Juvenile Diabetes Mellitus – Causes, Symptoms & Management for Nursing & Medical Students
Juvenile diabetes mellitus
INTRODUCTION DEFINITION:
A chronic condition in which the pancreas produces little or no insulin. Your child needs insulin to survive, so the missing insulin needs to be replaced with injections or with an insulin pump.
RISK FACTORS:
CLASSIFICATION:
The ADA 1998 has classified diabetes mellitus into 3 groups: •
INSULIN TYPE-- DEPENDENT DIABETES MELLITUS(IIDM) OR 1 DIABETES
Type 1 diabetes is also referred to as juvenile diabetes. It results from destruction of pancreatic ẞ cells which produce insulin, leading to absolute insulin deficiency. The person becomes completely dependent on exogenous insulin injections. lts onset is typically in childhood and adolescence but can be at any age. •
NONINSULIN-DEPENDENT DIABETES MELLITUS (NIDDM) OR TYPE II DIABETES: Type II
diabetes results from insulin resistance, a condition in which cells of the body fail to use insulin properly. The onset is usually after 40 years of age so it is also known as "Adult-onset diabetes.
• GESTATIONAL DIABETES:
When pregnant women who have never had diabetes before, have high blood glucose level during pregnancy, it is known as gestational diabetes. It may precede development of type II diabetes mellitus.
Genetic factors
PATHOPHYSIOLOGY:
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Autoimmune process activated
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Leucocytic infiltration
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Pancreatic islets
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Destruction of 𝜷 cells
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Type-1 diabetes Environmental factors
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For example, Autoimmune destruction of β cells
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Insulin production declines to less than 10-20% of normal
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Decrease transportation of glucose across cell membrane
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Less glucose available and used for energy production
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Hunger centre stimulated
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Polyphagia
MANAGEMENT:
The management of child with Type I Diabetes needs a multidisciplinary team approach involving the family, child and team of professionals including a paediatric endocrinologist, diabetes nurse educator, nutritionist and physiologist etc. Also communication with other individuals in child's life is essential like teachers, school health nurse, school guidance counsellor etc. The management includes:
I. INSULIN THERAPY
• The definitive treatment is replacement of Insulin. Most clinicians prefer human insulin, which is available in rapid acting, short, intermediate and long-acting preparations. Daily insulin is administered subcutaneously or by portable pumps.
• Insulin administration should be taught to the child as well as his parents. Nurses should provide information about site selection and rotation. Also the nurses should teach the technique of blood glucose monitoring using glucometer to the caregivers of the child.
The nurse should know and inform the child's caregivers about the side effects and complications of insulin therapy.
Local reactions:
Insulin injection may lead to pruritis and flare reaction at the site.
This is due to hypersensitivity. Also fat atrophy or lipodystrophy may occur at the Injection site. Generalized reaction: Insulin administration followed by unusual exercise, vomiting, and failure to eat the expected amount of food may lead to hypoglycemia manifested by shakiness, dizziness, pallor, headache, disturbed vision, hunger, fatigue, tachycardia, disorientation, confusion, seizures, and coma. Mild hypoglycemia can be managed effectively by giving the child orange juice, sugar cubes or other food items containing simple sugars. If shock is severe, emergency care in hospital is required.
ii. Glucose Monitoring Blood glucose
monitoring forms the basis of insulin therapy. It should be done regularly to estimate the dose of insulin required, to control the blood glucose level. The nurse should be knowledgeable about the devices (glucometers) available to check blood sugar. The same should be taught to parents also, so that they can monitor the child's blood glucose regularly.
iii. Urine Monitoring for Sugar and Ketones
Urine monitoring for glucose is used mainly to complement blood glucose testing. Parents should monitor both blood and urine glucose and ketones and then use this information with their physician to adjust the insulin dose, so as to avoid ketoacidosis.
iv. Diet, Meal Planning and Nutrition
Generally, the nutritionists prescribe 3 meals a day and 3 snacks for diabetic children.
v. Exercise •
Parents need to be instructed about the prevention and management of hypoglycemia in the following manners
• If exercise is planned before a meal, provide the child with a snack.
• If the exercise is strenuous, instruct the child to eat protein, or carbohydrate rich snack like milk or sandwich.
• If the exercise is extended over a period of hours, provide a child with the snacks in between and emphasize the importance of eating something at least every hour.
Vi. Family Education •
Involving school personnel in management plan for insulin administration, exercise, meal times.
• Monitoring child's blood glucose level, maintain insulin coverage and notify healthcare providers when child is ill.
• Evaluating the child for dehydration, hyperglycemia, and ketonuria. • Influence of exercise, emotional stress, and other illness on both insulin and dietary needs.
• Recognizing symptoms of insulin shock and diabetic acidosis and related emergency management.
vii. Taking the Following Precautions
• The child should carry an identification card which states that the child is a diabetic and includes the child's name, address, telephone number, and the treating physician's name and telephone number.
• The child should always carry some sugar source (like sugar cubes or glucose powder) that can be consumed in case, hypoglycemia occurs.
