1 / 29

Diabetes Mellitus Kristine Ruggiero, CPNP, MSN, RN

Diabetes Mellitus Kristine Ruggiero, CPNP, MSN, RN. Chapter 32 Pages 1263-1275. What is Diabetes?. Body does not make or properly use insulin: no insulin production insufficient insulin production resistance to insulin’s effects No insulin to move glucose into cells:

amato
Download Presentation

Diabetes Mellitus Kristine Ruggiero, CPNP, MSN, RN

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Diabetes MellitusKristine Ruggiero, CPNP, MSN, RN Chapter 32 Pages 1263-1275

  2. What is Diabetes? • Body does not make or properly use insulin: • no insulin production • insufficient insulin production • resistance to insulin’s effects • No insulin to move glucose into cells: • high blood glucose means: • fuel loss. cells starve • short and long-term complications

  3. Diabetes Mellitus • Statistics: • Diabetes is one of the most common chronic diseases in school-aged children. • In the United States, about 176,500 people under 20 years of age have diabetes. • About 1 in every 400 to 600 children has type 1 diabetes. Each year, more than 13,000 children are diagnosed with type 1 diabetes.

  4. Diabetes Mellitus • Cause is uncertain, likely environmental and genetic causes • Genetic factors • Autoimmune factors (Type 1) • Viral infection

  5. Pathophysiology of Disease • Characterized by disturbance in carbohydrate, protein and fat metabolism: • Insulin: • Allows glucose transport into the cells for use as energy or storage as glycogen • Stimulates protein synthesis and free fatty acid storage in adipose tissues • Deficiency compromises the body tissues’ access to essential nutrients for fuel and storage

  6. DM • Two primary forms: • Type 1: • characterized by absolute insulin insufficiency • Type 2: • characterized by insulin resistance with varying degrees of insulin secretory defects • Other forms: • Gestational • “Hybrid or Mixed” • Maturity-onset Diabetes of the Young (MODY) • Secondary Diabetes (from CF, steroids)

  7. Type 1 Diabetes • An autoimmune disease in which the immune system destroys the insulin-producing beta cells of the pancreas that regulate blood glucose. • Acute onset • About 75 percent of all newly diagnosed cases of type 1 diabetes occur in individuals younger than 18 years of age.

  8. Hypoglycemia (insulin reaction) Ketoacidosis Hyperosmolar, hyperglycemic syndrome Cardiovascular disease Peripheral vascular disease Retionopathy, blindness Nephropathy, renal failure Diabetic dermopathy Peripheral neuropathy Amputation Impaired resistance to infection Cognitive depression Poor wound healing Complications of DM

  9. Complications of DM • Refer to Table 32-4 in text: • Acute Complications: • DKA • Hypoglycemia • Chronic Complications: • Retinopathy • Nephropathy • Neuropathy • Peripheral vascular disease • Complications r/t G&D: • Delay in growth • Delay in puberty • Menstrual disturbances

  10. Polyuria Polydipsia Polyphagia Nocturia Weight loss and hunger Weakness and fatigue Dehydration Poor skin turgor Dry mucous membranes Vision changes Retinopathy or cataract formation Can lead to blindness Frequent skin and UTI’s Acanthosis nigricans (a velvety hyperpigmented thickening of the skin around the nape of the neck—mostly Type 2) Numbness or pain in hands/ feet Clinical Manifestations

  11. FIGURE 32–12Acanthosis nigricans. Courtesy of Audrey Austin, M. D., Children’s National Medical Center, Washington, D.C. Jane W. Ball and Ruth C. BindlerChild Health Nursing: Partnering with Children & Families © 2006 by Pearson Education, Inc.Upper Saddle River, New Jersey 07458All rights reserved.

  12. Skin changes Dry, itchy skin (esp hands/ feet) Cool temperature Postprandial feeling of nausea or fullness Nocturnal diarrhea Decreased peripheral pulses Diminished DTR’s Orthostatic hypotension Characteristic “fruity” breath odor in ketoacidosis Possible hypovolemia and shock in ketoacidosis Clinical Manifestations

  13. Type 1 Specific Symptoms • (Refer to Table on p 1267) • Rapidly developing sxs • Muscle wasting and loss of subcutaneous fat • Ketoacidosis • Honeymoon period • A one-time remission of the sxs, occurs shortly after tx is started • Last-ditch effort by pancreas to produce insulin • When sxs reappear the child will be insulin dependent for life

  14. Type 2 Specific Symptoms • Hypertension • Vague, long-standing symptoms that develop gradually • Severe viral infection • Other endocrine diseases • Recent stress or trauma • Use of drugs that increase blood glucose levels • Obesity, particularly around abdomen • Acanthosis nigricans

  15. Diagnosis of DM • Based on hx and PE • including the presence of classic symptoms as described previously • And serum glucose levels

  16. Diagnostic Test Findings • Fasting plasma glucose level greater than or equal to 126 mg/dl on at least 2 occasions • Random blood glucose level greater than or equal to 200 mg/dl • Two-hour postprandial blood glucose level greater than or equal to 200 mg/dl • Glycosylated hemoglobin increased • Urinalysis possibly showing acetone or glucose • Ophthalmologic examination may show diabetic retinopathy

  17. Management of DM • Glycemic Control to prevent complications • Nutritional Therapy • Regular exercise • Psychosocial support

  18. Insulin Therapy • The ADA recommends that blood glucose levels be normalized using basal-bolus tx for children and adolescents • Basal-Bolus Therapy: • Monitoring blood glucose 4-8X’s/ day and once a week at midnight and 3 am • Consistent carbohydrate monitoring • Anticipating exercise in the routine

  19. Insulin Therapy • Goal of insulin therapy: • Maintain serum glucose levels from 80-120 mg/dL b/f meals • 100-140 mg/dL at bedtime (ADA, 2002) • Insulin can be administered: • Subcutaneous insulin infusion (SCII) • Multiple daily injections (MDIs)

  20. Insulin Infusion Pump • Refer to Table 32-6: Age-based Criteria for Selecting Insulin Pump Therapy • Refer to Table 32-7: Advantages and Disadvantages of an External Insulin Infusion Pump

  21. Insulin Therapy • Stress, infection and illness may increase or decrease insulin needs • Increased insulin doses are often required during growth and puberty

  22. Insulin Therapy • Glycemic Control to Prevent Complications • Refer to Table 32-5 for Insulin Action • Rapid Acting Insulin • Lispro/ Humalog • Short Acting • Regular • Intermediate Acting • NPH, Lente • Long Acting • Ultralente, Lantos/ insulin glargine • Combine therapy • Intermediate acting mixed with short acting or rapid acting

  23. Evaluation of Insulin Therapy • Hemoglobin A1C: measures glycosylated hemoglobin • Performed every 3 months • Objective measurement of glycemic control • Represents amount of glucose irreversibly attached to Hgb molecule over its lifetime • HbA1C (w/o Diabetes)= b/l 6.2% • HbA1C (w/ Diabetes)= 7.5-8%

  24. HbA1C= average blood glucose control for the past few months With diabetes= extra glucose in bloodstream This extra glucose enters your red blood cells and links up (or glycates) with molecules of hemoglobin. HbA1C= Batting Average Evaluation of Insulin therapy

  25. Management of DM • Nutrition Therapy: • Establish daily nutrition therapy • Carbohydrate counting= flexibility in meal planning • Food pyramid to teach family adequate portion control • Exercise Program: • Physical activity= increased insulin sensitivity • Improves blood glucose control • Controls weight • Reduces cardiovascular risks

  26. Nursing Care • Focuses on teaching child/ family about DM and its management • Dietary intake • Promoting G&D milestones • Emotional support • Planning strategies for daily management • Medication teaching • Refer to Box 32-7 for questions to ask when planning diabetic education

  27. FIGURE 32–10 Insulin injection sites. Give all morning insulin in one site (e.g., arms) and all evening insulin in another (e.g., legs) because of different rates of absorption from these sites. Space injections about 1.25 cm (0.5 in.) apart. Jane W. Ball and Ruth C. BindlerChild Health Nursing: Partnering with Children & Families © 2006 by Pearson Education, Inc.Upper Saddle River, New Jersey 07458All rights reserved.

  28. Nursing Care • The child’s developmental stage and cognitive level influence their readiness to assume responsibility for self-care • Preschool child: need for autonomy and control can be met allowing child to choose the snack or pick the finger being stuck • School-aged: ensure they can recognize the s/sx of hypo/ hyperglycemia (can test blood sugar and give insulin shots) • Adolescents: need to adjust to chronic nature of disease; be clear about role in diabetes management/ parental involvement

  29. Any Questions??? Jane W. Ball and Ruth C. BindlerChild Health Nursing: Partnering with Children & Families © 2006 by Pearson Education, Inc.Upper Saddle River, New Jersey 07458All rights reserved.

More Related