Disorders of Pancreatic Hormone Secretion : Diabetes Mellitus (DM) And Nursing Care Plan

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Diabetes Mellitus (DM)

Diabetes is a serious disease, which, if not controlled, can be life threatening. It is often associated  with long-term complications that can affect every system and part of the body. Diabetes can, among other things, contribute to eye disorders and blindness, heart disease, stroke, kidney failure, amputation, and nerve damage. When a child is diagnosed with diabetes, it means life changes for both the child and the family. However, with proper medical care, clinical therapies, diet, hygiene, and exercise, diabetes does not have to prevent the child from living a full and normal life.

Diabetes is a condition in which sufficient amounts of insulin are either not produced, or the body is unable to use the insulin that is produced. Diabetes can be defined as a metabolic disorder, because the disease affects the way the body metabolizes, or uses, digested food to make glucose, the main source of fuel for the body. Diabetes may be the result of conditions such as genetic syndromes, chemicals, medications, malnutrition, infections, viruses, or other illnesses.

The three main types of diabetes include:

Type 1 Diabetes

The most common type of diabetes in children is type 1 diabetes. In fact, type 1 diabetes is one of the most common chronic diseases in children. It may also be known by a variety of other names, including: insulindependent diabetes mellitus (IDDM), juvenile diabetes, brittle diabetes, and sugar diabetes. There are two forms of type 1 diabetes:

· idiopathic type 1 – refers to rare forms of the disease with no known cause.

· immune-mediated diabetes – an autoimmune disorder in which the body’s immune system destroys, or attempts to destroy, the cells in the pancreas that produce insulin.

Immune-mediated diabetes is the most common form of type 1 diabetes and is generally referred to as type 1 diabetes.

Causes of type 1 diabetes

The cause of type 1 diabetes is unknown. However, it is believed that people inherit a tendency to develop diabetes, and that some outside trigger may be involved. Type 1 diabetes is the result of the body’s failure to produce insulin, the hormone that allows glucose to enter the cells of the body to provide fuel. This is the result of an autoimmune process in which the body’s immune system attacks and destroys the insulin producing cells of the pancreas.

When glucose cannot enter the cells, it builds up in the blood causing the body’s cells to starve to death.

People with type 1 diabetes must take daily insulin injections and regularly monitor their blood sugar levels.

Symptoms of type 1 diabetes:

Type 1 diabetes often appears suddenly. In children, type 1 diabetes symptoms may resemble flu symptoms, gastroenteritis, and appendicitis. The chemical events sequence that happened with diabetes results in hyperglycemia and acidosis which produce weight loss and the three “polys” of diabetespolyphagia,

polydipsia, and polyuria. Other symptoms may include:

· elevated glucose level in the urine

· unusual thirst

· blurred vision

· sores that are slow to heal

· nausea and vomiting

· abdominal pain

· extreme weakness and fatigue

· irritability and mood changes

Complications associated with type 1 diabetes

Although type 1 diabetes can cause many different problems, there are several key complications, including the following: hypoglycemia, hyperglycemia, & ketoacidosis.

Diagnosis : FBS ≥ 126 mg/dl  , RBS ≥ 200 mg/dl

OR An oral glucose tolerance test (OGTT) finding ≥ 200 mg/dl in the 2-hour sample.

With diabetic ketoacidosis (DKA):

BS ≥ 330 mg/dl

Ketonemia :stronge +ve

Acidosis: pH< 7.30 HCO3 < 15 mmol/L

Treatment for type 1 diabetes:

Specific treatment for type 1 diabetes will be determined based on:

· child’s age, overall health, and medical history

· extent of the disease

· child’s tolerance for specific medications, procedures, or therapies

· expectations for the course of the disease

Children with type 1 diabetes must have daily injections of insulin to keep the blood sugar level within normal ranges. A combination of rapid-acting (regular) and intermediate-acting (NPH or lente) insulin is usually ordered. Injection done subcutaneously 30 minutes before breakfast and before evening meal.

Treatment may also include:

· balanced diet, concentrated sweets are discouraged-fat is reduced

· exercise (to lower and help the body use blood sugar)

· regular blood testing (to check blood-sugar levels)

· regular urine testing (to check ketone levels)

Nursing considerations:

Depending on the child’s age, a type 1 diabetes diagnosis can be devastating. The younger child may not quite understand all the life changes that may occur because of the diagnosis, such as glucose monitoring and insulin injections. After being diagnosed with type 1 diabetes, children may feel as if they are being punished, guilty, fearful of death, or hostility toward the parent. Although a child who is diagnosed with type 1 diabetes requires supervised medical care, a parent should avoid being overprotective. Through parental encouragement, self-care of the diabetes by the child, starting at the appropriate age will foster improved self-esteem and independence. Nurse should also focuses on the following points:

– Child and family education:

– Nature of diabetes.

– Meal planning.

– Injection procedures and sites.

–  Medical identification

Type 2 Diabetes

Type 2 diabetes is the most common type of diabetes in adults, accounting for 90 to 95 percent of diabetes cases. There is an increase in the number of cases of type 2 diabetes in children and adolescents. The rise may be due to obesity and decreased physical activity among children. The risk for type 2 diabetes increases with age.

Type 2 diabetes is a metabolic disorder resulting from the body’s inability to produce enough, or to properly use insulin. It has previously been called non-insulin-dependent diabetes mellitus (NIDDM).

Without enough insulin, the body cannot move blood sugar into the cells. It is a chronic disease with no known cure.

The exact cause of type 2 diabetes is unknown. However, there is an inherited susceptibility, which causes it to run in families. Although a person can inherit a tendency to develop type 2 diabetes, it usually takes another factor, such as obesity, to bring on the disease.

Type 2 diabetes may be prevented or delayed by following a program to eliminate or reduce risk factors – particularly losing weight and increasing exercise.

Symptoms of type 2 diabetes

The following are the most common symptoms for type 2 diabetes. However, each child may experience symptoms differently. Symptoms may include:

· frequent infections that are not easily healed

· frequent urination

· extreme hunger but loss of weight

· unusual thirst

· blurred vision

· extreme weakness and fatigue

· irritability and mood changes

· nausea and vomiting

· high levels of sugar in the blood when tested

· high levels of sugar in the urine when tested

· dry, itchy skin

· tingling or loss of feeling in the hands or feet

Some people who have type 2 diabetes exhibit no symptoms. Half of all persons with diabetes do not know they have the disease.

Risk factors for type 2 diabetes include the following:

· age (incidence increases with age)

· family history of diabetes

· being overweight

· not exercising regularly

· a low level HDL (high density lipoprotein, the “good” cholesterol)

· a high triglyceride level

Treatment for type 2 diabetes:

The goal of treatment is to keep blood-sugar levels as close to normal as possible. Emphasis is on control of blood sugar (glucose) by monitoring the levels, regular physical activity, meal planning, and routine healthcare. Treatment of diabetes is an ongoing process of management and education that includes not only the child with diabetes, but also family members. Often type 2 diabetes can be controlled through losing weight, improved nutrition, and exercise. However, sometimes, these are not enough and either oral medications and/or insulin must be used. Treatment may include:

· proper diet

· weight control

· an appropriate exercise program

· proper hygiene

· insulin replacement therapy (under the direction of your child’s physician)

Hypoglycemia

Hypoglycemia is the condition of having a glucose level that is too low to effectively fuel the body’s blood cells. Hypoglycemia may be a condition by itself, or may be a complication of diabetes or another disorder. It is most often seen as a complication of diabetes, which is sometimes referred to as insulin reaction.

Causes hypoglycemia

Causes of hypoglycemia in children with diabetes may include the following:

· too much medication (insulin)

· a missed meal

· a delayed meal

· too little food eaten, as compared to the amount of insulin taken

· more exercise than usual

An additional cause of hypoglycemia in children includes a condition called hyperinsulinism. This may occur as a result of abnormal cell development of the special “beta” cells in the pancreas that secrete insulin or from a mass in the pancreas. Some children are also born with errors in their metabolism that can lead to hypoglycemia. Other causes of hypoglycemia in children are rare. However, hypoglycemia may occur after strenuous exercise, during prolonged fasting, or as a result of taking certain medications. Severe or prolonged hypoglycemia may result in seizures and serious brain injury.

Symptoms of hypoglycemia

The following are the most common symptoms for hypoglycemia. However, each child may experience symptoms differently. Symptoms may include:

· shakiness

· dizziness

· sweating

· hunger

· headache

· irritability

· pale skin color

· sudden moodiness or behavior changes, such as crying for no apparent reason

· clumsy or jerky movements

· difficulty paying attention, or confusion

· tingling sensations around the mouth

Treatment for hypoglycemia:

For children with diabetes, the goal of treatment is to maintain a blood sugar level that is appropriate for each child. This involves testing blood sugar often, learning to recognize oncoming symptoms, and treating the condition quickly. To treat low blood sugar immediately, the child should eat or drink something that has sugar in it, such as orange juice, milk, or a hard candy. For children who do not have diabetes, treatment for hypoglycemia may include:

· avoiding foods high in carbohydrates

· eating smaller meals more frequently

· frequent snacks

· eating a variety of healthy foods

· regular exercise

Children who have hyperinsulinism may require treatment with medications to decrease the production of insulin the body. In more serious cases, the child may have to undergo surgery to remove the pancreas.

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Posted in Endocrinology, Nursing Care Plans, Nursing Intervention

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