Diabetes Mellitus
1. Alpha cell
Produce glucagon
2. Beta cell
Produce insulin
3. Delta cell
Produce somatostatin
Normal fasting glucose level;
70-140mg/dl
Diabetes mellitus is disorder of glucose intolerance due to deficiency in insulin production and it's action leading to hyperglycemia and abnormalities in carbohydrate, protein and fat metabolism.
Common disorder of pancreas is diabetic mellitus in which beta cells of islets of Langerhans fail to produce insulin.
Types of Diabetes Mellitus
1. DM Type l
Insulin dependent diabetes (IDDM).
Type l diabetes mellitus is known as "Juvenile Diabetes".
Result from destruction of pancreatic Beta cell, which produce insulin leading to insulin deficiency.
2. DM Type ll
Non-insulin dependent DM (NIDDM).
Result from insulin resistance, a condition in which cell of body fail to use insulin properly.
Adult-onset diabetes.
3. Gestational diabetes
When pregnant women who have never diabetes mellitus before, have high glucose level during pregnancy.
4. Other type
Drug or chemically induced diabetes mellitus.
Etiological factor
1. Infectious disease like viral infection; mumps, CMV
2. Environmental toxins; chemicals
3. Genetic factors
4. Autoimmune diseases
Clinical manifestations
1. Major symptoms
Polyphagia (increased hunger)
Polydipsia (increased thirst)
Polyuria (increase Urination)
2. Minor symptoms
Lethargy
Weakness
Abdominal discomfort
Dry skin/ skin infection
Delayed wound healing
Frequent infection
Pathophysiology
Due to etiological factor
Deficiency of insulin
Alter metabolism of body
Decreased glucose uptake and stroage
Starvation of cells
Decrease transportation of glucose across cell membrane
1. Less glucose available and used for energy production.
Hunger center stimulated
Cellular starvation result Polyphagia
2. Increases blood glucose level (hyperglycemia)
Renal threshold of glucose is exceeded
Glucose excreted in urine (Glycosuria)
Excessive Urination (polyuria)
Dehydration and excessive thirst (polydipsia)
3. Body using fat and protein for energy production
Form ketone bodies
Weight loss
Children with Diabetic Ketoacidosis (DKA)
1. Drowsiness
2. Dryness of skin
3. Cherry red lips
4. Increased respiration
5. Nausea
6. Vomiting
7. Abdominal pain
Diagnostic Evaluation
1. Family history of Diabetes
2. Clinical features
Polyphagia
Polydipsia
Polyuria
3. Urine test detects glycosuria and ketones
4. Laboratory tests
Blood glucose estimation
Serum electrolytes
HbA1C level ; to check persistent hyperglycemia.
5. Glucose level monitoring;
1. Fasting plasma glucose; >140mg/dl
2. Glucose tolerance test (GTT)
Two hours after 75gm oral glucose load, plasma glucose >200mg/dl.
Management
1. Insulin therapy
Rapid, short, intermediate, long acting insulin therapy.
2. Glucose monitoring
3. Urine monitoring for sugar and ketone
4. Diet me planning and nutrition
5. Excercise
6. Maintain proper nutrition, attain normal growth and development and achieve diabetes control.
Nursing Management
1. Monitoring child blood glucose level
2. Evaluating child for;
Dehydration
Hyperglycemia
Ketones
3. Instruct parent about prevention and management of hypoglycemia.
4. instruct about dietary need and insulin need.
5. Recognized symptoms of insulin shock and diabetic acidosis or diabetic Ketoacidosis (DKA), emergency management.
6. Prevent from infection.
7. Carry identification card)/ diabetic card;
Child name, address, phone no., treating physician name.
8. Child should carry some sugar cubes; take in case of hypoglycemia.
9. Prevent from injury
10. Antibiotic therapy
11. Monitor intake/output chart
Nursing Diagnosis
1. High risk of injury related to hypoglycemia.
2. Altered nutrition related to insulin imbalance, food and physical activity.
3. Anxiety related to fear to inability to manage diabetes.
Complications
Acute complication of Diabetes
1. Hypoglycemia
2. Diabetic acidosis
3. Morning hyperglycemia
4. Dawn phenomenon
Abnormal early morning increase blood glucose.
Long term complication of Diabetes
1. Ischemic heart disease
2. Stroke
3. Peripheral vascular disease
4. Microvascular complication
(Diabetes causes damage to small blood vessel)
5. Diabetic retinopathy
6. Diabetic nephropathy
7. Diabetic neuropathy
8. Diabetic foot ulcer
9. Skin damage
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