Diabetes Mellitus Chapter 38
1. Chronic disorder of metabolism characterized by a partial or complete deficiency of the
hormone insulin
a. Most common metabolic disease
2. Type I- characterized by destruction of the pancreatic B cells, which produce insulin
a. Usually leads to absolute insulin deficiency
b. Autoimmune disease. Person with genetic predisposition is exposed to a precipitating
event
c. Most predominant form in pediatric age-group
3. Type II- usually arises because of insulin resistance
a. Body fails to use insulin properly
b. More likely to be influenced by stronger genetic factors
c. Changes in food consumption and exercise have increased the rate of type II diabetes in
children
4. Ketoacidosis- when glucose is unavailable for cellular metabolism, and the body chooses
alternate sources of energy (fat)
a. Fat berak down into fatty acids, and glycerol in the fat cells is converted by the liver into
ketone bodies
i. Excess is eliminated in the urine or lungs
ii. Ketone bodies in the blood are strong acids that lower pH producing
ketoacidosis
b. Respiratory system attempts to eliminate the excess carbon dioxide to raise pH
i. Kussmaul respiration
c. Cellular death results in potassium being released from the cell into the blood stream
and is excreted through the kidney
i. Total body K+ is decreased but the serum potassium level may be elevated
5. Long Term Complications
a. Microvascular- may occur as early as 2.5-3 yr after diagnosis with bad disease
management
i. Microvascular changes begin occurring after puberty
6. Clinical Manifestations
a. Hyperglycemia, weight loss, acidosis, polyphagia, polydipsia and polyuria
7. Diagnostic Evaluation (three candidate groups)
a. Children who have glycosuria, polyuria and a history of weight loss
b. Those with transient or persistent glycosuria
c. Those who display manifestations of metabolic acidosis, with or without stupor or coma
8. Diagnosis
a. An 8 hour flasting blood glucose level of 126 or more
b. A random blood glucose value of 200 or more accompanied by classic signs of diabetes
c. Oral glucose tolerance test with a finding of 200 or more in the 2 hour sample
9. Therapeutic Management
a. Insulin
