handout 20 maternal theory

• Diabetes mellitus (DM)

  A chronic metabolic disorder caused by an absolute or relative deficiency of insulin, an anabolic hormone
• Type 1 diabetes


  A chronic illness characterized by the body's inability to produce insulin due to the autoimmune destruction of the beta cells in the pancreas
• Insulin


  Produced by the beta cells of the islets of Langerhans located in the pancreas, and the absence, destruction, or other loss of these cells results in type 1 diabetes
• Diabetes mellitus is often considered an adult disease, but at least 5% of cases begin in childhood, usually at about 6 years of age or around the time of puberty
• Insulin


  • Essential to process carbohydrates, fat, and protein
  • Reduces blood glucose levels by allowing glucose to enter muscle cells and by stimulating the conversion of glucose to glycogen (glycogenesis) as a carbohydrate store
  • Inhibits the release of stored glucose from liver glycogen (glycogenolysis) and slows the breakdown of fat to triglycerides, free fatty acids, and ketones
  • Stimulates fat storage
  • Inhibits the breakdown of protein and fat for glucose production (gluconeogenesis) in the liver and kidneys
• Hyperglycemia


  Random blood glucose concentration of more than 200 mg/dL or 11 mmol/L, results when insulin deficiency leads to uninhibited gluconeogenesis and prevents the use and storage of circulating glucose
• Hyperglycemia


  • Kidneys cannot reabsorb the excess glucose load, causing glycosuria, osmotic diuresis, thirst, and dehydration
  • Increased fat and protein breakdown leads to ketone production and weight loss
• Hypoglycemia


  When glucose levels drop below 65 mg/dL (3.2 mmol/L), counterregulatory hormones (eg, glucagon, cortisol, epinephrine) are released, and symptoms develop
• The main function of the endocrine system is to secrete hormones into the bloodstream, which then travel throughout the body.
• Glucagon has the opposite effect on blood sugar levels, increasing them by breaking down glycogen stores and releasing glucose into the bloodstream.
• Insulin helps regulate blood sugar levels by promoting the uptake of glucose into cells where it can be used for energy or stored as glycogen.
• The pancreas secretes two types of hormones: insulin and glucagon.
• Endocrine glands include the pituitary gland, thyroid gland, parathyroid glands, adrenal glands (including the adrenal medulla), pancreas, ovaries/testes, and pineal gland.
• Insulin helps regulate blood sugar levels by promoting the uptake of glucose into cells where it can be used for energy or stored as glycogen.
• Endocrine glands include the pituitary gland, thyroid gland, parathyroid glands, adrenal glands (including the adrenal medulla), pancreas, ovaries/testes, and pineal gland.
• Hormones are chemical messengers that regulate various physiological processes such as growth, metabolism, reproduction, and homeostasis.
• Skeletal muscles attach to bones via tendons and allow voluntary movement.
• Examples of endocrine disorders include diabetes mellitus, hypothyroidism, hyperthyroidism, Addison's disease, Cushing syndrome, acromegaly, and growth hormone deficiency.
• Diabetes mellitus (DM)


  A chronic metabolic disorder caused by an absolute or relative deficiency of insulin, an anabolic hormone

  
• Type 1 diabetes


  A chronic illness characterized by the body's inability to produce insulin due to the autoimmune destruction of the beta cells in the pancreas

  
• Insulin


  • It reduces blood glucose levels by allowing glucose to enter muscle cells and by stimulating the conversion of glucose to glycogen (glycogenesis) as a carbohydrate store
  • It inhibits the release of stored glucose from liver glycogen (glycogenolysis) and slows the breakdown of fat to triglycerides, free fatty acids, and ketones
  • It stimulates fat storage
  • It inhibits the breakdown of protein and fat for glucose production (gluconeogenesis) in the liver and kidneys

  
• Hyperglycemia


  Random blood glucose concentration of more than 200 mg/dL or 11 mmol/L, results when insulin deficiency leads to uninhibited gluconeogenesis and prevents the use and storage of circulating glucose

  
• Symptoms of type 1 diabetes mellitus (T1DM)

  • Hyperglycemia
  • Glycosuria
  • Polydipsia
  • Polyuria
  • Polyphagia
  • Weight loss
  • Nonspecific malaise
  • Diabetic ketoacidosis (DKA)

  
• Glycosuria


  Increased urinary frequency and volume (eg, polyuria), which is particularly troublesome at night (eg, nocturia) and often leads to enuresis in a previously continent child
• Polydipsia


  Increased thirst, which may be insatiable, is secondary to the osmotic diuresis causing dehydration
• Polyuria


  A dramatic increase in urinary output, probably with enuresis
• Polyphagia


  An increase in hunger and food consumption
• Weight loss


  Insulin deficiency leads to uninhibited gluconeogenesis, causing breakdown of protein and fat; weight loss may be dramatic, although the child's appetite usually remains good; failure to thrive and wasting may be the first symptoms noted in an infant or toddler and may precede frank hyperglycemia

  
• Diabetic ketoacidosis (DKA)


  Characterized by drowsiness, dry skin, flushed cheeks, and cherry-red lips, acetone breath with a fruity smell, and Kussmaul breathing

  
• Diagnostic tests for diabetes

  • Fingerstick glucose test
  • Urine dipstick test for ketones
  • Fasting blood sugar (FBS)
  • Lipid profile
  • Glycated hemoglobin
  • Microalbuminuria

  
• Fasting blood sugar (FBS)


  An FBS result of 200 mg/dl or higher almost certainly is diagnostic for diabetes when other signs are present

  
• Glycated hemoglobin


  Glycosylated hemoglobin derivatives (HbA1a, HbA1b, HbA1c) are the result of a nonenzymatic reaction between glucose and hemoglobin; a strong correlation exists between average blood glucose concentrations over an 8- to 10-week period and the proportion of glycated hemoglobin

  
• Microalbuminuria


  The first evidence of nephropathy; an increased AER is commonly defined as a ratio of first morning-void urinary albumin levels to creatinine levels that exceed 10 mg/mmol, or as a timed, overnight AER of more than 20 mcg/min but less than 200 mcg/min

  
• Management of type 1 diabetes in children

  • Insulin therapy
  • Diet
  • Activity
  • Continuous glucose monitoring

  
• Insulin therapy


  Insulin therapy is an essential part of the treatment of diabetes in children; the dosage of insulin is adjusted according to blood glucose levels so that the levels are maintained near normal

  
• Diet


  Current dietary management of diabetes emphasizes a healthy, balanced diet that is high in carbohydrates and fiber and low in fat
• Activity


  Type 1 diabetes mellitus requires no restrictions on activity; exercise has real benefits for a child with diabetes

  
• Continuous glucose monitoring


  The American Diabetes Association's Standards of Medical Care in Diabetes-2018 recommend consideration of continuous glucose monitoring for children and adolescents with type 1 diabetes, whether they are using injections or continuous subcutaneous insulin infusion, to aid in glycemic control

  
• Nursing assessment for patients with diabetes mellitus type 1


  • History
  • Physical exam

  
• Nursing diagnoses for diabetes mellitus type 1

  • Imbalanced nutrition: less than body requirements
  • Risk for impaired skin integrity
  • Risk for infection
  • Deficient knowledge related to complications of hypoglycemia and hyperglycemia
  • Deficient knowledge related to appropriate exercise and activity