Pediatrics, part 51: Endocrine Disorders - Diabetes Mellitus


Cathy discusses diabetes mellitus. She explains the pathophysiology of type 1 and type diabetes, signs/symptoms of diabetes, diagnosis of diabetes, and treatment of diabetes. Cathy also discusses special care that is required for a child with diabetes during times of illness, and management of hypoglycemia in a conscious vs. unconscious child. She then explains a key complication of diabetes, which is diabetic ketoacidosis (DKA). Cathy discusses the risk factors, signs/symptoms, labs, treatment, and nursing care of a child with diabetic ketoacidosis. Finally, she provides a quiz at the end of the video to test your understanding of some of the key points she made during the video.

  • 00:00 Introduction - Diabetes Mellitus
  • 00:40 Type 1 vs. Type 2 Diabetes
  • 1:50 Signs/Symptoms, Diagnosis, and Treatment of Diabetes
  • 4:23 Diabetes - Illness Care
  • 5:18 Diabetes - Management of Hypoglycemia
  • 7:08 Diabetic Ketoacidosis
  • 9:01 Quiz Time!

Full Transcript: Pediatrics, part 51: Endocrine Disorders - Diabetes Mellitus

Hi, I'm Cathy with Level Up RN. In this video, I will be discussing diabetes mellitus, and at the end of the video, I'm going to give you guys a little quiz to test your knowledge of some of the key points I'll be covering, so definitely stay tuned for that. And if you have our Level Up RN pediatric nursing flashcards, definitely pull out your flashcards on diabetes mellitus so you can follow along with me, and pay close attention to the bold red text on these cards because diabetes is heavily tested on in nursing school, and those bold red items represent the most important facts that you are likely to get tested on.

Diabetes mellitus is a metabolic disorder characterized by chronic hyperglycemia. In terms of pathophysiology, with type 1 diabetes, we have autoimmune dysfunction, which results in the destruction of the beta cells in the pancreas, which leads to a lack of insulin secretion. So this type of diabetes is more common in children and adolescents, and individuals with type 1 diabetes are insulin-dependent. Type 2 diabetes used to be less common in children, but cases are definitely on the rise. With this type of diabetes, we have insulin resistance and decreased insulin production that occurs gradually over time. Risk factors include obesity, inactivity, hypertension, hyperlipidemia, as well as genetics and race. So African-Americans, American Indians, and Hispanic individuals are at higher risk for type 2 diabetes.

The signs and symptoms of diabetes are incredibly important to know, and you definitely need to be able to differentiate between the signs of hyperglycemia and hypoglycemia, which we will also be talking about in this video. So the signs and symptoms of hyperglycemia include the three P's. So polydipsia, polyphagia, and polyuria. So increased thirst, increased appetite, and increased urination. Other signs and symptoms include weight loss, dehydration, fruity breath odor, Kussmaul respirations, which is where we have an increase in the depth and rate of breathing, as well as nausea and vomiting, weakness, fatigue, and warm, dry skin. So our cool chicken hint to help you remember the warm, dry skin is warm and dry, sugar's high.

Diabetes is diagnosed when the patient has two abnormal test results. This includes a casual blood glucose level over 200, a fasting blood glucose level over 126, a glucose level over 200 with an oral glucose tolerance test, or an A1C over 6.5%. So as a reminder, a casual or a fasting blood glucose level really just measures the patient's blood glucose level at a point in time, as opposed to the HGB A1C, which reflects the patient's glucose levels over the past two to three months. So this lab value is the best way to monitor the patient's treatment compliance.

Treatment of type 1 diabetes includes the administration of insulin. Per the American Diabetes Association, the goal for the child is to achieve an A1C under 7%, which was recently updated from 7.5%. As the nurse caring for a patient with diabetes, there is a lot of patient teaching and family teaching that needs to be provided. This includes information on blood sugar monitoring, insulin administration, special care that needs to be taken during times of illness, as well as management of hypoglycemia.

Let's first talk about illness care. So when a child is sick, their blood glucose will need to be monitored more frequently, such as every two to three hours, or as directed by the provider. Their urine will need to be tested for the presence of ketones every four hours. And then it's going to be super important that the child not skip insulin, and they should increase their fluid intake in order to prevent dehydration. The child should be weighed daily, and their temperature should be taken every morning and night. And then the provider should be notified if the child's temperature is over 101 degrees Fahrenheit, if they have the presence of ketones in their urine, if they are unable to keep fluids down for more than four hours, or unable to keep food down for more than 24 hours.

Let's now talk about hypoglycemia, which is defined as a blood glucose level under 70. So as a reminder, you definitely need to know the differences in signs and symptoms between hyperglycemia and hypoglycemia, and this will likely show up on a select all that applies type question. So signs and symptoms of hypoglycemia include hunger, irritability, confusion, diaphoresis, headache, shakiness, blurred vision, decreased level of consciousness, seizures, coma, and pale, cool skin. So our cool chicken hint to help you remember what the patient's skin will be like when they have hypoglycemia is cold and clammy, need some candy.

In terms of treatment of hypoglycemia, if the child is conscious, then we want to provide approximately 15 grams of a quickly absorbed carbohydrate, such as 4 to 6 ounces of juice or soda, or 8 ounces of milk. We would then recheck their blood glucose level in 15 minutes. If it is still under 70, then we would repeat those steps. Once it is over 70, then we would provide a snack that contains a complex carbohydrate as well as a protein. If the child is unconscious, then we would administer IM or subcutaneous glucagon. If the child is still not conscious after 10 minutes, then we would repeat administration of glucagon. Once the child is conscious and able to swallow safely, then we would provide them with a snack that contains a carbohydrate.

Let's talk about a key complication of diabetes now, which is diabetic ketoacidosis, or DKA. This is a life-threatening condition characterized by high blood glucose levels and the presence of ketones in the blood and urine. It has a rapid onset, and it is more common with type 1 diabetes. Triggers for DKA include infection or illness, untreated or undiagnosed type 1 diabetes, as well as a missed insulin dose. Signs and symptoms of DKA include the three P's that we talked about before, so polydipsia, polyphagia, and polyuria, as well as a fruity breath odor, Kussmaul respirations, nausea and vomiting, and dehydration. In terms of labs, the patient will have a blood glucose level over 250, and the presence of ketones in their blood and urine. They will also have metabolic acidosis and hyperkalemia, and in nursing school, it is super important to remember that DKA, metabolic acidosis, and hyperkalemia go together. Treatment of DKA includes addressing the underlying cause, such as an infection. We are also going to administer IV fluids and insulin, and we will need to monitor our patient's blood glucose level hourly. We are also going to monitor their vital signs, their intake and output, as well as their electrolyte levels, especially potassium. So the K in DKA will remind you to monitor potassium.

All right. It's quiz time, and I've got five questions for you this time because we went over a lot of important information.

Question number one. Is cold, clammy skin, irritability, and diaphoresis indicative of hyperglycemia or hypoglycemia? The answer is hypoglycemia.

Question number two. An HGB A1C over blank is indicative of diabetes. The answer is 6.5%.

Question number 3. During times of illness, the child's urine should be tested for the presence of blank. The answer is ketones.

Question number four. What medication can be administered to an unconscious child with hypoglycemia to bring up their blood glucose level? The answer is glucagon.

Question number five. What acid-base imbalance is typically present with diabetic ketoacidosis? The answer is metabolic acidosis.

All right. Hope you did great with that quiz, and I hope you learned a lot from this video. Thank you so much for watching, and good luck with studying.


Super important that the-- or 8 ounces-- blood glucose level-- repeat administration of the [glucon?]. [Glucon?]. Glucagon. Ah.

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