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Juvenile DM.pptx

  1. 1. Juvenile DM Ms. K. Lavanya MSc(N)-CHN Associate Professor
  2. 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. 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. 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. 5. Incidence: • 5% of all diabetics are children. • Found around 5 years and about 10-12 years. • IDDM occurs at younger age.
  6. 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. 7. Pathophysiology:
  8. 8. Clinical Manifestations:
  9. 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. 10. Diagnostic Evaluation: • Finger stick glucose test. • Urine dipstick test • Fasting blood sugar (FBS). • Lipid profile. • Glycated hemoglobin. • Microalbuminuria.
  11. 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. 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 2/3rd of needed insulin. • Exercise and physical activity
  13. 13.  Nutrition: o CHO- 55-60% of total calories o Fiber- 2-35mg/day o Protein – 8-15% o Fats- 30-35% o Micronutrients
  14. 14. Complications:  DKA  Hypoglycemia  Tachycardia  Lipoatrophy  Limited joint motility  Impaired intellectual development  Retinopathy  Nephropathy • Neuropathy
  15. 15. Nursing Management: • Nursing Assessment • History. • Physical exam.
  16. 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. 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.

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