Peds Exam 4: Diabetes

DM labs if diabetic: (4)

1. 8 hr fasting glucose will be >120 mg/dL

2. random blood glucose will be > 200mg/dL

3. oral tolerance is >200 mg/dL

4. HgA1c is >6.5%

• okay range: 6.5%-8% in children

• over a 3 month period

Hypo/Hyperglycemia glucose level:

< 60mg/dL hypo

>250 mg/dL hyper

hypoglycemia signs: (10)

1. hunger

2. shaky/dizziness

3. pallor

4. diaphoresis

5. tachycardia/palpitations

6. tremors

7. slurred speech

8. shallow respirations

9. blurred vision

10. ⬇LOC (lethargic→ comas)

hypoglycemia management: (3)

1. give 10-15 g simple carbs (1 TBsp sugar)

• 4 oz OJ

• 4 oz regular soft drink

• 8 oz milk

• 2-3 glucose tablets

2. re-check glucose after 15 mins

3. follow with complex carbs

• PB crackers

• turkey club sandwich

• cheese and crackers

if child is unconscious/cant swallow in hypoglycemic episode, what do u do?

admin IM glucagon!!!

• then give simple carbs if tolerated

• watch vomiting

hyperglycemia s/s: (8)

1. poly-uria, dipsia, phagia

2. rapid, deep breathing & acetone/fruity odor & positive ketones (Kussmauls)

3. oliguria (later)

4. recurrent yeast infx (means early T2 DM)

5. warm, dry, flushed skin

6. dry mucous membranes

7. weak pulse

8. ⬇DTR

hyperglycemia management: (3)

"DRY”

1. Dehydrated: oral fluids

2. Raise insulin: give rapid acting (Lispro)

3. You monitor ketones, K+

DM personal hygiene: (6)

1. NO wearing sandals

2. NO being barefoot outside

3. Wear shoes with socks

4. clean any cut w/ warm water, mild soap & dry dressing

5. examine child’s eye yearly

6. regular dental care

children playing sports snack times: (2)

1. teams sports: 30 mins before activity

2. prolonged sports (running): need food every 45-60 mins

Management for SICK child with diabetes: (3)

1. monitor blood glucose & ketones in pee q3 hrs

• bad: glucose >250 mg/dL; positive ketones

2. sugar-free, non caffeinated drinks (keep hydrated)

3. eat soft carbs (rice, mashed potatoes, pasta, bread)

Educate families on insulin: (4)

1. rotate site for every 4-6 injections

2. 90 degree angle

3. mixing: short acting 1st, then longer acting 2nd

4. boluses can be given b4 meals

Rapid insulin

• name

• onset

• peak

• duration

• Lispro

• onset: 15-30 mins

• peak: 30 min-3 hrs

• duration: 3-5hrs

Short insulin

• name

• onset

• peak

• duration

• Regular

• onset: 30 mins-1hr

• peak: 1-5 hrs

• duration: 6-10 hrs

Intermediate insulin

• name

• onset

• peak

• duration

• NPH

• onset: 1-2 hrs

• peak: 4-14 hrs

• duration: 14-24 hrs

Long insulin

• name

• onset

• peak

• duration

• Glargine

• onset: 1-4 hrs

• peak: NONE

• duration: 24 hrs

DKA glucose level:

• what happend in DKA?

> 330 mg/dL

• pH 7.3 (acidic)

• bicarbonate < 15

• yikes

→ body burns fat (turns into ketones) instead of glucose

DKA hallmark signs: (3)

1. fruity breath

2. ketones in pee

3. rapid deep respirations

Electrolyte to monitor in DKA:

potassium!!

1. initially high → give insulin

2. drops (hypok+)

• monitor K+ bc correcting acidosis too fats → hypoK

3. give sodium bicarb if severe acidosis (blood pH <7)

4. give O2 to children whose cyanotic and < 80%