Juvenile Diabetes Mellitus
Juvenile Diabetes Mellitus
Juvenile Diabetes Mellitus is an autoimmune disease that causes the destruction of pancreatic beta cells resulting in insufficient insulin production, which is necessary.
Also known as Type 1 Diabetes Mellitus (T1D) or insulin-dependent diabetes, it is a chronic autoimmune condition usually diagnosed in children and adolescents.
The body's immune system mistakenly attacks and destroys the insulin-producing beta cells in the pancreas. This results in little or no insulin production, leading to high blood glucose levels unless treated with insulin replacement for glucose metabolism and energy production.
Causes
The exact cause is not fully understood but involves genetic predisposition combined with environmental triggers.
The immune system attacks the pancreas, destroying insulin-producing cells.
Possible triggers include viral infections and certain genes (HLA-DR and DQ alleles).
Family history increases risk.
Risk Factors
- Young age (most cases diagnosed in children <14 years)
- Family history of diabetes
- Genetic markers related to immune function
- Viral exposures during childhood
Pathophysiology
Juvenile diabetes mellitus is an autoimmune disorder where the body's immune system destroys insulin-producing beta cells in the pancreas.
Insulin deficiency leads to impaired glucose uptake by cells, resulting in high blood glucose (hyperglycemia).
Without insulin, the body uses fats and proteins for energy, producing ketones, which can cause diabetic ketoacidosis (DKA) — a life-threatening complication.
The lack of insulin affects carbohydrate, fat, and protein metabolism, causing symptoms such as polyuria, polydipsia, weight loss, and fatigue.
Signs and Symptoms
Children with juvenile diabetes may rapidly develop symptoms such as:
- Increased thirst (polydipsia)
- Frequent urination (polyuria), sometimes bedwetting in older children
- Extreme hunger (polyphagia)
- Unexplained weight loss
- Fatigue or weakness
- Blurred vision
- Fruity-smelling breath (sometimes in diabetic ketoacidosis)
- Irritability or mood changes
Investigations
- Blood glucose tests (random or fasting)
- Hemoglobin A1C (reflects blood sugar control over 2–3 months)
- Autoantibody testing to confirm autoimmune destruction
- Urine tests for glucose and ketones
- C-peptide levels to assess insulin production
Normal Blood Glucose Levels in Children
(Values may vary slightly by guideline, but generally accepted ranges are):
- Fasting (before meals): 3.3 – 5.6 mmol/L (60 – 100 mg/dL)
- Random (anytime of day): < 7.8 mmol/L (< 140 mg/dL)
- 2 hours after meals (postprandial): < 7.8 mmol/L (< 140 mg/dL)
- Bedtime / Overnight: 4.0 – 7.0 mmol/L (72 – 126 mg/dL)
- Hypoglycemia in children: < 3.3 mmol/L (< 60 mg/dL)
- Hyperglycemia in children: > 7.8 mmol/L (> 140 mg/dL fasting)
Medical Treatment
Insulin
Starting total daily dose: 0.5 – 1.0 units/kg/day (depending on age, puberty, and severity).
Younger children: often 0.5 units/kg/day.
Adolescents (during puberty): may need up to 1.5 units/kg/day due to insulin resistance.
Nursing Diagnoses
- Deficient Knowledge luck of information regarding disease management, insulin administration, and dietary control as evidenced by patient asking amany questions
- Unstable glucose level related to insufficient insulin in the blood as evidenced by high glucose level.
- Disturbed sleep pattern related to frequent urination as evidenced by patient reports of waking up frequently during night time.
- Risk for Infection related to high glucose levels and reduced immunity.
- Fatigue related to inadequate sleep evidenced by muscle weakness
- Imbalanced Nutrition: Less than Body Requirements related to inability to utilize glucose effectively as evidenced by an explained weight lost.
- Poor health maintenance related to difficulty in following dietary caution evidenced by frequent admission
- Risk for Injury related to high or low blood glucose levels and complications.
Nursing Interventions
- Monitor blood glucose levels regularly using glucometer and document results.
- Administer insulin as prescribed, ensuring correct dose and timing.
- Educate child and family about signs and symptoms of hypo- and hyperglycemia.
- Teach proper insulin injection techniques, rotation of injection sites to prevent lipodystrophy.
- Instruct on carbohydrate counting to align insulin dose with dietary intake.
- Monitor for signs of infection and promote optimal hygiene.
- Encourage balanced diet and adherence to prescribed meal plan.
- Promote regular physical activity while educating about its effects on blood glucose.
- Assess for symptoms of diabetic ketoacidosis (e.g., vomiting, abdominal pain, deep breathing) and report immediately.
- Teach the importance of wearing medical alert identification.
- Prepare for and manage hypoglycemic episodes with fast-acting carbohydrates and glucagon administration if needed.
- Collaborate with dietitians, endocrinologists, and diabetes educators for comprehensive care.
- Provide emotional support and counseling to help child and family cope with chronic disease.
- Ensure regular follow-up appointments and screenings for complications like eye, kidney, and nerve damage.
- Document all care, teaching, and observations accurately for ongoing evaluation.
- Consult a chiropodist a doctor specialised in naile care
- Educate on the diet (diabetic plate for bigger children).
- Care of the foot ;putting on close shoes,avoiding injury to the foot to prevent diabetic foot
- Hygen prevent infection
Complication
- Ketoacidosis present of ketones in the blood
- Hypoglycemia low blood glucose level
- Hyperglycemia high blood glucose level
- Infections
- Gangren dead tissue
- Nephropathies
- Neuropaties
.jpg)
