Diabetes mellitus type 1

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1. 9/22/2016 1

2. Insulin dependent diabetes mellitus & Diabetes Insipidus Presenter Irfan Ali Chandio 9/22/2016 2

3. Objectives At the end of this presentation, the learners will be able to ; Define IDDM & DI Discuss incidence and etiology of IDDM & DI Describe pathophysiology of IDDM Explain clinical manifestations of IDDM & DI Describe diagnostic findings of IDDM & DI Discuss management of IDDM & DI 9/22/2016 3

4. INSULIN DEPENDENT DIABETES MELLITUS (IDDM) Juvenile diabetes mellitus (type-1 or Insulin dependent diabetes mellitus) is a chronic metabolic disorder resulting from absolute lack of insulin and resulting in carbohydrate and lipid metabolism is impaired, and characterized by hyperglycemia, glycosuria. 9/22/2016 4

5. INCIDENCE & ETIOLOGY IDDM is the most common endocrine disorder in children, peak age of onset is 11 years in girls 13 in boys the average age of the onset of puberty. Siblings and offspring of a diabetic patient have 5% and twins 50% risks . Diabetes Mellitus is due to lack of insulin, type 1 characterized by pancreatic islet beta cell destruction mediated by immune mechanism. 9/22/2016 5

6. Cont.… An autoimmune disease that occurs genetically susceptible individuals. Several environmental factors such as Viruses ( Cytomegalo Virus, mumps, rubella virus) C hemicals (child exposed cow’s milk before 2 years of age). Or idiopathic 9/22/2016 6

7. PATHOPHYSIOLOGY The autoimmune destruction, mediated by T-lymphocytes of the beta cells results in inadequate insulin secretion and eventually insulin deficiency. Deficiency of insulin results in non-utilization of glucose by the peripheral tissues and hence hyperglycemia. The excess glucose causes polyuria and body tries to compensate that increase thirst and large intake of fluids (polydipsia). 9/22/2016 7

8. Cont.… Lack of glucose utilization by body leads to increased appetite (polyphagia). Now body utilize alternate source of energy fat from adipose tissues, when rate of free fatty acids exceeds rate of utilization, excess fatty acids are converted to ketone bodies and ketonuria occur. Protein synthesis is impaired resulting in loss of weight, muscle wasting and growth retardation. 9/22/2016 8

9. CLINICAL MANIFESTATIONS The individual with type 1 DM most commonly with a history of polyuria, polydipsia , polyphagia, weight loss and dehydration. In some individuals abdominal pain and vomiting will be presents. Lethargy , hypotension and recurrent infection may occur. 9/22/2016 9

10. DIAGNOSIS Blood sugar (fasting serum glucose above 126mg/dl) & (random above 200mg/dl). Urine examination ( reveals glycosuria & ketonuria ). Serum electrolytes (low chlorides ). Blood examination (Hemoglobin and hematocrit elevated due to dehydration). The measurement of HbA1c levels is also helpful in diabetic monitoring. 9/22/2016 10

11. NURSING MANAGEMENT Insulin management The patients and their parents should be knowledgeable about the action of the various types of insulin that are available. Insulin can be given subcutaneously into the thighs and lower abdominal wall by fine needle syringes. Prepubertal diabetic children will require 0.7–1 unit of insulin/kg per day. Children during puberty will require 30–50% more insulin. 9/22/2016 11

12. Cont.… Nutritional management The diet should provide adequate nutrition and calories for optimal growth and development. The total energy intake should comprise 55% complex unrefined carbohydrates, 15% protein and 30% fat. Avoid refined sugars and give more food with high fiber content. 9/22/2016 12

13. Cont.… Exercise Children with IDDM should be encouraged to exercise regularly at least 25mints. With exercise, insulin requirements lowered, and metabolic control is improved. 9/22/2016 13

14. DIABETES INSIPIDUS (DI) DI or neurogenic DI is a disorder of water regulation. The function of ADH is to concentrate urine by stimulating reabsorption of water in the renal collecting tubules. A deficiency of ADH results in excretion of large amount of dilute urine (more than 2 L/ per day). Affected children could be admitted in a severe dehydrated state. 9/22/2016 14

15. INCIDENCE AND ETIOLOGY DI is most often seen in children as a complication following head trauma or cranial surgery to remove tumors of hypothalamic-pituitary regions. Other causes vascular anomalies, infections (meningitis), and genetic factor. 9/22/2016 15

16. CLINICAL MANIFESTATION In infants, failure to thrive, fever, vomiting, constipation, dehydration and poor growth. In older child polyuria, polydipsia, nocturnal enuresis which interrupts sleep and increased thirst. 9/22/2016 16

17. DIAGNOSIS An outpatient screening includes obtaining first morning urine sample for osmolarity and specific gravity. Further investigation a Water deprivation test is commonly performed. The object of the water deprivation test is to measure the vasopressin release from pituitary in response to depriving the child’s of water. Further I & O fluid intake, weight measure, Vital sign, hydration assessment and urine and blood samples most frequently by nurse. 9/22/2016 17

18. NURSING MANAGEMENT Encourage and support patient. Instruct patient and family members about following care & everyday measure. Provide skin and mouth care. Keep accurate records of hourly fluid intake and urine output, vital signs, and daily weight. Monitor urine specific gravity and serum electrolyte and blood urea nitrogen levels . 9/22/2016 18

19. Cont.… During dehydration testing, watch for signs of hypovolemic shock. Check laboratory values for hyponatremia and hypoglycemia. Encourage the patient to maintain adequate fluid intake during the day to prevent severe dehydration. Inform the patient and his family about long-term hormone replacement therapy . 9/22/2016 19

20. Reference: L.Barbara L. mandleco & L.Nicke Potts. Pediatric Nursing ed:2002 by Delmar Thomon Learning E. Mary Muscari . Paediatric Nursing. Third Edition..Copy right 2001 by Lippincott Williams Wilkins. 9/22/2016 20

21. Thank you 9/22/2016 21