Diabetes mellitus type 1

• characterized by loss of beta cells, presence of islet cell antibodies, lack of insulin, excess of glucagon, and altered metabolism of fat, protein, and carbohydrates
• rapid onset
• child does not produce enough insulin to meet their bodies needs or cells do not respond properly to insulin
• insulin is a protein responsible for moving glucose from the blood into the cell to acts as a source of energy
• caused by genetic factors and autoimmune factors
• may also develop as viral infection
• type 1 isn't inherited but predisposition plays an important part in its development
• s/s: weakness and fatigue, polyuria and nocturne in children already having nighttime control, dehydration despite polydipsia, weight loss despite polyphasic, vision changes, frequent skin and urinary tract infections, skin changes
• complications: hypoglycemia, hyperglycemia, DKA
• Pancreas' last stand: onetime remission of symptoms may occur shortly after insulin treatment is started, lasts stick effort by the pancreas to produce insulin
• Pancreas' last stand: the child may not need insulin for up to 1 year but may need oral anti diabetic drugs, symptoms of hyperglycaemia will reappear and the child will be insulin dependent for life
• Pancreas: a triangular gland nestled in the curve of the duodenum, stretching horizontally behind the stomach and extending to the spleen, preforms endocrine and exocrine functions
• Hypoglycemia: can be a result of too much insulin, delayed or missed meals or snacks, more physical activity than usual without a corresponding increase in food or reduction in insulin
• hypoglycaemic risks: greatest immediate danger-is a situation where can't help themselves, impairs cognitive and motor functioning, early recognition and intervention can prevent an emergenct
• Dextrose IV solutions: 50% in water

  • dextrose can cause tissue extravasation and sclerosis
• Dextrose 12.5%, 10%, and 5%
• hyperglycemia: main causes

  • too little insulin
  • expired insulin
  • food not covered by insulin
  • decreased physical activity
• hyperglycemia causes: illness, injury, stress, other hormones, menstrual periods
• hyperglycemia risks: ketoacidosis
• ketoacidosis occurs when the body doesn't have enough insulin, without insulin the body can't use glucose for fuel, so it is left breaking down fats for energy
• hyperglycemia treatment: patients with type 1 diabetes must take insulin daily, insulin need changes and is affected by emotions, nutritional intake, activity, illness and events such as puberty
• hyperglycemia treatment: insulin dosages are based on home blood glucose monitoring, insulin can be administered as injections or by insulin pump
• hyperglycemia interventions: start with short term goals, major goal is to achieve participation with the overall health care plan and prevent long-term complications
• hyperglycemia treatment: health education is key:

  • glucose monitoring
  • insulin administration
  • dietary management
  • sick day management
  • exercise and insulin adjustment
• dietary mangement: children with diabetes should follow Canada's food guide just as children without diabetes

  • no nutrition therapy is recommended over another as it should be tailored to the child and family
• dietary management: carbohydrate counting is currently the most common practice

  • simple way of meal planning
  • determine target carbohydrate goals for each mean and snack
• carbohydrates: important nutrients and supply the glucose the body and brain need to work at their best, glucose is the form of carb the body cells use as a source of energy
• carbs= energy
• sources of carbs: another word for sugar, found in:

  • grains and starch
  • fruits
  • milk
  • sweet foods/snacks
• one serving has 15 grams of carbs and equals one carbohydrate of choice
• total carbs-total fibre=available carbohydrate
• one way to calculate the amount of insulin needed for carbohydrates is to use an insulin to carbohydrate ratio
• 1 unit of bolus insulin will cover a certain number of grams of carbohydrates that you are about to eat
• physician will determine the insulin to carbohydrate ratio specific to each individual
• only subtract fibre if its over 5 g
• why exercise?

  • improve fitness
  • improve bg control
  • decrease insulin resistance
  • improve lip profile and blood pressure
  • help maintain weight loss
• sick day rules: controlling BG can be challenging, nausea, vomitimg, illness and changes in eating will affect BG levels
• When a child with diabetes is ill

  • BG should be checked every 1-4 hours
  • ketones should be checked 1-4 hours
  • keep hydrated and choose foods that are easily tolerated
  • still take insulin
  • get plenty of rest
• when to call for help:

  • unable to eat or drink
  • persistent diarrhea or vomiting, blood glucose higher than 15mmol/L despite increasing insulin
  • very low glucose levels
  • persistent ketones or large amounts of ketones in the urine
  • become drowsy or confused
• as child grows compliance may become an issue