Diabetes mellitus type 1

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Insulin dependent diabetes mellitus & Diabetes Insipidus

Presenter Irfan Ali Chandio

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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

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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.

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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.

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Cont.…

• An autoimmune disease that occurs genetically susceptible individuals. • Several environmental factors such as Viruses (Cytomegalo

Virus, mumps, rubella virus) • Chemicals (child exposed cow’s milk before 2 years of age). • Or idiopathic

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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).

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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.

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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.

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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.

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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.

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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.

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Cont.…• Exercise• Children with IDDM should be encouraged to exercise

regularly at least 25mints. •With exercise, insulin requirements lowered, and metabolic

control is improved.

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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.

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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.

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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.

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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.

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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.

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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.

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Reference:

1. L.Barbara L. mandleco & L.Nicke Potts. Pediatric Nursing ed:2002 by Delmar Thomon Learning

2. E. Mary Muscari. Paediatric Nursing. Third Edition..Copy right 2001 by Lippincott Williams Wilkins.

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Thank you

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