Diabetes Mellitus

• VIII. DIABETES MELLITUS

  ● Results from damage to beta cells of the islets of Langerhans in pancreas which affects insulin secretion.

  ● As shown in the photo, insulin’s function is to take in glucose from the blood as glucose is needed for our body’s primary source of energy. It simply opens the door to body cells.

  ○ Insufficient Insulin: glucose will just remain in the blood and cannot enter cells.
• TYPE 1 DIABETES MELLITUS

  ● Formerly Called: Juvenile or insulin-dependent diabetes

  ● Caused by an autoimmune damage.

  ● Absolute or relative deficiency of insulin

  ○ No insulin secretion at all

  ● Occurs almost exclusively in childhood

  ○ Onset - 5 to 7 years old
• TYPE 2 DIABETES MELLITUS

  ● Formerly Called: Non-insulin-dependent diabetes mellitus

  ● Related to many factors; not caused by an autoimmune damage

  ● Diminished or less insulin secretion

  ● Once thought to occur only in older adults

  ○ Matury On-Set Diabetes of Youth - type 2 diabetes seen among overweight adolescents
• HREE CARDINAL SYMPTOMS

  1. Hyperglycemia – as glucose builds up in the blood because it cannot enter the cell

  2. Polyuria – as the body attempts to excrete excess glucose, the body also excretes a large amount of fluid

  3. Polydipsia – as the excess fluid loss triggers the thirst response
• ASSESSMENT

  ● Diagnosis is confirmed based on finding one of the following 3 criteria on 2 separate occasions:

  1. Random blood glucose level greater than 200 mg/dL

  ● A random blood glucose test is taken anytime, regardless of the last time the child ate

  2. Fasting blood glucose level greater than 126 mg/dL

  ● Usually 8 hours without food, typically taken in the morning before breakfast
• 3. 2-hour plasma glucose level greater than 200 mg/dL during an oral or IV glucose tolerance test (GTT)

  ● GTT - either involves oral or IV glucose administration.

  ○ First Step - get blood glucose level drawn at fasting as the baseline

  ○ Second Step - after 1 hour of glucose

  ○ Third Step - after 2 hours of glucose.

  ○ This is rarely performed in children because the test is difficult for them and tasking also for them to undergo
• MANAGEMENT

  1. Administer medications depends on the type of DM

  ● For Type 1 DM - give insulin in a combination of regular and NPH is a common maintenance dose. It is usually at 0.4 to 0.7 U/kg of body weight in 2 doses before breakfast and before dinner

  ○ Initially at the first diagnosis of a child with type 1 DM, a short acting insulin is given such regular or humolin N for the first 24 hours.

  ○ Then, an intermediate acting insulin such as NPH or humolin N is given on the 2nd day.

  ○ Afterwards, as a maintenance dose the combination insulin is now given
• ○ Remember also the nursing interventions when giving insulin.

  (1) Always inject insulin SQ except in emergencies when half required dose may be given IV.

  (2) Rotate the injection sites subcutaneously to prevent lipodystrophy.

  (3) When you aspirate insulin combination in asyringe, always draw up the regular or the short-acting insulin first.

  (4) Children can also be taught to self-administer insulin using an insulin pump.

  (5) Self-blood glucose monitoring using a glucometer can also be taught in children, not just for type 1 but for type 2 as well
• ● For Type 2 DM - give the oral hypoglycemic agent biguanide (Metformin) is recommended. If not effective, may try sulfonylurea (Glyburide).

  ○ Metformin - decreases glucose produced by the liver and increases insulin sensitivity.

  ○ Sulfonylurea - stimulates the beta cells in the pancreas to produce more insulin

  2. Regulate diet.

  ● There is also a possible need to force fluids but without sugar

  3. Encourage regular exercise

  ● But not through strenuous activities.