Module 7Caring for Children with Alterations in

Metabolism - Endocrine

Chapter 29

Diabetes Mellitus

Definition: metabolic disorder characterized by hyperglycemia because of lack of insulin or a resistance to insulin

Classifications Type 1 Diabetes

destruction on pancreatic beta cells Type 2 Diabetes

insulin resistance

Impact of Diabetes

leading cause of renal failure major cause of blindness most frequent cause of non-trauma

amputations affects 17 million increasing prevalence of type 2 in children

and adults >1/3 of all newly diagnosed diabetes in children

Historical Facts

Diabetes is from the Greek word “to siphon” Mellitus is from Latin word “sweet”

Usually died within 2-3 years from starvation

1921 - Insulin discovery increased life span experiencing long term effects of diabetes

1979 - self glucometers

Diabetes Type 1

Beta cells no longer produce insulin hyperglycemia fats and protein are broken down development of ketosis

accounts for 10-15% of all casesoccurs in childhood or adolescence

Diagnostic Tests

1. Symptoms of diabetes and random b.s. >200mg/dL

2. fasting glucose >126mg/dL 3. Oral glucose tolerance test - OGTT

after 2 hrs glucose is >200mg/dL 4. Glycosylated hemoglobin - Hemoglobin

A1Caverage glucose over 2-3 months

Routine accu checks for management Type 1 3x/day

Hyperglycemia

Hyperglycemia leads to polyuria glycosuria polydipsia polyphagia weight loss malaise and fatigue blurred vision

Diabetic Ketoacidosis DKA

Results from a breakdown of fatoccurs when undiagnosed or known

diabetic has an increased energy needblood sugar >250mg/dLpH < 7.3ketones and glucose in the blood and

urine

DKA - Treatment

Regular insulin - sub q or IV

Restore fluid balance - .9NS IV

Correct electrolyte imbalances - K+

Hypoglycemia verses Hyperglycemia

Long Term Complications of Diabetes

Coronary Artery Disease Hypertension Stroke

Peripheral Vascular DiseaseDiabetic Retinopathy

retinal ischemia leading cause of blindness ages 25-74

Complications of Diabetes

Diabetic nephropathy glomerular changes in

kidneys leading to impaired renal function

microalbuminuria most common cause ESRD

in America

Therapeutic Management

Monitoring keeping blood glucose levels close to normal

InsulinDietary managementExerciseFuture

pancreatic transplant, beta cell transplant

Medications

Insulin all type 1

Terms describing insulin onset, peak, duration

Types rapid acting, short acting,

intermediate, long and combinations

Injection sites

Nutrition

Need consistent meal times

Goals near-normal glucose levels optimal lipid levels adequate calories to maintain growth

Meal planning eat less fat and saturated fat sugars and sweets in moderation

Diet Management

Type 1 correlate eating with insulin onset Carb counting is main diet plan for children with

diabetes “Illness Management Plan”

change in insulin dosage attention to fluid balance

The Nursing Process

Working together child/family individualized plan follow-up support community support

Growth Hormone Deficiency

Decreased activity of pituitary gland Diagnosed in males earlier than females

Short stature is noticed more often in males Causes of deficiency

Infarct of pituitary gland (sickle cell) Central nervous system infection Tumors Brain trauma Chemotherapy Emotional deprevation

Signs and Symptoms

Below the 3rd percentile on growth chart in height by 1 year of age

Overweight Higher pitched voices Delayed dentition Decreased muscle mass Delayed sexual maturation hypoglycemia

Treatment

Treat underlying causeGrowth hormone replacement

Daily injections of hormone

Possible delay of puberty to allow more time for growth hormone therapy to work

Precocious Puberty

Appearance of any secondary sexual characteristics before 8 years of age in females and 9 years of age in males

Hypothalamus is activated to secrete gonadtropin-releasing hormone

In males is usually result of intracranial tumor

Females is usually idiopathic

Children will have advanced bone ageStop growing prematurely

Hormones stimulate early closure of epiphyseal plates

Mood swingsEmotional labilty

Treatment