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TYPE 1 & 2 DIABETES IN CHILDREN & ADOLESCENTS

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TYPE 1 & 2 DIABETES IN CHILDREN & ADOLESCENTS Lucie Jarrett, MS, APRN, CDE Diabetes Clinical Nurse Specialist Primary Children s Medical Center – PowerPoint PPT presentation

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Title: TYPE 1 & 2 DIABETES IN CHILDREN & ADOLESCENTS


1
TYPE 1 2 DIABETES IN CHILDREN ADOLESCENTS
  • Lucie Jarrett, MS, APRN, CDE Diabetes Clinical
    Nurse Specialist
  • Primary Childrens Medical Center
  • 2010

2
Objectives for Presentation
  • Discuss the differences between Type 1 and Type 2
    diabetes
  • Discuss age-related skills and responsibilities
  • Discuss advances in diabetes care and management
  • Encourage a more positive approach as you work
    with children and adolescents with diabetes

3
Quick Look At Diabetes
  • Disease affecting nearly 24 million Americans (8
    of U.S. population)
  • Type 2 represent roughly 90
  • Type 1 comprises the other 10
  • About 6 million of those currently affected do
    not know they have the disease additional 57
    million people are estimated to have pre-diabetes

4
Quick Look At Diabetes
  • It is our nations most costly disease, both in
    human terms and in economic terms
  • UTAH 120,000 (6) known with another 45,000 that
    have diabetes, but have not been diagnosed 2,300
    children (lt18 years) with diabetes

5
Diagnosis
  • Type 1
  • Ketoacidosis
  • Elevated blood glucose
  • Positive antibodies
  • Islet cell
  • Glutamic acid dehydrogenase (GAD-65)
  • Insulin auto-antibody 512
  • Type 2
  • Symptoms of DM plus random plasma glucose 200
    mg/dl (11.1 mmol/l)
  • Fasting plasma glucose 126 mg/dl (7.0 mmol/l)
  • 2 hour plasma glucose 200 mg/dl during OGTT

6
Type 1 Diabetes
  • Type 1 diabetes is the most common chronic
    disease of childhood
  • Increasing 3 per year
  • Most common type in Caucasians
  • Utah 33/100,000 children
  • 22 younger than 5 years of age
  • 24/100,000 nationally
  • Peak occurrence at ages 5-7 and at puberty

7
Type 1 Diabetes
  • Incidence is increasing with the most marked
    increase in ages lt 5 years
  • Has both a genetic component and an environmental
    component
  • Can now predict potential diagnosis
  • Islet cell antibodies
  • Insulin auto-antibodies
  • GAD antibodies

8
Type 1 Diabetes
  • Not related to diet, activity, or weight
  • Not preventable
  • Evolves over weeks to months
  • Good control of diabetes will decrease the risk
    of long term complications
  • Diabetes Complications Trial
  • (DCCT 1983-1993)

9
Type 2 Diabetes
  • Is increasing in young children
  • 15 (almost 9 million) are overweight,
  • putting them at greater risk for diabetes
  • and heart disease
  • Sedentary lifestyle
  • Inadequate exercise
  • Super-size eating habits

10
Type 2 Diabetes
  • Puberty exacerbates incidence
  • Growth hormone is counter-regulatory hormone
  • and increases peripheral insulin
    resistance
  • Focus on pubertal and pre-pubertal children (gt10
    years of age)
  • Type 2 has been reported in children as young
    as
  • 4 years

11
Type 2 Diabetes
  • Type 2 diabetes is more common in some ethnic
    groups
  • Hispanic, African American, Native
  • American, Pacific Islanders
  • Genetic predisposition compounded by
  • lifestyle insulin resistance

12
Type 2 Diabetes
  • Physical findings
  • Obesity In type 2 gt 90
  • BMI at diagnosis ? 85th percentile
  • Acanthosis nigricans

13
Characterization of
Diabetes
14
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15
Age-Related Responsibilities
Traits
16
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17
H. Peter Chase. Understanding Diabetes. 11th
Edition, 2006
18
Average Ages for Diabetes-Related Skills
Age of Mastery (in years)
19
Age of Mastery (in years)
H. Peter Chase. Understanding Diabetes. 11th
Edition, 2006. Abstracted from a survey done by
Drs. T. Wysocki, P. Meinhold, D.J. cox and W.L.
Clarke at Ohio State University and the
University of Virgina (Diabetes Care 11 65-68,
1990).
20
Infant Early Childhood
  • Role of siblings
  • Daycare, baby sitters, grandparents
  • Erratic physical activity and appetite
  • Parenting styles and coping skills
  • Parents concerns of invasive procedures
  • Parents fears of hyperglycemia and long-term
    complications
  • Temper tantrums vs. reactions
  • Choices helping children feel in control of
    their world by offering controlled choices
  • Not making eating a control issue
  • Transition issues getting back home
    after
  • hospitalization regression, day care

21
School Age
  • Self-esteem
  • Development of self-care skills, according to the
    developmental status of patient
  • Peers how to talk to friends about diabetes,
    teasing
  • School issues educating teachers and school
    personnel
  • Eating at parties, church, school, friends homes
  • Transition issues beginning school, increased
    self-care

22
Adolescents
  • Peers research regarding importance of emotional
    support, invite peers to clinic
  • Parents communication how does the family talk
    about diabetes (without WW III starting)
  • Egocentric
  • Fictitious blood glucose records
  • Risk taking behaviors sexual, diabetes related,
    drugs
  • Erratic schedules
  • More responsibility for self-care
  • Transition issues puberty, drivers license,
    dating,
  • sexuality, changing schools, shift
    in
  • responsibility of care (however,
    should not
  • mean absence of family involvement)

23
General Family Issues
  • Who is supporting Mom?
  • What is Dads involvement?
  • Siblings
  • Open communication
  • Not letting diabetes be used as a control or
    manipulation issue
  • Grief issues
  • Finances/insurance
  • Camp
  • Parents finding a healthy balance while providing
    support to the child

24
Approach to Diabetes Management
Care
  • Diabetes Control Complications Trial (DCCT)
    findings provide firm basis for advocating tight
    blood glucose control

10 year study (1983-1993) Reduced
risk findings Eye disease 76
Nerve disease 60
Kidney disease 50 Cardiovascular
disease 35
25
  • Epidemiology of Diabetes Interventions and
    Complications Study (EDIC) 1994-present
  • Intensive therapy, now the standard of care,
    should result in more than 50 reduction in the
    rates of complications over time, with
    implementation early in the course of diabetes
    providing the most powerful salutary effect.
  • Modern-Day Clinical Course of Type 1
    Diabetes Mellitus After 30 Years Duration,
    Archives Internal Medicine, Vol. 169, No. 14,
    July, 2009

26
Major Goals at Diagnosis
  • Maintain Growth
  • Avoid frequent extremes
  • hyperglycemia/hypoglycemia
  • Maintain a normal lifestyle

27
Management Care Advancements
  • Blood glucose monitoring
  • New insulin analogs
  • Insulin delivery systems
  • Nutritional guidelines and improved food labeling

28
Blood Glucose Meters
OneTouch UltraMini
AccuChek Compact Plus
OneTouch Ultra2
AccuChek Aviva
Freestyle Lite
Bayer Contour
29
Testing Ketones
Urine
Blood
30
Insulin
  • Rapid-acting
  • (Humalog, Novolog, Apidra)
  • Long-acting
  • (Lantus, Levemir)

31
Insulin Regimens
Individualized Age, BG Target, Desired
Control
  • Humalog/Novolog and Lantus
  • Humalog/Novolog and NPH and Lantus
  • Continuous subcutaneous insulin
  • infusion (CSII) insulin pump

32
Insulin Delivery Systems
Pen Needles
Lantus OptiClik and SoloStar
Humalog KwikPen, Memoir and Luxura HD
NovoLog FlexPen Novo Pen Jr.
33
Insulin Pumps
ANIMAS ONE TOUCH PING
OMNIPOD PERSONAL DATA MANAGER
MINIMED PARADIGM REVEL ONE TOUCH ULTRA
LINK
34
Continuous Blood Glucose Monitoring
Systems (CGMS)

DexCom SEVEN System
Medtronic Guardian
Receiver
Paradigm REAL-time Sensor
Sensor
Transmitter Pod
FreeStyle Navigator
35
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36
Nutrition Guidelines and Education
37
Publications
38
Support Systems Resources
  • PCMC Diabetes Clinic Education Program
  • Foundation for Children and Youth with Diabetes
    (FCYD)
  • Summer and winter camping program

39
Support Systems Resources
  • American Diabetes Association
  • www.diabetes.org
  • Juvenile Diabetes Research Foundation
  • www.jdrf.org

40
TOMORROW IS BRIGHTER AND
HOPE FOR A CURE IS REAL!
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