DM

• Diabetes Mellitus• It is a group of metabolic diseases in whichthere are high blood sugar over a prolongedperiod
• Type 1 DM(Insulin Dependent)• Characterized bydestruction of beta cells,usually leading to absoluteinsulin deficiency.• Onset in childhood andadolescence, but it canoccur at any age• Juvenile onset DMType 2 DM• Arises because of insulinresistance• Onset usually after age of40• Adult onset DM
• Normal blood glucose: 80-120mg/dL
• • Diagnostic test– Random Blood Sugar (RBS)• Blood specimen is drawn without preplanning• >200mg/dL + symptoms is suggestive of DM– Fasting blood sugar (FBS)• Blood specimen after 8 hours of fasting• No DM (70-110mg/dL, DM (>110 but <126mg/dL)– Postprandial Blood sugar• Blood sample is taken 2 hours after a high CHO meal• No DM (70-110mg/dL), DM (>140 but <200mg/dL)
• Oral Glucose Tolerance Test (OGTT)

  • Diet high in CHO is eaten for 3 days

  • Client then fast for 8 hours. A baseline blood sample isdrawn & a urine specimen is collected

  • An oral glucose solution is given and time of ingestionrecorded

  • Blood is drawn at 30 mins & 1, 2, 3 hours after theingestion of glucose solution.• Urine is collected

  • No DM (glucose returns to normal in 2-3 hours & urine isnegative for glucose)

  • DM (blood glucose returns to normal slowly; urine ispositive for glucoe
• 3 P’s:PolyuriaPolydipsiaPolyphagia
• Assessment DM :– Hyperglycemia– Weight loss– Fatigue/ Lethargy– Headache– Stomachache– Fruity odor to breath– Dehydration– Blurred vision– Change in LOC– Slow healing of wound
• Long term effect– Failure to grow normal rate– Delayed maturation– Recurrent infection– Neuropathycardiovascular disease– Renal/ retinal microvascular disease
• Complication– Hypo/ hyperglycemia– DKA Diabetic Ketoacidosis– Coma– Hypo/ hyperkalemia- cardiac arrhythmias– Cerebral edema
• Management:• Diet– Based on growth expectation– 3 meals a day with consistent interval– Midafternoon carbs snack; and bedtmime snack isneeded– Must carry candy all the times to avoid hypoglycemia– Participate in food choices• Exercise– Extra food need to be consumed for increasedactivity
• Insulin– Insulin must not be withheld during infection,illness or stress because of gyperglycemia &ketoacidosis may be present– Administer glucagon IM or SC if hypoglycemiathen unable to consume sugar containing itemorally– (+) spare bottle of insulin available
• The main functions of insulin are:-Decrease blood glucose-Inhibit fat breakdown-Inhibit protein breakdown
• DM PATHO

  
• insulion

  
• • Blood sugar monitoring– More accurate than urine testing– Requires the child to prick himself– Handwashing before & after procedure– Check expiration date• Urine testing– To check for ketone & glucose in urine– Second voided urine is the most accurate– If (+) ketone = impending ketoacidosis– Not recommended taking insulin