CHS
456
Mashael Huwaikem
1
Diabetes
among
Children
2
Content :
Introduction ………………………………………………….………….……………..….4-12
1-
Type 1diabetes …………......................………………..…………………...….…………..…4
2-
Type 2diabetes ……………...………………………...……………………..................……5
3-
Symptoms of hyperglycemia……….…………………...…………………...…………..….5
4-
Symptoms of hypoglycemia……………….……………….…...…………..…………....5-6
5-
The primary criteria used to diagnosed diabetes……………..…………….…………….6
6-
Chronic complication of diabetes ………………………………..………...................…6-7
7-
Treatment of Diabetes Mellitus…………………..………....................................................7-12
Goals……………………………………………..………...…………………...……………...13
Objective……………………………………….......................................................................................13
Theme ………………………………………………………………………………………...13
Target group …….…………………………………...........................………..………...................13
Location ………………………………………………………...….............................................…13
Time ………………………………………………………...………………….......…...…13-14
Plan ………………………………………………………..………….....................................14-17
A- Individual Teaching …………………………………………….………………14-15
B- Group Teaching ……………………………………..……………...………....…15-17
Material …………………………………….………………...……………..…............................17
Resource………………………………………………………....….............................................…17
Tool need it…………………………………………………………..…......…..................……...18
Referral……………………………………………………………..............................................…18
Health care team ……………………..…………………………………………………….....18
Evaluation …………………………………………………………………….………….…...18
Documentation ……………………………………………………………………..…….…..18
3
 Introduction :
Diabetes mellitus describe as a group of metabolic disorders
characterized by elevated blood glucose and altered energy
metabolism and cause by defective insulin secretion, defective
insulin action ,or combination of tow.
There tow major type of diabetes:
1-
Type 1 diabetes:
Type 1 diabetes is a common major type of diabetes which
children suffer of it, the pancreas cannot synthesize insulin,
Blood glucose rises abnormally high, but cannot enter cells that
need it for energy. Without insulin, the body energy
metabolism
is
dramatically
altered
with
such
severe
consequence that people with type 1 diabetes cannot survive
unless they inject insulin regularly. In many cases of type 1
diabetes , the individual appear to inherit a defect in which
immune cells mistakenly attack and destroy insulin producing
pancreatic cells.
Children with siblings parents type 1 diabetes risk developing
the disease themselves .
4
2-
Type 2 diabetes:
The predominant type of diabetes for the adult , the pancreas
produce insulin , and cells respond to it, but with less
sensitivity. As blood glucose rises, the pancreas makes more
insulin ,and blood insulin rises to abnormally high levels
(hyperinsulinemia). During this period of impaired glucose
intolerance, the body is able to maintain blood glucose within
fairly normal range but at cost. The chronic demand for insulin
gradually exhausts the beta cells of pancreas, and finally
production may falters as the disease progresses.
The exact causes are unknown, appear to be associated with
obesity, especially abdominal fat, physical inactivity, and aging.
3-
Symptoms of Hyperglycemia:
 Increase thirst.
 sometimes hunger .
 Increase urination .
 Blurred vision.
 Fatigue .
 Acetone breath.
4-
Symptoms of hypoglycemia:
 Headache .
5
 Sweating.
 Shakiness.
 Nervousness.
 Confusion.
 Hunger .
5-
The primary criteria used to diagnosed diabetes
include :
 Random blood glucose sample that exceed 200mg
\100ml in person with symptoms of diabetes.
 Blood glucose of 126 mg\100ml or grater in person who
been fasting for at least 8 hours.
 Blood glucose level of 200mg\100ml or grater anytime
during glucose tolerance test that measure person's
fasting blood glucose and then rests it several times after
specific amount of glucose is given orally.
6-
Chronic complication of diabetes:
 Cardiovascular disease :
Atherosclerosis tend to develop early , progress rapidly , and
more rapidly, and more advanced at time of diagnosis in people
with diabetes. More than 80% of people with diabetes die as a
consequence of cardiovascular disease ,especially heart attack.
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 Small blood vessel disorder :
Disorders of the smallest blood vessel may also develop and
lead to loss of kidney function and retinal degeneration and
loss of vision. About 85 % of people with diabetes have
nephropathy or retinopathy or both.
 Neuropathy :
Nerve tissue may also deteriorate , resulting in neuropathy. The
person may experience a painful pricking sensation , often in
the arms and legs, which progress until person loss sensations
in the hand and feet. Injuries in these area may go unnoticed
and infections can progress rapidly. If tissues die as
consequence ,amputation of the affected limbs may be
necessary.
Nephropathy can also delay gastric emptying. When the
stomach empties slowly after a meal (gastroparesis), the person
may experience a premature feeling of fullness ,nausea ,
vomiting , weight loss, and poor blood glucose control due to
irregular nutrient absorption.
7-
Treatment of Diabetes Mellitus :
A diagnosis of diabetes can be devastating. The parents of
young child with diabetes may feelings overwhelmed, angry
7
anxious, and even guilty. An adolescent may feel that it is the
end of the world. To control blood glucose successfully , the
child must master the complex task of coordinating diet
,physical activity medications or insulin injection. On the
bright, such mastery helps child live a full and active life and
significantly reduces the risk of chronic complications.
The diet for diabetes parallels a healthy diet for all children in
both amounts and types of nutrient. Attention to all energy is
important: controlling carbohydrate prevent hyper- and
hypoglycemia; controlling protein can help prevent loss of
kidney function; controlling fat helps prevent cardiovascular
complication. In addition, the diet plan must be coordinated
with medication or insulin injection and physical activities.
Energy : first focuses on providing food energy in the amount
necessary to achieve or maintain a healthy and realistic body
weight and to support growth in children, high and weight
measures periodically and adjusts the diet as necessary.
Protein: provide about 10 to 20% of the of the total kcalories in
the diet. Providing adequate, but not excessive , protein may
help delay the onset or progression of kidney disease .
Carbohydrate : the child needs to have glucose available
throughout the day but not so much at any time that blood
8
glucose level rise too high. Of all energy nutrients,
carbohydrates raise blood glucose, in about an hour. The
amount of carbohydrates to include depend on the diet plan; a
typically plan provides about 45 to 60% of the total kcalories
from carbohydrates.
Encourage children with diabetes to select foods rich in
complex carbohydrates : whole-grain breads and cereals,
legumes, fruits, and vegetables. In addition to carbohydrates,
these foods provide fiber, vitamins, and minerals and offer
many health benefits .
Fat : children with diabetes who have acceptable blood lipid
concentrations benefit from fat intake consist with dietary
guidelines for Americans (30% or less of kcalories from fat ,
less than 10% of kcalories from saturated fat, and less than
300mg of cholesterol )
Sodium
:
children
with
diabetes
frequently
develop
hypertension, and for some limiting sodium can help reduce
blood pressure. Recommendations for appropriate sodium
intake vary from 2400 to 3000mg of sodium per day for all
children. People with diabetes and hypertension may benefit
from restricting sodium to 2400 mg or less per day.
9
Carbohydrate counting: a widely used diet strategy called
carbohydrate counting. It teaches client to focus mainly on the
carbohydrate contents of foods. Client learn to eat consist
amount of carbohydrates at meals and snacks. They must have
the motivation to monitor their blood glucose and keep records
of their glucose levels, and the time and amount of insulin or
antidiabetic agent they use. They must also be able to perform
the mathematical operations necessary to calculate their
carbohydrate intakes. Regardless of the diet strategy, all clients
receive instructions on planning well-balanced healthy meals,
eating consistent amounts of foods at regular times, and
maintaining a desirable weight .
Treating hypoglycemia: if patient dose develop hypoglycemia
for any reason, judicious treatment prevent overcorrection and
subsequent hyperglycemia. As soon as the symptoms are
observed, the patient needs 10 to 15g of carbohydrate. Any
carbohydrate is readily available and easy to eat is a good
choice. Advise client to avoid foods that contain fat because fat
slows the absorption of carbohydrate.
Blood glucose id then checked within 15 to 20 minutes to see if
it has risen to acceptable level. If not an additional 10 to 15g of
carbohydrate are given, and blood glucose rechecked. The
10
procedure continues until blood glucose return to acceptable
range .
Drug therapy for diabetes : all people with type 1 diabetes need
insulin to control blood glucose and utilize energy. People with
type 2 diabetes can sometimes control their blood glucose
without medications by using a combination of diet and
physical activity .
Diabetic agent: the number of oral agents available to treat
people with type 2 diabetes has grown markedly in recent
years. Some oral agents work by stimulating the release of
insulin from beta cells, some work by reducing insulin
resistance and depressing the liver's production of glucose
without raising insulin levels, and still others reduce the rate of
complex carbohydrate and source digestion in intestine and
slow the rate of carbohydrate absorption must use glucose to
treat episodes of hypoglycemia.
Oral antidiabetic agent : medications takenby mouth to lower
blood glucose levels in people with type 2 diabetes.
Insulin and insulin analogs : for children who need insulin
,commercial is available in different forms that act with
different timings so that it can be delivered in a manner that
mimics the body's normal insulin actions as closely as possible.
11
Insulin can be either rapid acting (regular), intermediate acting
(NPH and lente), or long acting (ultralente). Insulin analog
(lispro) is a rapid –acting insulin whose amino acid
composition has been modified so that it works faster and has a
shorter duration of action. As a result, lispro reduced aftermeal hyperglycemia to a greater extent than regular insulin
and is also associated with lower risk of hypoglycemia between
meals and during the night.
Insulin is a protein, so if it is taken orally , digestive enzymes
reduce it to amino acids. Because the pancreas of person who
needs insulin cannot synthesize insulin or cannot synthesize
enough of it from amino acids, it would not be available to the
body. The person who chooses injections often receives
multiple daily injections- a mixture of 2 or more types of
insulin three or more times daily.
Glycated hemoglobin: In addition to check in blood glucose
records, physicians monitor control by evaluating the
percentage of glycated hemoglobin (GHb). As blood glucose
rises, glucose attaches to amino acid on hemoglobin molecules
and remains there until the red blood cells that carry the
hemoglobin die (about 120days). Glycated hemoglobin reflects
diabetes control over the past 2 to 3 months, rather than just
porior to the test.
12
 Goals :
Control diabetes among children by 20% during 6 month at
King Abdul Aziz University Hospital .
 Objective :
By the end of program patient and family will be able to :
 Applied dietary instructions.
 List of diabetes symptoms .
 Informed what is the diabetes and its effect .
 Demonstrated how can measure blood glucose level .
 Identify hyperglycemia, hypoglycemia and can
management.
Theme :
‫معا يا صغير السكر‬
 Target group :
Diabetic children and family
 Location:
King Abdul Aziz University Hospital \ Dietitian Clinic
 Time :
13
I will start at 1 February 2010 until 1 July 2010
 Plane
:
I am going to implement my program by :
A-Individual Teaching:
1- Objective of sessions :
 Assessed patient .
 Informed patient and family about diabetes.
 Explained to patient and family signs and symptoms.
 Improved knowledge about diabetes.
 Instructed patient and encouraged him.
 Managed blood glucose .
 Recommended dietary instruction.
2- Session plan :
Each patient will receive 5 sessions for 6 months then follow
up sessions.
14
Sessions:
sessions
Date
Location
Time
Subject
Tools
1
1.2.2010
Dietitian clinic
8:30 a.m
What is diabetes? (4)
Presentation
What is the2type of
Videos
diabetes? (4-5)
What is the symptoms of
hyper-hypoglycemia?
(5-6)
2
1.3.2010
Dietitian clinic
9:30 a.m
Treatment of diabetes
Modules
(7-12)
Presentation
3
1.4.2010
Dietitian clinic
10:30 a.m
Dietary instruction (8-10)
Modules
4
1.5.2010
Dietitian clinic
11:30 a.m
Chronic complication of
Videos
5
1.6.2010
Dietitian clinic
12:oo p.m
Review
presentation
diabetes (6-7)
Materials :
Pursuers, Handouts
3- Evaluation :
Give patient and family test about how can control diabetes.
4- Documentation :
Special form in patient file.
B-Group Teaching:
15
1- Objective of sessions :
 Improved patients and families knowledge.
 Explained to patients and families the side effect of
diabetes.
 Informed patients and families the different between
hyperglycemia and hypoglycemia.
2- Session plan :
The patients and families will takes sessions in the waiting area.
Time :
At 8:30 a.m of each Sunday of every month.
Session (1)
What diabetes? (4)
The different of diabetes (4-5)
Session(2)
Symptoms of hypo-hyperglycemia (5-6)
Session (3)
How can treat diabetes? (7-12)
Session (4)
16
Different type of insulin (11-12)
Session (5)
Complication of diabetes (6-7)
Tools:
Presentation, videos
Materials :
Posters, pressures
3- Documentation :
In groups file.
 Material :
 Presentation .
 Modules.
 Videos.
 Pursuers.
 Handouts.
 Posters.
Resource :
Tools and Material take from Diabetic Department in King
Abdul Aziz Hospital and Understanding Normal and Clinical
Nutrition Book
17
 Tools need it :
Telephone , food modules, video , presentation, blood glucose
monitor.
 Referral :
By E-mail and clinic number and it's extension.
 Health care team involved :
Dietitian , Physician, Health Educator , pediatric
consultant, nurses ,family.
 Evaluation :
Make a blood test or HbAc1
 Documentation :
Make a report or published in magazine
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