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NCP
Pediatric and Diabetes
I.
II.
Disease Process
Diabetes mellitus is the most common endocrine system disorders in todays
society. It affects over 25.6 million individuals in the United States. Hyperglycemia is
a result from all forms of diabetes. Hyperglycemia is correlated with organ
dysfunction and damage, progressing to failure of numerous organs, particularly the
eyes, kidneys, nerves, heart, and blood vessels.
Type 1 diabetes in children is a condition in which the pancreas no longer
produces the insulin needed to survive, and insulin must be replaced. Type 1 diabetes
in children used to be known as juvenile diabetes or insulin-dependent diabetes.
Signs and symptoms of type 1 diabetes in children usually develop quickly, over a
period of weeks. Some symptoms include increased thirst and frequent urination,
extreme hunger, weight loss, fatigue, irritability or unusual behavior, and blurred
vision.
Normally the hormone insulin helps glucose enter cells to provide energy to the
muscles and tissues. Insulin comes from the pancreas. When everything is working
properly, the pancreas secretes insulin into the bloodstream. Insulin lowers the
amount of sugar in the bloodstream. When insulin levels are low the liver releases the
stored glycogen, which is then converted to glucose to keep your blood glucose level
within a normal range. In type 1 diabetes, none of this occurs because there's no or
very little insulin to let glucose into the cells. Instead of being transported into cells,
the sugar builds up in the bloodstream, where it can cause life-threatening
complications.
Treatment for type 1 diabetes is a lifelong commitment of blood sugar monitoring,
insulin, healthy eating and regular exercise. A diabetic care plan will change over
time to account for growing and aging. Depending on what type of insulin therapy
needed, blood sugar levels may need to be checked at least four times a day. This
requires frequent finger sticks. Insulin is often injected using a fine needle and
syringe or an insulin pen. An insulin pump also may be an option.
Nutrition therapy for diabetes is individualized. There needs to be a
comprehensive assessment, a self-care treatment plan, and patients health status,
learning ability, readiness for change, and current lifestyle should be the foundation of
nutrition therapy. Intervention for diabetes is individualized as well, there is no one
diabetic diet. Nutrition education is the basis to understand the food- and nutritionknowledge deficit. The primary goals for nutrition therapy are the following:
HbA1c <7%
Blood pressure < 140/80 mmHg
LDL cholesterol <100 mg/dl; triglycerides <150 mg/dl; HDL cholesterol
>40 mg/dl (men); HDL cholesterol >50 mg/dl (women)
Achieve and maintain body weight
IV.
V.
Patient History
Patient describes extreme thirst and polyuria I have been thirsty thirstier than I
have ever been in my whole life and then I have to use the bathroom a lotI even
have to get up at night to go to the bathroom. Patient was admitted to the ER after
fainting at soccer practice. Her serum glucose was 724 mg/dL Patient stated her
original weight was 55 lbs, this is a 9% loss of weight.
Course of Hospital Treatment - N/A
Nutrition Care
a. Assessment
Weight: 50 lbs = 22.7 kg
Height: 4 = 48 = 1.2192 m
BMI: ((50)/(48)(48))x703= 15.3 kg/m2
Growth Chart: 25th percentile
Lab Values:
Blood Glucose (683/250 mg/dl)
HbA1C (14.6%)
C-peptide (0.10 ng/mL)
Sodium (126/131 mEq/L)
Osmolality (295.3/304 mmol/kg/H2O)
Ketones- Positive
Specific Gravity (1.035)
Protein- Positive (100 mg/dL)
Glucose- Positive
pH (4.9)
Drugs:
Apidra insulin
Glargine insulin
Nutrient Needs
o [(135.3-30.8) x 8y + [1.56 x [(10x23kg) + (934x1.2192m)]] = 2,333.5
kcals/d