Chapter 18 | Endocrine Disorders 449
weight, the dose is 1.0 mg. Doses may be repeated in 15 minutes if needed (Vallerand & Sanoski, 2021). Family Teaching Guidelines: Managing Hyperglycemia How to: Recognize the signs of hyperglycemia—child is tired, is thirsty, has dry mucous membranes, is urinating more, is
during illness, pre- and post-exercise, and when symptomatic of hyperglycemia or hypoglycemia. Self-monitoring of blood glucose may be useful for anyone on a noninsulin therapy to provide information regarding impact of therapy, diet, and/or physical activity on blood sugars (ADA, 2021). Self-monitoring may be achieved by traditional glucometers and continu- ous glucose monitors. Families and children should be taught how to safely use the technology in addition to its limitations. Reinforcement and periodic reassessment of education may be needed, especially if the child is not in a therapeutic range. Because most children spend a large portion of the day in the care of others, at school, daycare, after school programs, it is important that alternative caregivers have education about using diabetes management technologies.
losing weight, is weak, has deep rapid breathing Causes: Taking too little insulin, eating too many
carbohydrates, taking old insulin, insulin pump or pen failure, carbohydrates, injecting insulin under the skin and not into fatty tissue, skipping insulin doses, illness and stress
Essential Information: • Check blood glucose levels
• Test blood or urine for ketones • Give additional insulin as directed • Encourage the child to drink extra water • If blood glucose is elevated and ketones are present, seek emergency care
TYPE 2 DIABETES MELLITUS
Type 2 diabetes mellitus (T2DM) occurs because of decreasing beta cell production of insulin and cellular insulin resistance. Al- though T2DM is more prevalent in adults, pediatric obesity has led to an increase in type 2 diabetes among children and adoles- cents (ADA, 2021). Imperatore and colleagues (2012) estimate that the number of people younger than 20 with type 2 diabetes will increase fourfold to approximately 84,000. This is concerning, as younger people diagnosed with diabetes have a faster decline in beta cell function and faster onset of complications (ADA, 2021). Risk-based screening for T2DM should be done for children at puberty or older than 10 (whichever is first) if they meet cri- teria. Screening should be done for children who have a BMI ≥ 85% and one or more additional risk factors such as mater- nal history of diabetes or gestational diabetes during the child’s gestation, family history of type 2 diabetes in a first- or second- degree relative, race/ethnicity (American Indian, black, Latino, Asian American, Pacific Islander), or signs of insulin resistance or conditions associated with insulin resistance (acanthosis nigri- cans, hypertension, dyslipidemia, polycystic ovary syndrome, or small-for-gestational-age birth weight) (ADA, 2021). Children with T2DM may have no symptoms or they may present with symptoms of hyperglycemia (weight loss, polyuria, polydipsia). Children who are obese may be diagnosed with T1DM, and children who have T2DM may present with ketosis. Children who may have diabetes should have islet autoantibody testing to assist with accurate diagnosis (ADA, 2012). Assessment The following measures are used to assess for T2DM among pediatric patients. Clinical Presentation ● Elevated blood glucose level or complications such as DKA. ● Acanthosis nigricans (dark pigmented areas of the skin on the back of the neck, axilla, and arms) is evidence of insulin resistance.
SAFE AND EFFECTIVE NURSING CARE: Promoting Safety
Technology for Diabetes Management Use of technology in the management of diabetes is rapidly changing. Children who have diabetes should be supported in the use of developmentally appropriate technology. Children may be administered insulin and other injectable antihypergly- cemics via pen devices. These devices may help patients and/ or families who have dexterity and vision issues. They may also be useful for children who have a fear of needles. Newer “smart” insulin pens work in conjunction with continuous glucose monitors to adjust the insulin dose. Insulin pumps are a device worn at all times (with a few exceptions specific to each device). They deliver basal insulin continuously and bolus doses as needed. It is recommended that all patients with T1DM and T2DM with a multidose insulin regimen be considered for the use of insulin pump if it can be safely maintained (ADA, 2021). A variety of insulin pumps are available, including sensor-augmented pumps that allow the glucometer and the insulin pump to communicate. This type of pump is closest to an automated closed loop system like a pan- creas would be. The child or caregiver does need to input meal information, but the systems will adjust basal insulin rates based on information from the continuous glucose meter. Patch systems are an option for patients with T2DM. This system delivers 2 units of basal insulin with each push of a but- ton (ADA, 2021). Self-monitoring of blood glucose should be encouraged for anyone taking insulin therapy. Frequency will depend on the regimen and other factors that might cause hypoglycemia but may include when fasting, pre- and post-meal,
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