Diabetes Mellitus

DIABETES MELLITUS
Diabetes is classified into two major types:

TYPE1 – one of the most common chronic diseases in
children and most significant endocrine disorder that affects
children.
TYPE 2 – previously seen more commonly in adults, has been
seen more commonly in children.
TYPE 1 DIABETES MELLITUS
• Usually diagnosed between the age of 4 to 15 years.
PATHYSIOLOGY
• The disease is caused as the result of an autoimmune destruction of beta
(insulin-secreting) cells of the islets of Langerhans in the pancreas.
• Genetics appears to be a contributing factor.
• Some researchers believe that the presence of an acute infection during
childhood may trigger a mechanism in genetically susceptible children,
activating beta-cell dysfunction and disrupting insulin secretion.
• The secretion of insulin is inadequate or nonexistent, allowing sugar to
accumulate into the blood stream and spill over the urine.
• In children, type 1 diabetes mellitus causes and abrupt pronounce decrease
in insulin production, resulting in decreased ability to derive energy from food
eaten.
Clinical Manifestation
• Polyuria (dramatic increase in urinary output with enuresis)
• Polydipsia (increased thirst)
• Polyphagia (increased hunger and food consumption)
These symptoms are usually accompanied by weight loss and lack
of energy.
• Diabetic ketoacidosis – characterized by drowsiness, lethargy, dry
skin, flushed cheeks and cherry red lips, acetone breath with a fruity
smell
• Kausmaul breathing – (abnormal increased in the depth and rate of
the respiratory movements.)
Nausea and vomiting may occur.
If left untreated, the child lapses into coma and exhibits
dehydration, electrolyte imbalance, rapid pulse, and subnormal
temperature and blood pressure.
DIAGNOSIS
• Carefully observe for signs and symptoms in all members of family with
a history of diabetes.
• The family should be taught to observe children for frequent thirst,
urination, and weight loss.
• All relatives of people with diabetes are considered a high-risk group
and should have periodic testing.
• Urine dipstick test - Fingerstick glucose test and test for ketones in the
urine.
• If the blood glucose level is elevated or ketonuria is present, a fasting
blood sugar is performed.
*A fasting blood sugar result 200 mg/dL or more almost certainly is
diagnostic for diabetes when other signs are present such as polyuria
and weight loss despite polyphagia, are present.
TREATMENT
• Insulin therapy
• Meal Plan
• Exercise Plan
Method
Usually taken right before a meal. Often used

with longer-acting insulin.
Usually taken 30 to 60 minutes before a meal.
Covers insulin needs for half a day or overnight.
Often used with rapid- or short-acting insulin.
Covers insulin needs for about a full day. Often
used, when needed, with rapid- or short-acting
insulin.
•Onset: How quickly insulin lowers your blood sugar.

•Peak time: When insulin is at maximum strength.
•Duration: How long insulin works to lower your blood sugar.
Neutral protamine
Hagedorn (NPH) insulin
REGULAR LISPRO:
GLARGINE https://www.lillyinsulinlispro.com/assets/imag
es/pen-and-vial.png
Treatment of Diabetic Ketoacidosis
• May be admitted to a pediatric unit intensive care unit.
• Regular insulin is administered intravenously
• IV fluid are given to treat dehydration and to correct electrolyte
imbalance.
• Glucose level are monitored closely to prevent the levels from
falling to rapidly
NURSING DIAGNOSIS
• Malnutrition related to insufficient caloric intake to meet growth
and development needs and the inability of the body to use
nutrients.
• Altered skin integrity related to slow healing process and decrease
circulation
• Infection risk related to elevated glucose levels
• Altered health maintenance risk related to unstable glucose levels
• Knowledge deficiency related to managing hypoglycemia and
hyperglycemia
• Knowledge deficiency related to insulin administration
• Knowledge deficency related to exercise and activity
NURSING INTERVENTIONS
• The food plan should be well balance with foods that
accommodate the child’s food preferences, cultural customs, and
lifestyle.
• Help the child and family caregiver understand the importance of
eating regularly scheduled meals
• Children should be included in meal planning when possible to
learn what is permissible and to learn what us not.
• Inspect the skin daily and promptly treat even small breaks in the
skin
• Encourage daily bathing.
• Emphasize good foot care
NURSING INTERVENTIONS
• Reinforce teaching with the child and family caregiver to be alert
for signs of infection like urinary tract infection or respiratory
infection and report promptly to the health care provider.
• The child blood glucose level must be monitored and maintain it
within normal limits
• Provide direct supervision unless proficiency is demonstrated
• Physical education should never be scheduled right before lunch,
and should not be scheduled for late lunch period.
https://type1diabetesinchildren.weebly.com/uploads/1/3/6/7/13678731/7208039_orig.jpg
EVALUATION/DESIRED OUTCOME
• The child eats food at meal and snack time and maintain normal
weight for age and height.
• The child demonstrates (along with family caregiver) understanding of
meal planning by making appropriate menu choices.
• The child exhibits skin is intact with no signs of breakdown.
• The child describes (along with family caregiver) method for skin
inspection and care.
• The child shows no sign of infection
• The child maintains glucose level of 80 to 130 mg/dL.
• The child and family caregiver demonstrate insulin injection.
TYPE 2 DIABETES MELLITUS
• Also referred to as noninsulin-dependent diabetes.
• It is a condition in which the body does not use insulin properly.
Clinical Manifestation
• Many symptoms similar of type 1 diabetes (see table 38-3)
TREATMENT
• Insulin treatment is insulin administration, but then oral
hypoglycemic agent such as metformin, are often effective for
controlling blood glucose levels.
• Life changes such as weight loss and exercise.
• Hatfield, Nancy T, and Kincheloe, Cynthia A (2022). Introductory
Maternity & Pediatric Nursing, Fifth Edition. Wolters Kluwer
• https://www.cdc.gov/diabetes/about/how-to-use-
insulin.html?CDC_AAref_Val=https://www.cdc.gov/diabetes/basi
cs/type-1-types-of-insulin.html

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DIABETES MELLITUS

Diabetes is classified into two major types:

Usually taken right before a meal. Often used

•Onset: How quickly insulin lowers your blood sugar.

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