body to retain
water.
ÿ Oxytocin
Ɗ stimulates uterine contractions during labor and
milk secretion in lactating mothers.
a
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ÿ Glucocorticoids (Cortisol, Cortisone,
Cortecosterone)
- increase blood glucose levels by increasing
rate of glyconeogenesis; increases CHON
catabolism; increase mobilization of fatty acids;
promote sodium & water retention; anti-
inflammatory effect; aid the body in coping stress.

ÿ Mineralocorticoids (Aldosterone, Deoxycortisone)

- regulate  E balance; stimulate reabsorption
of sodium, chloride & water; stimulate potassium
excretion.
a
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ÿ Epinephrine and Norepinephrine
- function in acute stress; increase heart
rate & BP; dilate bronchiole; convert glycogen
to glucose when needed by muscles for energy.


ÿ T3 & T4
Ɗ regulate metabolic rate, CHO, fat and CHON
metabolism; aid in regulating physical and mental
growth & development.
ÿ Thyrocalcitonin
Ɗ lowers serum calcium by increasing bone
deposition.
Pa
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ÿ PTH
Ɗ regulate sodium calcium and
phosphate levels.
Pa
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ÿ Insulin
Ɗ allows glucose to diffuse across cell
membrane; converts glucose to glycogen.
ÿ Glucagon
Ɗ increases blood glucose by causing
gluconeogenesis in the liver; secreted in
response to blood sugar.
a

ÿ Estrogen & Progesterone
- development of secondary sex characteristics
in female, maturation of sex organs, sexual
functioning , maintenance of pregnancy.

ÿ Testosterone
Ɗ development of secondary sex characteristics
in males , maturation of sex organs, sexual
functioning.
RADIOACTIVE IODINE UPTAKE (RAIU)

*A thyroid function test that measures the absorption of the

iodine isotope to determine how the thyroid gland is functioning.
*Administration of I123 or I131 orally followed in 24 hrs. by a
scan of the thyroid for the amount of radioactivity emitted.
*Normal value is 5-35% in 24 hours
*Elevated values indicate hyperthyroidism, thyrotoxicosis,
decreased iodine intake or increased iodine excretion.
*Decreased values indicate hypothyroidism, thyroiditis, low T4,
use of antithyroid meds.
*Thyroid medication must be discontinued 7-10 prior to test.
*No radiation precautions necessary.
T3 & T4 RESIN UPTAKE TEST
*Blood test for diagnosis of thyroid disorders
*T3 & T4 regulate thyroid-stimulating hormone
*Normal Value of T3: 80-230 ng dL
T4: 5-12 ng dL
*Both values increase in hyperthyroidism & decreased in hypo-
thyroidism

THYROID-STIMULATING HORMONE (TSH)

*Blood test used to differentiate the diagnosis of primary
hypothyroidism from secondary hypothyroidism.
*Normal value is 0.2 to 5.4 micro units ml
*Elevated in primary hypothyroidism & decreased in hyper-
thyroidism or secondary hypothyroidism
THYROID SCAN

*Performed to identify nodules or growths in the thyroid

glands

*A radio isotope of iodine or technetium is administered prior

to the scanning of the thyroid gland.

*Level of radioisotope is not dangerous to self or others.

*Discontinue medications containing iodine 14 days prior to

test
and discontinue thyroid meds 4-6 weeks prior to test.

*NPO post MN; if iodine is used client will fast an additional

45 minutes after ingestion of radioactive isotope & scan is
done after 24 hours.
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Eight-hour intravenous ACTH Test

*Administration of 25 units of ACTH in 500 ml of

saline over an 8-hr period.
*Used to determine function of adrenal cortex.
*24-hr urine specimens are collected, before & after
administration, for measurement of 17-ketosteroids
and 17-hydrocorticosteroids.
*In Addisonƍs disease, urinary output of steroids does
not increase following administration of ACTH;
normally steroid excretion increases threefold to
fivefold ff. ACTH administration.
*In Cushingƍs syndrome, hyperactivity of the adrenal
cortex increases the urine output of steroids in the
second urine specimen tenfold.
GLUCOSE TOLERANCE TEST (GTT)
*Aids in the diagnosis of diabetes mellitus
*If the glucose level peaks at higher than normal at 1 to 2 hours
after injection or ingestion of glucose, and are slower than normal
to return to normal levels, DM is diagnosed
*Preparation:
-eat a high-carbohydrate (200 to 300 g) diet for 3 days before
the test
-avoid alcohol, coffee & smoking 36 hours before testing
-fast midnight before test
-fasting blood glucose & urine glucose specimens obtained.
-avoid strenuous exercise 8 hours before & after test
-client ingests 100g glucose; blood sugar drawn at 30 & 60 mins.
then hourly for 3-5 hrs.; urine specimens may also be collected.
GLYCOSYLATED HEMOGLOBIN
Glycosylated hemoglobin is blood glucose
bound to hemoglobin
*Is a reflection of how well blood glucose levels have
been controlled for up to the prior 4 months
*Hyperglycemia in clients with DM causes increase in
glycosylated hemoglobin
*asting is not needed
*Values:
Diabetics with good control: 7.5% or less
Diabetics with fair control: 7.6% to 8.9%
Diabetics with poor control: 9% or greater
ANTERIOR PITUITARY
Hypopituitarism
Hyperpituitarism

POSTERIOR PITUITARY
Diabetes Insipidus
SIADH (Syndrome of Inappropriate Antidiuretic
Hormone)
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*Hyposecretion of growth hormone by

the anterior pituitary
gland

Etiology:
- tumors, trauma, encephalitis,
autoimmunity, or stroke
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Pituitary Dwarfism
*Hypersecretion of GH by anterior pituitary
gland which results
in gigantism or acromegaly
*Gigantism occurs in childhood before the closure
of epiphyses of the long bones vs acromegaly
which occurs after the closure of epiphyses of the
long bones

 Etiology:
- Unknown, Pituitary adenomas tumors
 
 
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àigantism

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a romegaly
’ Pituitary adenectomy, transsphenoidal pituitary
surgery
’ Is the removal of the pituitary tumor via craniotomy
or via transsphenoidal (endoscopic transnasal)
approach.
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*Removal of pituitary gland

*Post-operative care:
-Monitor V S, neurological status & LOC
-Elevate head of bed
-Monitor for increased intracranial pressure & any
postnasal drip which might be CS
-Avoid sneezing, coughing & blowing nose
-Monitor for temporary diabetes insipidus
-Monitor I & O & water intoxication
-Administer antibiotics, analgesics, antipyretics,
hormones & glucocorticoids if entire gland is removed
 -Hyposecretion of ADH & deficiency
of vasopressin
-Kidney tubules fail to reabsorb water

 Etiology:
-by trauma, strokes, or idiopathic causes
Pathophysiology

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Causes:
- trauma, strokes, malignancies,
medications and stress
 Pathophysiology
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ADRENAL CORTEX
Addisonƍs disease
Cushingƍs syndrome
Aldosteronism (Connƍs Syndrome)

ADRENAL MEDULLA
Pheochromocytoma
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1. Decrease stress:
a. Provide quiet environment, nondemanding schedule.
2. Promote adequate nutrition:
a. Diet: acute phase- high sodium, low potassium;
nonacute phase- increase CHO and CHON
b. luids: force to balance fluid, monitor I&O, WOD
c. Administer lifelong exogenous replacement therapy as
ordered:
1. Glucocorticoids- prednisone, hydrocortisone
2. Mineralocorticoids- fludrocortisone (lorinef)
3. Health teaching:
a. Take meds with food or milk.
b. Avoid stress
4. Monitor for s sx of addisonian crisis
Life-threatening disorder caused by acute adrenal
insufficiency precipitated by stress, infection, trauma or
surgery.

*May cause hyponatremia, hypoglycemia, hyperkalemia & shock.

*Given glucocorticoids IV e.g. hydrocortisone Na succinate (Solu-

Cortef), mineralocorticoids e.g. fludrocortisone (lorinef).

*Severe, generalized muscle weakness, severe hypotension,

hypovolemia, shock (vascular collapse)

*Check BP & electrolyte levels.

*Strict bed rest in quiet environment & protect from infection


 
  


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1. Promote comfort: protect from trauma.
2. Prevent complications: monitor fluid balance, glucose
metabolism, hypertension, infection.
3. Health teachings:
a. Diet: increased protein, potassium, decreased calories,
sodium
b. Meds:
1. Cytoxic agents: aminoglutethimide (Cytaden),
trilostane (Modrastane), mitotane (Lysodren)- to
decrease cortisol production.
2. Replacement hormones as needed.
c. S Sx of progression of disease.
d. Prepare client for adrenalectomy.

 


 










 

 
  
 


 
   




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*Catecholamine-producing tumor
usually found in the adrenal gland.
*Causes hypersecretion of epinephrine
& norepinephrine by the adrenal
medulla
Pathophysiology

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*Surgical removal of one or more of the adrenal gland
because of tumors or overactivity

*or unilateral adrenalectomy, up to 2 years of glucocorticoid

therapy needed; for bilateralƕlifelong replacement

*Preop: reduce risk of postop cx

a. Prescribed steroid therapy, given 1 wk. before surgery
b. Antihypertensive drugs discontinued
c. Sedation as ordered

*During surgery: monitor for hypotension & hemorrhage

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bethamethasone (Celestone), cortisone (Cortone)
dexamethasone (Decadron), prednisone (Orasone)

*Stimulate the adrenal cortex to secrete cortisol

*Produces an antiinflammatory effect.

*A R: Increased appetite, mood swings, water & Na

retention, hypocalcemia & hypokalemia, cushing-like
symptoms
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*Produce metabolic effects; alters normal immune response &
suppress inflammation; promote Na & H2O retention & K+
excretion

*Produce antiinflammatory , antiallergic & anti-stress effects;

replacement for adrenocortical insufficiency

*A R: hyperglycemia, hypokalemia, edema & masks signs &

symptoms of infection

*C I: DM, increases effect of anticoagulants & oral antidiabetic

agents; increases potency of aspirins & NSAIDS & K-sparing
diuretics

*Check for overdose or signs of Cushingƍs syndrome; additional

doses during stress or surgery.
fludrocortisone (lorinef)

*Steroid hormones that enhance the reabsorption of NaCl &

promote K+ excretion & hydrogen at the renal tubule promoting
fluid & electrolyte balance

*Used in primary & secondary Addisonƍs disease

*S E: Na H2O retention, hypokalemia, hypocalcemia, delayed

wound healing, increased susceptibility to infection, mood
swings, weight gain

*Take with food or milk; high-K+ diet

*Wear Medic-Alert bracelet

HYPOTHYROIDISM (MYXEDEMA)

HYPERTHYROIDISM (GRAVEƍS DISEASE)

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 - Hyposecretion of the thyroid hormone
characterized by decrease rate of body
metabolism.

Etiology
- autoimmune thyroiditis, ablative
theraphy, and idiopathic
^ypothyroidism

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Subjective data:
6 Weakness, fatigue, lethargy, headache, slow memory, loss of
interest in sexual activity.

Objective data:
6 Cardiomegaly, bradycardia, hypotension, anemia

6 Menorrhagia, amenorrhea, infertility

6 Dry skin, brittle nails, coarse hair, hair loss
6 Slow speech, hoarseness, thickened tongue
6 Weight gain: edema, periorbital puffiness
6 Lab data: elevated TRH, TSH; normal-low serum T4 & T3;
decreased RAUI.
6 Depressed BMR; intolerance to cold
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Levothyroxine (Synthroid, Levothroid, Levoxyl)
Thyroglobulin (Proloid)

*Controls the metabolic rate of tissues & accelerates heat

production & oxygen consumption
*or hypothyroidism, myxedema & cretinism

*A R: cramps, diarrhea, nervousness, tremors, hypertension,

tachycardia, insomnia, seating & heat intolerance

*Taken same time every day preferably in the a.m. with food
*Teach client to how to take HR
*Avoid foods that will inhibit thyroid secretions such as:
strawberries, peaches, pears, cabbage, turnips, spinach,
Brussels sprouts, cauliflower, peas & radishes
*Wear Medic-Alert bracelet
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1. Provide for comfort and safety: monitor for
infection or trauma; provide warmth, prevent heat
loss & vascular collapse; administer thyroid meds
as ordered.
2. Health teaching:
a. Diet: low calorie, high protein
b. S Sx of hypothyroidism & hyperthyroidism
c. Lifelong meds, dosage, desired effects, side
effects.
d. Stress-management techniques
e. Exercise program
*Rare but serious d o which result from persistently
low thyroid hormone precipitated by acute
illness, rapid withdrawal of thyroid meds, use of
sedatives & narcotics

Assessment
- hypotension, bradycardia, hypothermia, hyponatremia,
hypoglycemia, respiratory failure & death
- Patent airway
- Keep patient warm & check V S frequently
- Administer IV fluids & levothyroxine Na (Synthroid)
- Give IV glucose & corticosteroids
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 - Hypersecretion of the thyroid hormone
T3 and T4

Etiology:
- benign adenomas, Graveƍs disease
- frequently in adults between ages 20
and 50
- 2 to 4x common in women
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Subjective data:
 nervousness, mood swings, palpitations, heat
intolerance, dyspnea, weakness.

Objective data:
 Eyes: exophthalmos, characteristic stare, lid lag.
 Skin: warm, moist, velvety; increased sweating;
increased melanin pigmentation; pretibial edema
with thickened skin & hyperpigmentation
 Weight loss despite increased appetite
 V S: increased systolic BP, widened pulse
pressure, tachycardia
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^yperthyroidism
^yperthyroidism

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1. Protect from stress: private room, restrict visitors, quiet

environment.
2. Promote physical & emotional equilibrium:
a. cool, quiet, cool well ventilated environment.
b. eye care: sunglasses to protect from photophobia,
protective drops (methylcellulose) to soothe cornea
c. diet: high calorie, protein, vit. B; avoid stimulants
3. Prevent complications: give medications as ordered.
4. Monitor for thyroid storm.
5. Health teaching: stress reduction techniques;
importance of medications; methods to protect eyes
from environment; s sx of thyroid storm.
ÿAcute & life threatening condition in
uncontrolled hyperthyroidism

*Risk factors:
Infection, surgery, beginning labor to
give birth, taking inadequate antithyroid
medications before thyroidectomy.

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 MEDICAL MANAGEMENT
1. Propylthiouracil (PTU)
- blocks thyroid synthesis

2. Methimazole (Tapazole)
- to inhibit synthesis of thyroid hormone

3. Iodine preparations (SSKI, Lugolƍs Solution)

- decrease size & vascularity of the thyroid gland
- palatable if diluted with water, milk or juice
- give through straw tp prevent staining of teeth
- takes 2-4 weeks before results are evident
4. Beta blockers: Propranolol (Inderal), atenolol
(Tenormin), metoprolol (Lopressor)
- given to counteract the increased metabolic effect of thyroid
hormones
- relieve symptoms of tachycardia, tremors & anxiety
*Removal of thyroid gland & performed for
persistent hyperthyroidism

*PRE-OPERATIVE CARE:
-Assess V S, weight, electrolyte & glucose
level
-Teach DBE & coughing as well as how to
support neck in post-op period when
coughing & moving
-Administer antithyroid meds etc. to prevent
thyroid storm

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HYPOPARATHYROIDISM

HYPERPARATHYROIDISM
 A condition which reflects deficient PTH secretion
resulting in hypocalcemia and hyperexcitability

Etiologic Classifications:
ÿCongenital absence of all the parathyroid glands
ÿAcquired deficiency
ÿNeck surgery (removal of parathyroid adenoma,
thyroidectomy, bilateral neck resection for cancer
ÿMalignancy or metastasis from a cancer to the parathyroid
glands
ÿInfection
ÿMagnesium deficiency Ɗ (magnesium regulates PTH release)
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Clinical Manifestation:
- hypercalcemia & hypophosphatemia
- fatigue & muscle weakness
- skeletal pain & tenderness
- bone deformities resulting from
pathologic fractures
-weight loss
-constipation
- hypertension,
-cardiac dysrhythmias
- renal stones
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*PRE-OPERATIVE CARE:
-monitor calcium, phosphate & magnesium
level
-ensure that calcium is near normal
-explain to patient that talking may be painful
2 days post-op
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CALCIUM SUPPLEMENTS
calcium carbonate (Tums)
calcium gluconate
calcium lactate

VITAMIN D SUPPLEMENTS
calcifediol (Calderol)

CALCIUM REGULATORS
calcitonin human (Cibacalcin)

ANTIHYPERCALCEMICS
edetate disodium (Disotate)
*Parathyroid hormone regulates serum calcium levels

*Low serum calcium level stimulate parathyroid

hormone release

*Hyperparathyroidismƕgiven antihypercalcemics

*Hypoparathyroidismƕgiven calcium & Vit. D

DIABETES MELLITUS
A CHRONIC DISORDER O IMPAIRED GLUCOSE
INTOLERANCE AND CARBOHYDRATE, PROTEIN &
LIPID METABOLISM; CAUSED BY A DEIECIENCY
O INSULIN
1. INSULIN-DEPENDENT DIABETES

2. NON-INSULIN DEPENDENT DIABETES

 *Insulin increases glucose transport into cells & promotes con-
version of glucose to glycogen, decreasing serum glucose
levels
*Primarily acts in the liver, muscle, adipose tissue by attaching
to receptors on cellular membranes & facilitating transport of
glucose, potassium & magnesium

*Hormone secreted by the alpha cells of the islets of Langerhans

in the pancreas
*Increase blood glucose by stimulating glycogenolysis in the
liver
*given SC, IM or IV routes
*Used to treat insulin-induced hypoglycemia when
semiconscious unconscious
 Deficient insulin production
[
Hyperglycemia
[
Inc. concentration of blood glucose
[
Glucosuria
[
Excess glucose excreted in urine
[
Excess fluid loss
[
Polyuria Polydipsia
 Insulin deficiency
[
Impaired metabolism of CHON and fats
[
Weight loss
[
Decreased storage of calories
[
Polyphagia
ASSESSMENT
ù POLYPHAGIA
ù POLYDIPSIA
ù POLYURIA
ù HYPERGLYCEMIA
ù WEIGHT LOSS
ù BLURRED VISION
ù SLOW WOUND HEALING
ù VAGINAL INECTIONS
ù WEAKNESS & PARESTHESIAS
ù SIGNS O INADEQUATE EET CIRCULATION
APPROACH TO DIABETES MELLITUS:

ÿ DIET

ÿ EXERCISE

ÿ MONITORING

ÿ ORAL HYPOGLYCEMIC AGENTS INSULIN

ÿ EDUCATION
Advantages of SMBG
actors affecting SMBG - visual acuity, fine motor coordination,
cognitive ability, comfort with technology, willingness to use it,
cost

Disadvantages
IMproper application of blood
Damage to reagent strips(outdated strips)
Improper cleaning & maintenance

Every 6-12 months - patient should conduct comparison of

Their meter with laboratoy-measured blood
PHARMACOLOGIC
THERAPY
TYPE ONSET PEAK DURATION

RAPID-ACTING INSULIN
Lispro (Humalog) 10-15 mins 1 hour 3 hours

SHORT-ACTING INSULIN
Humulin Regular 0.5-1 hour 2-3 hours 4-6 hours

INTERMEDIATE-ACTING INSULIN
Humulin NPH 3-4 hours 4-12 hours 16-20 hours
Humulin Lente 3-4 hours 4-12 hours 16-20 hours

LONG-ACTING INSULIN
Humulin Ultralente 6-8 hours 12-16 hours 20-30 hours

PREMIXED INSULIN 0.5-1 hour 2-12 hours 18-24 hours

70% NPH-30% Regular
 COMPLICATIONS O
INSULIN THERAPY

ùLOCAL ALLERGIC REACTIONS

ùSYSTEMIC ALLERGIC REACTIONS
ùINSULIN LYPODYSTROPHY
ùRESISTANCE TO INJECTED INSULIN
ùMORNING HYPERGLYCEMIA
Sulfonylureas(1st Generation)
Acetohexamide (Dymelor)
Chlorpropamide (Diabinase)
Tolbutamide (Orinase)
Sulfonylureas(2nd Generation)
Glimepiride (Amaryl)

Non-Sulfonylureas Insulin Secretagogues

Repaglinide (Prandin)
Thiazolidinediones
Rosiglitazone (Avandia)
Biguanides
Metphormine (Glucophage)
Alpha-Glucosidase Inhibitors
Acarbose (Precose)
 DUCau

7 TIPS OR DIABETES MANAGEMENT
ùHEALTHY EATING
ùBEING ACTIVE
ùMONITORING
ùTAKING MEDICATIONS
ùPROBLEM SOLVING
ùREDUCING RISKS
ùHEALTHY COPING
*HYPOGLYCEMIA
*DIABETIC KETOACIDOSIS (DKA)
*HYPERGLYCEMIC HYPEROSMOLAR
NONKETOTIC SYNDROME (HHNS)
*sweating
*tremor
*tachycardia
*palpitations
*nervousness
*hunger
*3 or 4 commercially prepared glucose tablets
CHILD: 2-3 GLUCOSE TABS
*4-6 ounces of fruit juice or regular soda
CHILD: ½ CUP OR 120 ML O ORANGE JUICE OR SUGAR-SWEETENED JUICE

*6-10 Life Savers or hard candy

CHILD: 3-4 HARD CANDIES OR 1 CANDY BAR
*2-3 teaspoons of sugar or honey
CHILD: 1 SMALL BOX O RAISINS
 Progressive insulin deficiency
[
Glucogenolysis
Gluconeogenesis
[
Contribute to further hyperglycemia
[
Breakdown of fats
[
Increased production of ketones
Assessment:

*3 Ps
*Blurred Vision
*Weakness
*Headache
*Orthostatic Hypotension
*rank Hypotension Weak, rapid pulse
*Anorexia, nausea, vomiting & abdominal pain
*Acetone breath (fruity odor)
*Kussmaul respirations
*Mental status changes
Hyperglycemic Hyperosmolar
Nonketotic Syndrome

Similar to DKA but without Kussmaul

Respirations and acetone breath.

 Hypotension
 Profound dehydration
 Tachycardia
 Neurologic signs
*DIABETIC RETINOPATHY
*DIABETIC NEPHROPATHY
*DIABETIC NEUROPATHY
*Prevent moisture from accumulating between toes
*Wear loose socks & well-fitting (not tight) shoes & instruct
client not to go barefoot
*Change into clean cotton socks daily
*Wear socks to keep feet warm
*Do not wear the same shoes 2 days in a row
*Do not wear open toed shoes or shoes with strap that goes
between toes
*Check shoes for tears or cracks in lining & for foreign objects
before putting them on
*Break in new shoes gradually
*Cut toenails straight across & smooth nails with an emery board
*Do not smoke
*Meticulous skin care & proper foot care
*Inspect feet daily & monitor feet for redness, swelling or break
in skin integrity
*Avoid thermal injuries from hot water, heating pads & baths
*Wash feet with warm (not hot) water & dry thoroughly
(avoid foot soaks)
*Do not soak feet
*Do not treat corns, blisters or ingrown nails
*Do not cross legs or wear tight garments that may constrict
blood flow
*Apply moisturizing lotion to feet but not between toes
*Take insulin or oral hypoglycemic agents as prescribed.

*Test blood glucose & test the urine for ketones every 3-4
hours

*If meal plan cannot be followed, substitute with soft food 6-8
x per day

*If vomiting, diarrhea or fever occurs, consume liquids every ½

to 1 hour to prevent dehydration & to provide calories

*Notify doctor if vomiting, diarrhea, or fever persists, if blood

glucose levels are greater than 250 to 300 mg dL, when
ketonuria is present for more than 24 hours, when unable to
take food or fluids for a period of 4 hours, when illness persists
for more than 2 days
END