Peds Exam #3
Diabetes Mellitus
Alpha Cells = produce glucagon Beta cells = produce insulin
Delta cells = produce somatostatin (regulates insulin & glucagon)
→ Most common endocrine disorder of childhood
→ Peak incidence is in early adolescence (b/w 10 -15)
Type 2 Diabetes → insulin resistance
→ Onset usually ~ age 45
→ Most common in Native Americans, Hispanic, and African American kids d/t cultural
diets & resources
Type 1 Diabetes → complete lack of insulin production by destruction of Beta cells
→ Typical onset in childhood, but can occur any time
→ Non obesity related
Causes : an autoimmune disease that arises when a person is exposed to a precipitating
event (EX: virus) - Heredity is a prominent factor
Pathophysiology :
1. Low Insulin = glucose not in the cells & staying in the blood = Hyperglycemia
2. Kidneys filter & excrete sugars …But cells still need the sugar
3. Glucogenesis = cells break down protein for conversion to sugar by the Liver
Long-Term Complications : Microvascular → nephropathy & retinopathy
Macrovascular → neuropathy (develops after 25 yrs)
Management : - Insulin Therapy - Glucose monitoring (Goal: <126)
- Monitoring A1C - Urine testing for Ketones
- Nutrition - Exercise
- Management of ketoacidosis & HHNK
Patient Education
→ Recognition & tx of ↑or ↓ sugar
→ Management of minor illnesses (↑ metabolic demands will mess up sugar levels)
→ Record keeping
→ Family support & acute care
,Types of Insulin
1. Rapid -Acting : (Bolus) Aspart (Novolog) , Lispro (Humalog)
- Usually given on sliding scale before meals
2. Short - Acting : Novolin R , Humulin R
3. Intermediate : Novolin N, Humulin N (NPH)
4. Long - Acting : Glargine (Lantus), Detemir (Levemir)
5. Mixed : - NPH + Regular (Intermediate & short acting)
- Novolog 70/30 (Intermediate & rapid)
- Humalog 70/30 or 50/50 (Intermediate & rapid)
Hypoglycemia (< 70 mg/dl)
S / S : Mild → headache, shakiness, ↑HR, paleness, clammy, sweaty, dizzy
Moderate → yawning, irritable/ frustrated, sudden crying, extreme tiredness, confusion,
& restlessness Severe → unusual behavior, dazed, seizures, unconsciousness
TX : - If able to swallow = Give sugar source ; If unable to swallow = Glucagon
- Under 4 yrs → (8 grams)
● ¼ C Juice, ¼ C regular soda, 2 glucose tabs
- 4+ yrs → (15 grams)
● ½ C juice, ½ C soda, 3-4 glucose tabs
* Rule = give 15 g of sugar, wait 15 mins to recheck *
Hyperglycemia
S / S : - High glucose in Urine - Frequent urination - Increased thirst
- Shakiness - Irritation - Sweating
, Exercise w/ Diabetes
● If BS is 100 or below = must eat a snack before exercise
● If BS is 240+ w/ Ketones = no exercise
○ Muscles secrete lactic acid + ketones = Acidosis
Diabetic Ketoacidosis (DKA) → when glucose is unavailable, the body breaks down alternate
sources of energy → Ketones are released & excess ketones are eliminated by urine or lungs
↪ Ketones in the blood are strong acids that lower pH & produce ketoacidosis
→ Pediatric emergency
→ Results from progressive deterioration w/ dehydration, electrolyte imbalance, acidosis, &
coma ; May cause death
S / S : - Ketonuria - Acetone breath - Lethargy
- Kussmal Respirations (↑ rate & depth)
Nursing Dx for Child w/ DM
● Risk for injury r/t insulin deficiency / Hypoglycemia
● Knowledge deficit r/t care of newly diagnosed child w/ DM
Endocrine System
Hormones = chemical messengers that stimulate/ regulate actions of other tissues, organs, or
other endocrine glands
Metabolism = all physical & chemical reactions occurring in the body’s cells that are necessary
to maintain & sustain life
→ Endocrine development begins in 1st trimester (Incomplete at birth)
→ Infants lack full ability to : balance fluid, electrolytes, amino acids, or glucose
Pituitary Gland Disorders
Pituitary Gland : Hypothalamus affects the releasing / inhibiting of pituitary hormones
- Anterior Pituitary → regulates growth, metabolism, & reproduction hormones
- Posterior Pituitary → controls water balance & childbirth hormones
1. Growth Hormone Deficiency (Hypopituitarism) [Anterior Pituitary]
→ Growth assessments show below 3%tile on growth charts
Pathophysiology
- Insufficient GH production, d/t tumors, genetic syndromes (Turner), or
congenital birth traumas
Complications : altered metabolism, hypoglycemia, DM, joint issues, risk of
CNS tumor recurrence, infection, Na retention
Diabetes Mellitus
Alpha Cells = produce glucagon Beta cells = produce insulin
Delta cells = produce somatostatin (regulates insulin & glucagon)
→ Most common endocrine disorder of childhood
→ Peak incidence is in early adolescence (b/w 10 -15)
Type 2 Diabetes → insulin resistance
→ Onset usually ~ age 45
→ Most common in Native Americans, Hispanic, and African American kids d/t cultural
diets & resources
Type 1 Diabetes → complete lack of insulin production by destruction of Beta cells
→ Typical onset in childhood, but can occur any time
→ Non obesity related
Causes : an autoimmune disease that arises when a person is exposed to a precipitating
event (EX: virus) - Heredity is a prominent factor
Pathophysiology :
1. Low Insulin = glucose not in the cells & staying in the blood = Hyperglycemia
2. Kidneys filter & excrete sugars …But cells still need the sugar
3. Glucogenesis = cells break down protein for conversion to sugar by the Liver
Long-Term Complications : Microvascular → nephropathy & retinopathy
Macrovascular → neuropathy (develops after 25 yrs)
Management : - Insulin Therapy - Glucose monitoring (Goal: <126)
- Monitoring A1C - Urine testing for Ketones
- Nutrition - Exercise
- Management of ketoacidosis & HHNK
Patient Education
→ Recognition & tx of ↑or ↓ sugar
→ Management of minor illnesses (↑ metabolic demands will mess up sugar levels)
→ Record keeping
→ Family support & acute care
,Types of Insulin
1. Rapid -Acting : (Bolus) Aspart (Novolog) , Lispro (Humalog)
- Usually given on sliding scale before meals
2. Short - Acting : Novolin R , Humulin R
3. Intermediate : Novolin N, Humulin N (NPH)
4. Long - Acting : Glargine (Lantus), Detemir (Levemir)
5. Mixed : - NPH + Regular (Intermediate & short acting)
- Novolog 70/30 (Intermediate & rapid)
- Humalog 70/30 or 50/50 (Intermediate & rapid)
Hypoglycemia (< 70 mg/dl)
S / S : Mild → headache, shakiness, ↑HR, paleness, clammy, sweaty, dizzy
Moderate → yawning, irritable/ frustrated, sudden crying, extreme tiredness, confusion,
& restlessness Severe → unusual behavior, dazed, seizures, unconsciousness
TX : - If able to swallow = Give sugar source ; If unable to swallow = Glucagon
- Under 4 yrs → (8 grams)
● ¼ C Juice, ¼ C regular soda, 2 glucose tabs
- 4+ yrs → (15 grams)
● ½ C juice, ½ C soda, 3-4 glucose tabs
* Rule = give 15 g of sugar, wait 15 mins to recheck *
Hyperglycemia
S / S : - High glucose in Urine - Frequent urination - Increased thirst
- Shakiness - Irritation - Sweating
, Exercise w/ Diabetes
● If BS is 100 or below = must eat a snack before exercise
● If BS is 240+ w/ Ketones = no exercise
○ Muscles secrete lactic acid + ketones = Acidosis
Diabetic Ketoacidosis (DKA) → when glucose is unavailable, the body breaks down alternate
sources of energy → Ketones are released & excess ketones are eliminated by urine or lungs
↪ Ketones in the blood are strong acids that lower pH & produce ketoacidosis
→ Pediatric emergency
→ Results from progressive deterioration w/ dehydration, electrolyte imbalance, acidosis, &
coma ; May cause death
S / S : - Ketonuria - Acetone breath - Lethargy
- Kussmal Respirations (↑ rate & depth)
Nursing Dx for Child w/ DM
● Risk for injury r/t insulin deficiency / Hypoglycemia
● Knowledge deficit r/t care of newly diagnosed child w/ DM
Endocrine System
Hormones = chemical messengers that stimulate/ regulate actions of other tissues, organs, or
other endocrine glands
Metabolism = all physical & chemical reactions occurring in the body’s cells that are necessary
to maintain & sustain life
→ Endocrine development begins in 1st trimester (Incomplete at birth)
→ Infants lack full ability to : balance fluid, electrolytes, amino acids, or glucose
Pituitary Gland Disorders
Pituitary Gland : Hypothalamus affects the releasing / inhibiting of pituitary hormones
- Anterior Pituitary → regulates growth, metabolism, & reproduction hormones
- Posterior Pituitary → controls water balance & childbirth hormones
1. Growth Hormone Deficiency (Hypopituitarism) [Anterior Pituitary]
→ Growth assessments show below 3%tile on growth charts
Pathophysiology
- Insufficient GH production, d/t tumors, genetic syndromes (Turner), or
congenital birth traumas
Complications : altered metabolism, hypoglycemia, DM, joint issues, risk of
CNS tumor recurrence, infection, Na retention
