NUR 340- Test #3
Diabetes Mellitus - answer-Chronic illness characterized by increased levels of blood
glucose
Results from defects in:
-Insulin production
and/or
-Insulin action
-Most common metabolic disease in children
Types of Diabetes Mellitus - answer2 Major Types
-TYPE 1 (Insulin dependent)
-40,000 new diagnoses each year
-TYPE 2 (May or may not be insulin dependent)
-Typically considered an adult disease- on the rise in children
Type 1 Diabetes - answer-1 in every 400-600 children have T1 DM
-Peak incidence in childhood is between 7-15 years of age
-Complications of T1 DM:
Retinopathy
Heart disease
Renal failure
Peripheral vascular disease
-Destruction of insulin-producing pancreatic islet beta cells
Risk Factors:
-Genetic predisposition
-Environmental
Etiology:
-Autoimmune mechanism
-The body begins to destroy its own beta cells
-At least 90% of beta cells need to be destroyed before glucose intolerance occurs
,No Beta cells = No insulin
Symptoms of T1 DM - answer-Polyuria- increased pee
-Polyphagia- increased hunger
-Polydipsia- increased thirst
-Fatigue
-Weight loss
-Bedwetting- secondary enuresis
-Polyphagia- Hard to distinguish in young children
-May vary in children of different ages:
-Young children cant tell you if thirsty or hungry
-If not potty trained you cant tell polyuria
-Infant symptoms of type 1 diabetes:
-Not specific, child is probably eating poorly
-Children less than 5 more likely to present with diabetic ketoacidosis because they cant
report their symptoms to be diagnosed
-FRUITY BREATH, lethargic= ketoacidosis
Management Of T1 DM - answerElements of control:
-Insulin
-Nutrition/Dietary
Management:
-Exercise
-Psychosocial support
CAN NOT GIVE PILLS FOR TYPE 1 DIABETES LIKE YOU CAN FOR TYPE II.
Insulin - answer-Varied regimens
-Rapid acting insulin with meals/snacks
-Long acting insulin injected once daily
-Insulin pens available
-Wearable insulin pump is available
Rapid acting - answerHumalog, Novalog, Apidra
-Onset: 10-20 minutes
-Peaks: 30-90 minutes
-When is Novalog insulin given? Right before a meal
,-Rapid acting works VERY quickly. Sometimes the care provider says to give it as soon
as they are DONE eating because you never know how much a child is going to eat. If
you give it before the meal and then they hardly eat they may get low blood sugar.
Long acting - answerGlargine (Lantus) or Detemir (Levemir)
-Long acting
-Onset: 1-2 hours
-No true peak
-Given every 24 hours
-Cannot mix with other insulins
-Child receiving Lantus or Levemir
will also need rapid acting insulin
-Maintains good control of blood sugar
-Can not give this to cover meals because the onset is 1-2 hours which takes too long
CSII Pump PROS AND CONS - answerPumps keep blood sugar maintained at more
normal level throughout and decreases need to have frequent injections.
Sometimes malfunctions. Be aware of signs of hyper and hypo glycemia due to
malfunctions. Body image issues
Diabetes- Dietary Management - answer-Meals & snacks
-Carbohydrate counting
-Caloric requirements are individualized
-Need calories for growth
Diabetes- Exercise - answer-Regular physical activity is essential
-Helps body use insulin more effectively and lower blood sugar
-Need a snack before exercise
Blood Glucose Monitoring - answer-Hemoglobin A1c: Current recommendation is 7% or
lower for children (reference range: 4 - 5.9%)
-Normal blood glucose: 70-110
-Monitored:
-before meals and snacks
-when first diagnosed also checked at 3:00am
-Good control: (preferred values may vary depending on child and physician)
-Before meals = 90-180 mg/dl
, -Bedtime = 100-180 mg/dl
-AIC= shows how well their diabetes is being managed. Shows how the blood sugar has
been in the last three months
-Assess if they have controlled their glucose levels. If their AIC is 15 they are not
controlling their blood sugar and probably not taking their insulin
Ketones In Urine - answer-When too little insulin is present, body cannot use glucose
for energy
-Breaks down fat for energy
-Body produces ketones (acids) and releases them in the blood and urine
Type 2 Diabetes Mellitus - answer-Primarily in adults
-Incidence in children is increasing
-Children of African American, Native American, Hispanic/Latino, and Asian/Pacific
Islander origins are at greater risk for developing Type 2 diabetes
-Primarily controlled with oral medication, diet, and exercise
Primary medication approved for children= Metformin
-Onset:
-Gradual
-Occurs more frequently in adults
Etiology:
-Cells unresponsive to insulin (resistance)
-Prevalence:
90-95% of all diabetes cases
Risk Factors:
-Obesity
-Sedentary lifestyle
-Ethnicity/race
-Genetic Factors
Morbidity of T2 DM - answer-Earlier onset of heart disease
-Peripheral vascular disease
-Vision impairments (retinopathy)
-Renal disease (nephropathy)
-End stage renal disease dialysis & limb amputations
-Higher risk of depression, behavioral disorders
Diabetes Mellitus - answer-Chronic illness characterized by increased levels of blood
glucose
Results from defects in:
-Insulin production
and/or
-Insulin action
-Most common metabolic disease in children
Types of Diabetes Mellitus - answer2 Major Types
-TYPE 1 (Insulin dependent)
-40,000 new diagnoses each year
-TYPE 2 (May or may not be insulin dependent)
-Typically considered an adult disease- on the rise in children
Type 1 Diabetes - answer-1 in every 400-600 children have T1 DM
-Peak incidence in childhood is between 7-15 years of age
-Complications of T1 DM:
Retinopathy
Heart disease
Renal failure
Peripheral vascular disease
-Destruction of insulin-producing pancreatic islet beta cells
Risk Factors:
-Genetic predisposition
-Environmental
Etiology:
-Autoimmune mechanism
-The body begins to destroy its own beta cells
-At least 90% of beta cells need to be destroyed before glucose intolerance occurs
,No Beta cells = No insulin
Symptoms of T1 DM - answer-Polyuria- increased pee
-Polyphagia- increased hunger
-Polydipsia- increased thirst
-Fatigue
-Weight loss
-Bedwetting- secondary enuresis
-Polyphagia- Hard to distinguish in young children
-May vary in children of different ages:
-Young children cant tell you if thirsty or hungry
-If not potty trained you cant tell polyuria
-Infant symptoms of type 1 diabetes:
-Not specific, child is probably eating poorly
-Children less than 5 more likely to present with diabetic ketoacidosis because they cant
report their symptoms to be diagnosed
-FRUITY BREATH, lethargic= ketoacidosis
Management Of T1 DM - answerElements of control:
-Insulin
-Nutrition/Dietary
Management:
-Exercise
-Psychosocial support
CAN NOT GIVE PILLS FOR TYPE 1 DIABETES LIKE YOU CAN FOR TYPE II.
Insulin - answer-Varied regimens
-Rapid acting insulin with meals/snacks
-Long acting insulin injected once daily
-Insulin pens available
-Wearable insulin pump is available
Rapid acting - answerHumalog, Novalog, Apidra
-Onset: 10-20 minutes
-Peaks: 30-90 minutes
-When is Novalog insulin given? Right before a meal
,-Rapid acting works VERY quickly. Sometimes the care provider says to give it as soon
as they are DONE eating because you never know how much a child is going to eat. If
you give it before the meal and then they hardly eat they may get low blood sugar.
Long acting - answerGlargine (Lantus) or Detemir (Levemir)
-Long acting
-Onset: 1-2 hours
-No true peak
-Given every 24 hours
-Cannot mix with other insulins
-Child receiving Lantus or Levemir
will also need rapid acting insulin
-Maintains good control of blood sugar
-Can not give this to cover meals because the onset is 1-2 hours which takes too long
CSII Pump PROS AND CONS - answerPumps keep blood sugar maintained at more
normal level throughout and decreases need to have frequent injections.
Sometimes malfunctions. Be aware of signs of hyper and hypo glycemia due to
malfunctions. Body image issues
Diabetes- Dietary Management - answer-Meals & snacks
-Carbohydrate counting
-Caloric requirements are individualized
-Need calories for growth
Diabetes- Exercise - answer-Regular physical activity is essential
-Helps body use insulin more effectively and lower blood sugar
-Need a snack before exercise
Blood Glucose Monitoring - answer-Hemoglobin A1c: Current recommendation is 7% or
lower for children (reference range: 4 - 5.9%)
-Normal blood glucose: 70-110
-Monitored:
-before meals and snacks
-when first diagnosed also checked at 3:00am
-Good control: (preferred values may vary depending on child and physician)
-Before meals = 90-180 mg/dl
, -Bedtime = 100-180 mg/dl
-AIC= shows how well their diabetes is being managed. Shows how the blood sugar has
been in the last three months
-Assess if they have controlled their glucose levels. If their AIC is 15 they are not
controlling their blood sugar and probably not taking their insulin
Ketones In Urine - answer-When too little insulin is present, body cannot use glucose
for energy
-Breaks down fat for energy
-Body produces ketones (acids) and releases them in the blood and urine
Type 2 Diabetes Mellitus - answer-Primarily in adults
-Incidence in children is increasing
-Children of African American, Native American, Hispanic/Latino, and Asian/Pacific
Islander origins are at greater risk for developing Type 2 diabetes
-Primarily controlled with oral medication, diet, and exercise
Primary medication approved for children= Metformin
-Onset:
-Gradual
-Occurs more frequently in adults
Etiology:
-Cells unresponsive to insulin (resistance)
-Prevalence:
90-95% of all diabetes cases
Risk Factors:
-Obesity
-Sedentary lifestyle
-Ethnicity/race
-Genetic Factors
Morbidity of T2 DM - answer-Earlier onset of heart disease
-Peripheral vascular disease
-Vision impairments (retinopathy)
-Renal disease (nephropathy)
-End stage renal disease dialysis & limb amputations
-Higher risk of depression, behavioral disorders
