Juvenile DM.pptx

Juvinile Diabeties Mellitus

1. Juvenile DM Ms. K. Lavanya MSc(N)-CHN Associate Professor

2. Definition: DM is the most common endocrine metabolic disorder of childhood and adolescence with long term effects on child’s physical and psychological growth and development . DM is a disorder of glucose intolerance due to deficiency in insulin production and its action leading to hyperglycemia and abnormalities in carbohydrate, protein and fat metabolism.

3. Types: Type I DM: It results from autoimmune destruction of beta cells. It is characterized by gross deficiency of insulin and dependence on exogenous insulin for prevention of Ketoacidosis. Reason is of idiopathic

4. Type II DM: Type II DM is now rapidly increasing in children due to morbid obesity, sedentary life style, high caloric intake and family history of DM.

5. Incidence: 5 % of all diabetics are children. Found around 5 years and about 10-12 years. IDDM occurs at younger age.

6. Etiology: In 95% cases the reason is idiopathic with absolute deficiency of insulin due to hereditary inborn error of metabolism. Genetic- Heredity is prominent factor in etiology multifactorial inheritance (or) recessive gene linked to human lymphocyte antigen. Environmental factors Autoimmune reactions Endocrinopathies- Cushing syndrome, hyperthyroidism Infections- rubella virus, CMV Immune mediated- Anti insulin receptor antibodies Other genetic syndromes- Downs syndrome, turners syndrome, klinefelters syndrome

7. Pathophysiology :

8. Clinical Manifestations:

9. Contd ….. Polyphagia Polyuria Polydypsia Weight loss Enuresis Irritability Shortened attention span Fatigue Dry skin Blurred vision Poor wound healing Flushed skin Headache Frequent infection Hyperglycemia Glycosuria Diabetic ketosis DKA Dehydration Deep rapid breathing (kusmaul)

10. Diagnostic Evaluation: Finger stick glucose test.   Urine dipstick test Fasting blood sugar (FBS).   Lipid profile.   Glycated hemoglobin.   Microalbuminuria.  

11. Management : Management of type 1 diabetes in children includes insulin therapy and a meal and exercise plan. Insulin therapy: 4 types of insulin based on criteria Rapid acting insulin ( Lipro )- reaches the blood within 15min after injection – peaks 30-90 min last for 5 hrs. Short acting insulin ( regular )- reaches blood within 30 min peaks 2-4hrs and stays in blood for 4-8 hrs. Intermediate acting insulin- reaches blood 2-6 hrs after injection and lasts upto 14-20 hrs. Long acting insulin - 6-14 hrs to start working   Combinations of the insulin available- daily insulin is administered SC by twice daily injections by multiple dose injection by means of portable pump.

12. Management:     Intranasal & inhaled insulin administration- Has capacity to cross the mucosa to increase serum level. The duration is not long. Islet cell or whole pancreas transplantation- Visible insulin producing cells have been injected to portal vein. Where they take root in liver and eventually provide upto 2/3 rd of needed insulin. Exercise and physical activity

13. Nutrition: CHO- 55-60% of total calories Fiber- 2-35mg/day Protein – 8-15% Fats- 30-35% Micronutrients

14.   Complications: DKA Hypoglycemia Tachycardia Lipoatrophy Limited joint motility Impaired intellectual development Retinopathy Nephropathy Neuropathy

15. Nursing Management: Nursing Assessment   History.   Physical exam.  

16. Nursing Diagnosis Imbalanced nutrition less than body requirements related to insufficient caloric intake to meet growth and development needs and the inability of the body to use nutrients. Risk for impaired skin integrity related to slow healing process and decreased circulation. Risk for infection related to elevated glucose levels. Deficient knowledge related to complications of hypoglycemia and hyperglycemia. Deficient knowledge related to appropriate exercise and activity.

17. Nursing Interventions: Ensure adequate and appropriate nutrition.   Prevent skin breakdown.   Prevent skin infection.   Regulate glucose levels.   Provide child and family teaching in the management of hypoglycemia and hyperglycemia.