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 2/3rd of needed insulin.
• Exercise and physical activity

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. 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.