Chapter 10: Endocrine Nursing — Diabetes, Thyroid, and Adrenal Disorders

The endocrine system regulates metabolism, growth, reproduction, and stress response. Nursing management of endocrine disorders requires precise monitoring of blood glucose, hormone levels, and vital signs — errors can be fatal.

Diabetes Mellitus

Type 1 vs. Type 2

Feature	Type 1 DM	Type 2 DM
Mechanism	Autoimmune destruction of beta cells; absolute insulin deficiency	Insulin resistance + relative deficiency
Onset	Abrupt; usually < 30 years	Gradual; usually > 40 years (increasing in youth)
Body type	Usually lean	Often overweight/obese
Insulin	Always required	May start with oral agents; insulin added over time
Ketoacidosis	Common (DKA)	Rare (more likely HHS)

Insulin Types

Type	Onset	Peak	Duration	Example
Rapid-acting	10–30 min	1–3 hr	3–5 hr	Lispro (Humalog), Aspart (NovoLog)
Short-acting (Regular)	30–60 min	2–4 hr	5–8 hr	Humulin R, Novolin R
Intermediate (NPH)	1–3 hr	4–12 hr	12–18 hr	Humulin N, Novolin N
Long-acting	1–2 hr	No peak	20–24 hr	Glargine (Lantus), Detemir (Levemir)
Ultra-long-acting	6 hr	No peak	> 42 hr	Degludec (Tresiba)

Nursing rule: Rapid-acting insulin is given within 15 minutes of a meal. Never mix glargine with other insulins.

DKA vs. HHS

Feature	DKA	HHS (HHNS)
Patient	Type 1 DM	Type 2 DM (older)
Blood glucose	250–600 mg/dL	> 600 mg/dL (often > 1000)
Ketones	Positive (ketonemia, ketonuria)	Absent or trace
pH	< 7.3 (acidosis)	Normal or slightly low
Osmolality	Mildly elevated	Severely elevated (> 320 mOsm/kg)
Level of consciousness	Alert to confused	Profoundly altered (coma)
Treatment	IV fluids (NS), insulin drip, K⁺ replacement	Aggressive IV fluid replacement; lower glucose slowly

Critical: Do NOT start insulin in DKA until K⁺ ≥ 3.5 mEq/L (insulin drives K⁺ into cells, can cause fatal hypokalemia).

Thyroid Disorders

Hypothyroidism: bradycardia, cold intolerance, fatigue, weight gain, constipation, myxedema. Treatment: levothyroxine (take on empty stomach; do not take with calcium, iron, or antacids).

Hyperthyroidism: tachycardia, heat intolerance, weight loss, exophthalmos (Graves’ disease), anxiety, diarrhea. Treatment: antithyroid drugs (PTU, methimazole), radioactive iodine, beta-blockers for symptom control.

Thyroid Storm (thyrotoxic crisis): fever > 38.5°C, tachycardia > 140, altered consciousness — medical emergency. Treatment: PTU, SSKI (potassium iodide), beta-blockers, corticosteroids, cooling measures.

Adrenal Disorders

Addison’s Disease (adrenal insufficiency): low cortisol and aldosterone → weakness, hypotension, hyperpigmentation, hyponatremia, hyperkalemia, hypoglycemia.

Adrenal Crisis (Addisonian crisis): life-threatening acute cortisol deficiency, often triggered by stress/infection. Signs: severe hypotension, shock, confusion. Treatment: immediate IV hydrocortisone, aggressive fluid resuscitation (NS with dextrose).

Cushing’s Syndrome: excess cortisol → central obesity, moon face, buffalo hump, purple striae, hypertension, hyperglycemia, immunosuppression.

Key Checklist

• Compare DKA and HHS in terms of blood glucose level, ketone status, pH, and fluid management priorities
• Explain why potassium levels must be checked before starting insulin in DKA and describe the management protocol
• Identify the clinical signs of thyroid storm and adrenal crisis and state the immediate nursing interventions for each