Endocrine disorders

Question 1

What is diabetes mellitus (DM)

type 1?

Answer 1

• A chronic disorder which results from either a partial or complete deficiency of insulin
• It is the pancreatic beta cell destruction leading to absolute insulin deficiency
• It is the most common endocrine disease of childhood also known as Juvenile diabetes

Question 2

What are the characteristics?

Answer 2

• Persistent blood glucose level >10mmol/L results in glycosuria leading to osmotic diuresis
with polyuria and polydipsia
• Excessive ketone production cause diabetic ketoacidosis (DKA)
- Characterized by marked hyperglycemia, metabolic acidosis, dehydration and altered level
of consciousness ranging from lethargy to coma

Question 3

What are the signs and symptoms of DM type 1?

Answer 3

• Polydipsia
• Polyuria
• Polyphagia
• Fatigue
• Weight Loss
• Dry Skin
• Blurred Vision
• Signs of DKA
- Hyperglycemia, acidosis, glycosuria and ketonuria

Question 4

What are the early signs and symptoms of hypoglycemia?

Answer 4

Trembling, tachycardia, sweating, anxiety, hunger, pallor and headache

Question 5

What are the late signs of hypoglycemia?

Answer 5

Loss of coordination, personality and mood changes, slurred speech and sleepiness

Question 6

What are the nursing interventions for DM type 1?

Answer 6

• Assess child for signs of hypoglycemia, hyperglycemia and their complications
• Provide care during acute phase, such as DKA
• Monitor neurologic status, vital signs, blood glucose level
• Monitor level of hypokalemia
• Promote adequate fluid volume by maintaining accurate and careful record of IV
infusion blood glucose level, intake and output and urine specific gravity
• Test urine for ketones every 3 hours when child is ill and whenever blood sugar
level >15 mmol/L
• Administer insulin to do decrease elevated blood glucose level

Question 7

What is the age appropriate blood glucose level?

PRE-MEALS

Answer 7

Pre-meals ( last intake 2 hours before )

0-6 years old : 5 - 12mmol/LL
6-12 years old : 4 - 10 mmol/L
>12 years old : 4 - 8 mmol/L

Question 8

What is the age appropriate blood glucose level?

POST-MEALS

Answer 8

0-6 years old : < 12mmol/LL
6-12 years old : < 10 mmol/L
>12 years old : < 8 mmol/L

Question 9

What is diabetes mellitus type (DM) type 2?

Answer 9

• Type 2 DM is a complex disorder of various
causes with social, behavioral and
environmental risk factors unmasking the
effects of genetic susceptibility
• Heredity is a strong component to the disorder
and obesity is a significant risk factors

Question 10

What is the pathophysiology for DM type 2?

Answer 10

• Children with Type 2 DM develop insulin resistance
• Progression deterioration of insulin secretion as a result of hyper-tryglyceridemia
• Diet modification and physical activity can reduce the incidence in children at risk for
Type 2 DM

Question 11

What is the clinical manifestation for DM type 2?

Answer 11

• Most children with Type 2 DM are overweight
• Velvety hyperpigmented patches In intertriginous area found in children with Type 2 DM
• Hypertension and lipid disorders can also occur
• Laboratory finds:
• Ketonuria: 33% of children at the time of diagnosis
• Ketoacidosis: 5-25% of children at presentation

Question 12

What is the nursing management for DM type 2?

Answer 12

• Administer medication ordered

• Metformin, first line treatment for Type 2 DM, is use in children older than 8
  years old

• Insulin and oral anti -diabetic are usually added to diet and exercise regime to
improve blood glucose control
• Calorie-restricted diet
• Behaviors medication if compliance is poor

• Promote lifestyle change

• Increase physical activity to decrease insulin resistance
• Decrease sedentary activity eg. Watching TV, computer games