1. Module 7 Caring for Children with Alterations in Metabolism - Endocrine Chapter 29

2. Diabetes Mellitus Definition: metabolic disorder characterized by hyperglycemia because of lack of insulin or a resistance to insulin Classifications  Type 1 Diabetes destruction on pancreatic beta cells  Type 2 Diabetes insulin resistance

3. Impact of Diabetes leading cause of renal failure major cause of blindness most frequent cause of non-trauma amputations affects 17 million increasing prevalence of type 2 in children and adults  >1/3 of all newly diagnosed diabetes in children

4. Historical Facts Diabetes is from the Greek word “to siphon” Mellitus is from Latin word “sweet” Usually died within 2-3 years from starvation 1921 - Insulin discovery  increased life span  experiencing long term effects of diabetes 1979 - self glucometers

5. Diabetes Type 1 Beta cells no longer produce insulin  hyperglycemia  fats and protein are broken down  development of ketosis accounts for 10-15% of all cases occurs in childhood or adolescence

6. Diagnostic Tests 1. Symptoms of diabetes and random b.s. >200mg/dL 2. fasting glucose >126mg/dL 3. Oral glucose tolerance test - OGTT  after 2 hrs glucose is >200mg/dL 4. Glycosylated hemoglobin - Hemoglobin A1C average glucose over 2-3 months Routine accu checks for management  Type 1 3x/day

7. Hyperglycemia Hyperglycemia leads to  polyuria  glycosuria  polydipsia  polyphagia  weight loss  malaise and fatigue  blurred vision

8. Diabetic Ketoacidosis DKA Results from a breakdown of fat occurs when undiagnosed or known diabetic has an increased energy need blood sugar >250mg/dL pH < 7.3 ketones and glucose in the blood and urine

9. DKA - Treatment Regular insulin - sub q or IV Restore fluid balance -.9NS IV Correct electrolyte imbalances - K+

10. Hypoglycemia verses Hyperglycemia

11. Long Term Complications of Diabetes Coronary Artery Disease  Hypertension  Stroke Peripheral Vascular Disease Diabetic Retinopathy  retinal ischemia  leading cause of blindness ages 25-74

12. Complications of Diabetes Diabetic nephropathy  glomerular changes in kidneys leading to impaired renal function microalbuminuria  most common cause ESRD in America

13. Therapeutic Management Monitoring  keeping blood glucose levels close to normal Insulin Dietary management Exercise Future  pancreatic transplant, beta cell transplant

14. Medications Insulin  all type 1 Terms describing insulin  onset, peak, duration Types  rapid acting, short acting, intermediate, long and combinations

15. Injection sites

16. Nutrition Need consistent meal times Goals  near-normal glucose levels  optimal lipid levels  adequate calories to maintain growth Meal planning  eat less fat and saturated fat  sugars and sweets in moderation

17. Diet Management Type 1  correlate eating with insulin onset  Carb counting is main diet plan for children with diabetes “Illness Management Plan”  change in insulin dosage  attention to fluid balance

18. The Nursing Process Working together  child/family  individualized plan  follow-up support  community support

19. Growth Hormone Deficiency Decreased activity of pituitary gland Diagnosed in males earlier than females  Short stature is noticed more often in males Causes of deficiency  Infarct of pituitary gland (sickle cell)  Central nervous system infection  Tumors  Brain trauma  Chemotherapy  Emotional deprevation

20. Signs and Symptoms Below the 3 rd percentile on growth chart in height by 1 year of age Overweight Higher pitched voices Delayed dentition Decreased muscle mass Delayed sexual maturation hypoglycemia

21. Treatment Treat underlying cause Growth hormone replacement  Daily injections of hormone Possible delay of puberty to allow more time for growth hormone therapy to work

22. Precocious Puberty Appearance of any secondary sexual characteristics before 8 years of age in females and 9 years of age in males Hypothalamus is activated to secrete gonadtropin-releasing hormone In males is usually result of intracranial tumor Females is usually idiopathic

23. Children will have advanced bone age Stop growing prematurely  Hormones stimulate early closure of epiphyseal plates Mood swings Emotional labilty

24. Treatment