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PAEDIATRICS.doc--- DIABETIC MELITUS

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					PAEDIATRICS
ENDOCRINE
 DISORDER




DIABETES
MELLITUS
      INTRODUCTION

DIABETES 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.

IT IS A COMMONEST ENDOCRINE
METABOLIC DISORDER OF CHILDHOOD
AND ADOLSCECNCE WITH LONG TERM
EFFECT ON CHILD’S PHYSICAL AND
PSYCHOLOGICAL GROWTH AND
DEVELOPMENT .
       INCIDENCE
APPROXIMATELY 5% OF ALL
DIABETICS ARE CHILDREN. PEAK
INCIDENCE IN CHILDREN IS
FOUND AROUND 5YRS. AND
ABOUT 10 TO 12 YRS.




        ETIOLOGY
 1)   GENETIC PREDISPOSITON

 2) AUTO- IMMUNE PROCESS
          MECHANISMS OF
BETA CELL DAMAGE IS
BELIEVED TO BE AN AUTO-
IMMUNE PROCESS.


3) ENVIRONMENTAL FACTORS

 a) STERSS ( EMOTIONAL AND
  PHYSICAL FACTORS)
   CLASSIFICATION
1. TYPE- 1 INSULIN
 DEPENDENT DIABETES
 MELLITUS.


2. TYPE-2 NON- INSULIN
 DIABETES MELLITUS.
   TYPE-1 INSULIN
DEPENDENT DIABETES
     MELLITUS

IT RESULTS FROM AUTO-
IMMUNE DESTRUCTION OF BETA
CELLS. IT IS CHARACTERISED
BY GROSS DEFICIENCY OF
INSULIN AND DEPENDENCE ON
EXOGENOUS INSULIN FOR
PREVENTION OF KETO-ACIDOSIS
. IT OCCURS MAINLY IN
CHILDHOOD THOUGH THERE IS
NO AGE BAR . MAJORITY OF
TYPE-1 CASES AS IDIOPATHIC.
TYPE-2 NON- INBSULIN
DEPENDENT DIABETES
MELLITUS

IT IS RARE IN CHILDHOOD AND
IS NOT ASSOSCIATED WITH
AUTO- IMMUNE PROCESS. IT IS
USUALLY NOT COMPLICATED
BY KETO- ACIDOSIS.
PREVIOUSLY IT WAS ALSO
KNOWN AS ADULT-ONSET
DIABETES OR MATURITY ONSET
DIABETES.




PATHOPHYSIOLOGY
DUE TO ETIOLOGICAL FACTOR
           ↓
  DEFICIENCY OF INSULIN
             ↓
GLUCOSE IS UNABLE TO ENTER
THE CELL AND ITS
CONCENTRATION INCREASES IN
BLOOD STREAM.
             ↓
MOVEMENT OF BODY FLUIDS
FROM INTRACELLULAR SPACES
TO EXTRACELLULAR SPACE.


             ↓
PROTEIN AND FAT IS
BREAKDOWN AND CONVERTED
TO GLUCOSE FOR ENERGY.
             ↓
AS THE BODY ATTEMPTS TO
MEET ITS ENERGY NEEDS,
HUNGER MECHANISMS IS
TRIGGERED.




     CLINICAL
MANIFESTATION
HYPERGLYCEMIA

GLYCOSURIA

POLYURIA

POLYDEPSIA

 POLYPHAGIA

 WEIGHT LOSS

 IRRITABILITY

  OVERLY TIRED

 DRY SKIN

 BLURRED VISION
SLOW- HEALING PROCESS

FREQUENT INFECTION

FAINTING ATTACKS

NAUSEA , VOMITTING




   DIAGNOSTIC
   EVALUATION

a) HISTORY COLLECTION
 b) PHYSICAL EXAMNTN.
   c) LAB INVESTIGATION
  d) URINE EXAMINATION




    MANAGEMENT
a) INSULIN THERAPY


b) EXERCISE AND PHYSICAL
 ACTIVITY

c) DIET THERAPY

d) FOLLOW- UP
e) EMOTIONAL SUPPORT AND
 DIABETIC EDUCATION




NURSING DIAGNOSIS

 ALTERED NUTRITION INTKE
 DUE TO INSULIN DEFICIENCY
 AND ALTERATION OF
 METABOLISM.
 FLUID VOLUME DEFICIT r/t
 DIABETIC KETOACIDOSIS
 RISK FOR INFECTION r/t
 HYPERGLYCEMIA
 RISK FOR INJURY r/t
 HYPOGLYCEMIA
 KNOWLEDGE DEFICIT r/t
 INSULIN THERAPY
 FEAR AND ANXIETY r/t
 LONG- TERM ILLNESS

				
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