Diabetes Flashcards
What type of diabetes do most children have?
Type 1
Pediatric Plasma Glucose level for diabetes diagnosis
11.1 or higher with symptoms
Pediatric Fasting Glucose level for diabetes diagnosis
Greater than or equal to 7
Pediatric Oral Glucose Tolerance Test level for diabetes diagnosis
Greater than or equal to 11
Pediatric Random Plasma Glucose level for diabetes diagnosis
Greater than or equal to 11.1
Purpose of A1C in pediatric diabetes
Monitoring, not diagnosis
When is the peak incidence of type 1 diabetes
4-6yrs and 10-14yrs
Type 1 Diabetes Definition
Autoimmune destruction of insulin producing beta cells resulting in complete insulin deficiency
What are the main therapy for type 1 diabetes?
Insulin injections
Describe the incidence of T2DM in Saskatchewan
increasing, disproportionately affecting Indigenous, women > men
Projected global T2DM adolescent increase
49% in next 3 years
What ethnic groups are disproportionately affected by T2DM?
Asian, Indigenous, African
Recent research found that Indigenous youth with diabetes experience higher long-term risks for ________________ and ____________ than non-first Nation
end stage renal disease and death
What is important to consider about young people with diabetes in regards to their metabolism?
They have prolonged exposure; within 10 years of diagnosis complications develop
70 yr old developing complications at 80 vs 8 year old developing complications at 18
Why is coverage for diabetic devices and medication not covered in treaties?
Formed before diabetes was in Indigenous populations; treatment not covered by treaties
What is the most important risk factor for T2 diabetes?
Obesity
Following obesity, what is the next most significant risk factor for diabetes?
family history
Why might complications of T2DM occur more quickly in adolescents than adults?
loss of B-cell function is accelerated in young type 2 diabetes, leading to premature development of complications, with adverse effects on quality of life and long-term outcomes
What 5 things are those with T2DM at increased risk for?
Kidney Disease
Retinopathy
Neuropathy
Dyslipidemia
Hypertension
What is glycosylated hemoglobin?
What the A1C test measures;
a form of hemoglobin used primarily to identify the average plasma glucose concentration over prolonged periods of time.
Why is there a higher parameter for pediatric A1C values?
To assure hypoglycemia doesn’t occur r/t children’s increased metabolism
Explain the pathophysiology of DKA
- occurs when there isn’t enough insulin (T1DM) so glucose is in the blood, not being used by cells
- body breaks down fat for energy creating ketones
- ketones can make the blood acidic, which causes dehydration and confusion
Why does dehydration occur in DKA?
- Body tries to get rid of ketones through osmotic diuresis
- Increased urination leads to increased thirst
What is the leading cause of morbidity and mortality in children with diabetes?
DKA
What is a complication of DKA leading to death in pediatric patients?
Cerebral edema
Why are there less stringent glycemic goals for pediatric patients with diabetes?
Risk for hypoglycemia r/t increased metabolism
Signs of hypoglycemia
Cool, diaphoretic, confused, shakey
Signs of hyperglycemia
increased hunger, thirst, urination, dehydrated, fruity/SOB, blurry vision, confusion
Target A1C for T1DM
less than or = to 7.5
Target FG for T1DM
4-8
2hr PG for T1DM
5-10
Role of insulin
Alters permeability of cell membranes so glucose can be used for energy, while inhibiting glucose release from the liver
What are the advantages of the Insulin pump?
- continuous subQ infusions mimicking normal pancreatic function
- maintains BG/decreases A1C
- less injections
- allows kids to eat with less adherence to a schedule
What of insulin pump covered by SAIL
1 every 5 years
Treatment for emergency presentation of DKA in hospital
- ABC
- Fluid/electrolyte replacement (child is dehydrated)
- Continuous SC insulin (child is hyperglycemic)
Treatment for emergency hypoglycemia presentation in hospital
- ABC
- Bolus dextrose 10% (short term)
- IV infusion matching normal glucose production after bolus
5 Nursing Interventions for Diabetes
- Optimize normal G+D
- Promote optimal serum glucose regulation
- Assess S+S hyper/hypoglycemia
- Hx of events
- Prevent LT complications
