(Diabetes)

Danielle Downey

Khadene Bookal

Jessica Whittemore

Nami Khwakhali

Michael Stevens

Jeanine Mucci

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(Diabetes)

http://icanhascheezburger.files.wordpress.com

DiabetesWhat is Juvenile (Type 1)

Diabetes?

Diabetes is a metabolic disorder characterized by deficiency or lack of the hormone insulin.

Type 1 diabetes is an autoimmune disorder where the beta-cells of the pancreas are destroyed.

Insulin is not produced endogenously, therefore supplemental insulin is required to sustain life.

Type 1 diabetes has two peaks of onset.

-early childhood, 5-7 years

-puberty, 11-13 years

(Felner, Klitz, Ham, Lazaro, Stastny, 2005)

(Schub, Strayer, 2008)

Diabetes on the Cellular Level

Food → Increases intracellular concentration of glucose → Increases the ATP/ADP ratio → depolarizes plasma membranes→ Calcium can enter via voltage gated calcium channels →Increases intracellular calcium→ glucose induced insulin release → insulin → glucose uptake from liver fat and muscles→ Decrease of blood glucose→ decrease of ATP/ADP ratio→ opens potassium ATP channels→ membrane hyper polarization→ no more insulin. (Hussain & Cosgrove, 2005)

So you got that… Right?

3*

Causes & Risk Factors Genetics-related to the

human leukocyte antigen complex.

Genetic factors account for about half of the risk

Environmental factors include: viruses

Diabetes patients have antibodies that attack the beta cells of the pancreas

Diet: cow’s milk has been thought to trigger the destruction of pancreatic beta cells

(A.D.A.M., 2006) Rate of mortality in

African Americans are higher, which is related to acute complications

(Hussain, Cosgrove, 2005)

Manifestations of DiabetesPolyphagia

Polyuria

Polydipsia

Weight loss

Enuresis or nocturia

Irritability

Shortened attention span

Lower frustration tolerance

Fatigue

Dry skin

Blurred vision-sudden vision changes

Poor wound healing

Headache

Flushed skin

Frequent infections

Hyperglycemia

-glucosuria

Diabetic ketosis*

Diabetic ketoacidosis*

Tingling or numbness in hands or feet

(Hokenberry & Wilson, 2008)

2*-textbook

Treatment and Management Surgery-Replace or transplant the

pancreas, its cells, or beta-cells. Insulin Diet modification Low impact aerobic exercise,

moderate and regular

(Hokenberry & Wilson, 2008)

DIABETES

Insulin Facts

-Human insulin is recommended by physicians as the drug of choice.

-Analogs of human insulin include Humalog and Novalog.

-Human insulin's may be substituted for each other

-Human and pork insulin should never be substituted for each other

(Hokenberry & Wilson, 2008, pg. 1710)

Insulin

• Rapid Acting Insulin- Enters the blood within 15 minutes of injection. Peaks within 30-90 minutes.

• Short acting insulin- Reaches blood within 30 minutes of injection. Peaks within 2-4 hours.

• Intermediate acting insulin- Reaches the blood within 2-6 hours. Peaks within 4-14 hours

• Long-acting insulin-Reaches the blood within 6-14 minutes. Peaks within 10-16

(Hokenberry & Wilson, 2008, pg. 1710)

Methods of Insulin Administration

• Multiple-dose injections, syringes and pens.

• Insulin infusion pump

Future Therapies

-Islet cell or whole pancreas transplant

Glucose Monitoring

-Daily monitoring is essential

(Hokenberry & Wilson, 2008, pg. 1711)

InsulinPreparation Name Onset (H) Peak (H) Duration (H)

Rapid Acting Lispro 0.25 1-1.5 3-4

Aspart

(novolog)

0.25 0.4-0.5 3-5

Glulisine 0.25 1-1.5 3-5

Short Acting Regular 0.5-1.0 2-3 4-6

Intermediate

Acting

NPH 2 6-8 12-16

Long Acting Lantus 2 16-20 24+

Combinations Humulin 50/50

0.5 3 22-24

Humulin

70/30

0.5 4-8 24

Novolin

70/30

0.5 4-6 24

Diabetes rap

Impact on individual family and community

•Adjustment to a chronic illness is difficult and follows grief process.•School age children tend to accept their condition more easily than adolescents. •For all family, daily compliance with numerous procedure and structured living schedule is difficult. (Hokenberry & Wilson, 2008, pg. 1715)

Diet• needs to include balanced proportion of

protein and carbohydrates eaten several times day .

• Concentrated sweets should be generally avoided, but small exceptions are acceptable if the remainder of the day’s dietary intake and insulin dosages are adjusted accordingly.

• Children with diabetes should take in a prescribed number of calories every day and may require six small meals a day to keep blood sugar levels constant.

(Hokenberry & Wilson, 2008)

• Insulin pump • Finger stick• Insulin injection

Principles of teachingIt is important to educate both the child and the parentMake a list of important concepts for child and parent

Initially establish what the child believes or understands about diabetes.

Address fears and concerns of both the child and parent.

Personalize the education

Use a pace that is appropriate for the family.

Use illustrations and analogies to facilitate learning.

Focus on positives, but include “what if” situations.

Reinforce and build on previous sessions.

(Lowes, 2008)

Initial education should include:

How to recognize hyperglycemia, hypoglycemia and DKA.

How to avoid and manage hypo and hyperglycemia and what to do if DKA occurs.

How to manage diabetes in relation to the child’s normal schedule. Including school, parties and sleepovers.

Childs dietary needs.

Use of insulin, insulin adjustment.

How to test blood sugar levels. Norms.

The importance glycemic control is for growth and development.

(Lowes, 2008)

Outcome of Teaching Outcome of Teaching

Clients will:

Understand diabetes

Understanding and verbalizing the signs and symptoms of hypo and hyperglycemia

Ability to test blood sugar levels

Demonstrate understanding of normal blood glucose levels

Ability and knowledge to administer insulin

Understand the meal planning and appropriate food choices

Understanding the importance of exercise

Maintain proper hygiene

Child will have a positive self-image

(Hokenberry & Wilson, 2008)

2*

Statistics• About 186,300 young people in the

US under age 20 had diabetes in 2007.

• 15,000 US youths, under 20 years of age, are diagnosed annually with type 1 diabetes while 3,700 are newly diagnosed with type 2 diabetes.

• Non-Hispanic white youth had the highest rate of new cases in 2003.

• Diabetes was the 7th leading cause of death listed in the US in 2006.

• The risk for death among people with diabetes is twice that of people without diabetes who are similar in age.

(NDIC, 2008)

ResourcesA.D.A.M. Inc., (2006, July 18). Patient Educatoin. Retrieved December 3, 2008, from

University of Maryland Medical Center Web site: http://www.umm.edu/patiented/articles/what_cause_type_1_diabetes...

Hockenberry, M.J., & Wilson, D. (2007). Wong’s Nursing care of infants and children. St. Louis, Missouri: Mosby Inc.

Hussain, K., & Cosgrove, K. (2005). From congenital hyperinsulinism to diabetes mellitus: the role of pancreatic beta-cells KATP channels. Pediatric Diabetes, 6, Retrieved December 3, 2008, from CINHAL plus.

Felner, E.I., Klitz, W., Ham, M., Lizaro, A., & Stastny, P. (2005). Genteic interaction among three genomic regions creates distinct contributions to early and late-onset type 1 diabetes mellitus. Pediatric Diabetes, 6, Retrieved 27 November, 2008, from CINAHL.

National Diabetes Information Clearinghouse(NDIC), (2008, June). National Diabetes Statistics. Retrieved December 3, 2008, Web site: http://diabetes.niddk.nih.gov/dm/pubs/statistics

NS450 Lowes L. (2008) Managing type 1 diabetes in childhood and adolescence. Nursing Standard. 22(44), 50-56. Retrieved November 27, 2008, from CINHAL.

Schub, T., & Strayer, D.A. (2008). Diabetes Mellitus, Type 1. CINAHL informationsystems, Retrieved November 27, 2008, from CINAHL.