Diabetes Mellitus

Question 1

Type 1

Answer 1

• Most common endocrine disorder of childhood
• Autoimmue
• Characterized by destruction of beta cells, usually leading to absolute insulin deficiency
• Onset typically in childhood & adolescence
  > can occur at any age
  > peaks 10-15yrs
• more prominent in caucasians
• abt 10% of world population

Question 2

Type 2

Answer 2

• Arises bc of insulin resistance
• Onset usually after age 45
• Incrd incidence in Native American, Hispanic, & AA children
• Affected ppl may require insulin injections

Question 3

Diabetes Mellitus - Patho

Answer 3

• W/ a deficiency of insulin, glucose is unable to enter cell & remians in blood, causing hyperglycemia
• When serum glucose exceeds renal threshold, glucose spills into urine(glycosuria)
• Cells break down protein for conversion to glucose by liver (glucogenesis)
• Insulin stimulates protein synthesis & free fatty acid storage in adipose tissues
• Deficiency of insulin or insulin resistance compromise body tissues’ access to essentail nutrients for feul & storage
  polydipsia, polyuria, polyphagia

Question 4

Type 1- CMs

Answer 4

• Polyuria
• Polydipsia
• Polyphagia
• Glycosuria
• Weakness/fatigue
• Enuresis/nocturia
• Dehydration
• Wt loss
• Vision changes
• Frequent skin & UTI infections
• Skin changes (cool, dry, itchy)
• Headaches
• Hyperglycemia
• Diabetic ketosis
• DKA

Question 5

Hyperglycemia

Answer 5

• Glucose >250mg/dl
• Gradual onset
• Lethargic/weak
• Confusion
• Thirsty
• N/V
• Flushed
• Deep/rapid breathing
• Fruity breath
  > acetone
• Diminished reflexes
• Acidosis
• Coma
  hot and dry, sugar high

Question 6

Hypoglycemia

Answer 6

• Glucose <60mg/dl
• Rapid onset
• Irritable
• Headaches
• Pallor
• Shallow breathing
• Shakey
• Tachycardia
• Palpations
• Sweating
• Confusion
• Shock
• Coma
  cold and clammy, need some candy

Question 7

DM - Assessment

Answer 7

• Long-term effects
  > failure to grow at normal rate
  > delayed maturation
  > recurrrent infections
  > neuropathy
  > cardiovascular disease
  > retinal disease
  > renal disease
  effects can occur a lot quicker if DM is uncontrolled

Question 8

DM - Compliations

Answer 8

• Hypoglycemia
• Hyperglycemia
• DKA
• Hypokalemia
• Hyperkalemia
• Microvascular changes
• Cardiovascular changes

Question 9

Diabetic Ketoacidosis

Answer 9

• When glucose is unavailable for cellular metabolism, the body breaks down alternative sources of energy; ketones are released, and excess ketons are eliminated in urine (ketonuria) or by the lungs (acetone breath)
• Ketones in blood are strong acids tht lower serum pH & produce ketoacidosis
• Pediatric emergency
• Results from profressive deterioration w/ dehydration, electrolyte imbalance, acidosis, coma
  > may cause death
• Should be instituted in an ICU setting
• Undiagnosed T1 typically present in DKA

Question 10

Most Common Times of DKA

Answer 10

• Run out of insulin
• Pump malfunction
• Infection
• Stress
  > released cortisol, dumping out sugar

Question 11

DKA - Nurse Priority

Answer 11

• Fluids 1st
• Insulin drip
• Electrolytes
  > potassium
• Once at 250, also give sugar
• Head & body cooling to slow perfusion, once controlled warm back up

Question 12

DM - Diagnostic Evaluation

Answer 12

• Check risk factors
• Glycosuria w/ or w/out ketonuria
• 4 different tests to confirm DM
  > 8hr fasting BG of 126mg/dl
  > random BG 200mg/dl+
  > oral glucose tolerance test of 200mg/dl or more in 2hr sample
  > hgb A1C of 6.5% or more

Question 13

Therapeutic Management of Diabetes Mellitus

Answer 13

• Mutlisciplinary Approach
  > parents, school nurse, teachers, anyone tht will be alone w/ child
• Insulin therapy
• Insulin preparations
  > dosage
  > methods of admin
• Monitoring
  > blood glucose 3-5x/day
  > glycosylated hgb
  > urine

Question 14

DM - Education

Answer 14

• Nutrition
• Exercise
  > snack before if exercise is >30 mins
• Hypoglycemia
• Interdisciplinary management
• Pain management
• Medical indentification
  > bracelet identifier
• Sports
  > snack before & during
  > stress will incr BG

Question 15

Sick Day Managment

Answer 15

• Always give insulin, even if child in not eating
• Test blood glucose q4
• Check for urinary ketons
• Follow normal meal plan if child is able
• Encourage liquids
• Encourage rest
• Notify PCP is moderate/high ketone lvls, vomiting, fruity breath, deep/rapid respirations, dcrs LOA, presistent hyperglycemia, not drinking or eating anything in 24hrs

Question 16

Newborn Screening

Answer 16

MO law requires all babies born in the state to be screened for certain metabolic, genetic, & endocrine disorders as well as hearing loss & critical CHD. The newborn screening should be done btwn 24-48hrs of age (before d/c). The test screens for 76 conditions:
- Amino acid disorders (PKU, Maple syrup disease)
- Endocrine disorders (congenital adrenal hyperplasia)
- Hemoglobin disorders (SCD, thalassemia)
- Lysosomal storage disorders
- Organic acid conditions
- Fatty acid oxidation disorders (galactosemia, CF)