GUIDE TO HbA1c :

Guide to HbA1c

HbA1c forms when haemoglobin joins with glucose in the blood

HbA1c is a term commonly used in relation to diabetes. This guide explains what HbA1c is, how it differs from blood glucose levels and how it's used for diagnosing Diabetes.

What is HbA1c?

The term HbA1c refers to glycated haemoglobin. It develops when haemoglobin, a protein within red blood cells that carries oxygen throughout your body, joins with glucose in the blood, becoming 'glycated'.

By measuring glycated haemoglobin (HbA1c), clinicians are able to get an overall picture of what our average blood sugar levels have been over a period of weeks/months.

For people with diabetes this is important as the higher the HbA1c, the greater the risk of developing diabetes-related complications. 

HbA1c is also referred to as haemoglobin A1c orsimply A1c.

Definition of HbA1c

HbA1c refers to glycated haemoglobin (A1c), which identifies average plasma glucose concentration.

How does HBA1c return an accurate average measurement of average blood glucose?

When the body processes sugar, glucose in the bloodstream naturally attaches to haemoglobin.

The amount of glucose that combines with this protein is directly proportional to the total amount of sugar that is in your system at that time.

Because red blood cells in the human body survive for 8-12 weeks before renewal, measuring glycated haemoglobin (or HbA1c) can be used to reflect average blood glucose levels over that duration, providing a useful longer-term gauge of blood glucose control.

If your blood sugar levels have been high in recent weeks, your HbA1c will also be greater.

HbA1c targets

The HbA1c target for people with diabetes to aim for is:

48 mmol/mol (6.5%)

Note that this is a general target and people with diabetes should be given an individual target to aim towards by their health team.

An individual HbA1c should take into account your ability to achieve the target based on your day to day life and whether you are at risk of having regular or severe hypos.

HbA1c in diagnosis

HbA1c can indicate people with prediabetes or diabetes as follows:

JAUNDICE : REVIEW

Jaundice Disease with Causes, Treatment and Nursing Intervention

Definition of Jaundice:

Jaundice disease (also known as icterus) is a yellowish discoloration of the skin, conjunctival membranes over the sclera and other mucous membranes caused by elevated levels of bilirubin in the blood.

The normal level of bilirubin is below 1.2mg/dl. When the level of bilirubin exceeds more than 2.5-3mg/dl, it leads into jaundice.

 Jaundice – Causes:

The causes of the Jaundice are usually classified on based up the dysfunction of the normal metabolism or execration of bilirubin. The disruption in the metabolism of bilirubin can occur at various stages.

Jaundice disease

Depend upon the stages of dysfunction; the causes of Jaundice are divided into three ways-

Pre-Hepatic,Hepato cellular,Post Hepatic.

Those are described in the following:

1. Pre-Hepatic:

The pathology is occurring outside of liver. An infection or medical condition destruct the red blood cells sooner than usual and increased level of bilirubin such as-

Sick cell anemia,Malaria,Thalassaemia,Hereditary spherocytosis,Drugs or other toxins,Gilbert’s syndrome,Autoimmune disease,Hemolytic uremic syndrome,Glucose-6-Phosphate Dehydrogenase Deficiency (G6PD).

2. Hepato cellular:

The problems are mainly occurred in liver. When the liver is damaged, it losts function in the metabolism and/or excretion of bilirubin.

Acute or chronic hepatitis commonly viral (Hepatitis A, B, C, D, E)Alcoholic liver disease,Liver cirrhosis,Glandular fever,Paracetamol overdose or toxicity (Drug induced hepatitis),Crigler- najjar syndrome,Alcoholic fatty disease,Illegal drug use.

3. Post Hepatic:

The problem is located after the conjunction of bilirubin in the liver caused due to obstruction of biliary passage-

Gallbladder stones,Cancer in the gallbladder, pancreas or bill duct,Biliary atresia,Cholangiocarcinoma,Pancreatitis,Parasites (Like liver flukes),Cholestasis of pregnancy.Pancreatic pseudo cysts,Mirizzi’s syndrome.

Sign and Symptoms of Jaundice Disease:

There are different types of sign and symptoms for jaundice disease, those are mentioned in the below:

Yellow color of skin, sclera of eye and mucous membrane of mouth and nose,Dark colored urine,Skin itching,Nausea and vomiting,Pale colored stool,Fever and chills,Stomach pain,Weight loss,Loss of appetite,Diarrhea,Weakness,Confusion,Headache,Swelling of leg and abdomen.

Risk factors of Jaundice Disease:

There are various types of risk factors for jaundice disease, which are mentioned in the following:

Heavy consumption of alcohol,Pancreatitis,Hepatitis (B,C),Liver cirrhosis,Thalasemia,Hereditary spherocytosis.

Test and Diagnosis for Jaundice Disease:

There are different types of test and diagnosis for jaundice; those are mentioned in the following:

Liver function test,Complete blood test,Physical examination,Urinalysis,Electrolytes panel, conjugated or unconjugated bilirubin,USG of hepatobiliary system,CT Scan or MRI,ERCP (Endoscopic Retrograde Cholangio Pancreatography),Per-cutaneous Tans-hepatic Cholangiography,Liver biopsy.

Treatment for Jaundice Disease:

The treatment depends upon the underlying cause and how serious it is. If the main cause is diagnose, treatment can then be directed to particular condition.

Watchful waiting and home rest.For supportive treatment may need various medications such as painkiller, antibiotics, antiviral, steroids etc.Anti-emetic Medicine for controlling nausea or vomiting.IV fluids in cases of dehydration.Chemotherapy/ radiation therapy.If the cause is genetic such as- sickle cell anemia, a blood transfusion may be needed.If any drugs make toxicity, these must be discontinued.Surgical or various invasive procedures may need to treat Jaundice, such as Laparoscopic Cholecystectomy (Removal of gall bladder stones or bile duck blockage l), Liver transplant, Respectability of neoplastic causes of biliary obstruction.

Complication of Jaundice Disease:

There are different types of complication for jaundice disease; those are mentioned in the below:

Electrolytes imbalance,Anemia,Chronic hepatitis,Cancer,Bleeding,Liver failure,Acute bilirubin encephalopathy,Kernicterus,Kidney failure,Death.

Prevention of Jaundice Disease:

Various types of prevention ways for jaundice disease are described in the below:

Cessation of alcoholism (alcoholic hepatitis, cirrhosis, and pancreatitis).Maintain healthy weight and avoid extra buttery food and fast food.Having a healthy and balanced diet.Avoid coffee, tea, hot spices and red chilli.Avoid stress as much as possible.Avoid potentially road side and contaminated food/water and maintain good hygiene (hepatitis A).Take Vaccines against hepatitis (Hepatitis-A, Hepatitis-B).Aware details information about the country and take medications which prevent malaria before traveling to high-risk regions.Avoid illegal behaviors such as intravenous drug use or unprotected intercourse (Hepatitis-B).Avoid medications that can cause hemolysis in susceptible individuals (Such as-those with G6PD deficiency, a condition that leads to red blood cell breakdown after consumption of certain substances).Avoid medications and toxins which can cause hemolysis or directly damage the liver.

Nursing Intervention for Jaundice Disease:

There are different types of nursing interventions for jaundice disease; those are discussed in the following:

Assess s colour of skin, sclera of eye and mucous membrane of mouth and nose for every 8 hours.
Check for any signs for complication and notify to physician.
Check neurological status 8 hourly to identify complication of bilirubin encephalopathy.Check vital signs every 4 hourly.
Monitor intake output and check urine and stool colour.
Administer medication as order.Control of nausea and vomiting and administer anti-emetic drug as order.
Monitor direct and indirect bilirubin to evaluate treatment efficacy.
Provide healthy diet consult with dietician.Give mouth care to increase appetite and prevent vomiting and provide low fat diet.
Encourage patient to take plenty of fluid at least 6-8 glass daily.
Check weight daily to evaluate weight loss or gain.
Administer IV fluid if diarrhea present.Ensure proper rest and keep everything reaches to patient.
Keep skin clean and dry to prevent itching.
Provide health education to patient and patient party how to prevent jaundice.
Arrange vaccination programme and administer vaccine to patient as order.
Provide psychological support to patient and encourage patient express feeling.

HYPOPITUITARISM :

Hypopituitarism Disease with Causes and Nursing Intervention

Definition of Hypopituitarism Disease:

Hypopituitarism disease is a clinical syndrome in which pituitary gland fails to produce normal amounts of one or more hormone. Pituitary gland produce 8 hormones, when it unable to supply one or more of hormone that affect normal body function such as growth, blood pressure, reproduction etc.

Hypopituitarism disease

The most important 8 hormones are mentioned in the following:

Adrenocorticotropic hormone (ATCH)- Stimulates the adrenal gland to release cortisol. Cortisol helps to maintain blood pressure and blood sugar.Anti-diuretic hormone (ADH)- Controls water loss by the kidneys.Follicle stimulating hormone (FSH)- Controls sexual function and fertility in males and females.Growth hormone (GH)- Stimulates growth of tissues and bone.Liteinizing hormone (LH)- Controls sexual function and fertility in males and females.Oxytocins- Stimulate the uterus to contract during labour and the breasts to release milk.Prolactine- Stimulates female breast development and milk production.Thyroid stimulating hormone (TSH)- Stimulates the thyroid gland to release hormones that affect the body’s metabolism.

Causes of Hypopituitarism Disease:

Various types of causes for hypopituitarism disease are in the below:

Tumor or carcinoma of pituitary gland,Head injury,Brain surgery,Radiation therapy to head and neck area,Infection or inflammation of brain,Stroke,Necrosis of pituitary gland,Subarachnoid haemorrhage,Post partum haemorrhage,Hypovolemia and hypotension during delivery,Infiltrative disease such as sarcodosis,Congenital hypopituitarism disease.

Sign and Symptoms of Hypopituitarism Disease:

There are different types of sign and symptoms for hypopituitarism disease, which are mentioned in the following:

Fatigue and weakness,Decreased appetite,Sensitivity to cold,Slow growth,Immature facial features and immature voice,Slow growth of nails and thin hair,Weight loss,Delayed puberty,Infertility (In women),Uterine and vaginal atrophy,Potential atrophy of breast tissues,Oligomenorrhea or Amenorrhea,Decreased sex drive,Failure to lactate in the postpartum women (Sheehan’s syndrome- Sheehan’s syndrome is a condition that may occur in a woman who has a severe uterine haemorrhage during childbirth),Decreased serum level of prolactin,Papilledema,Low blood sugar,Hydrocephalus,Headache,Visual disturbance,Dizziness.

Diagnosis and Test of Hypopituitarism Disease:

Various diagnosis ways and test for hypopituitarism disease are given in the below:

Brain CT Scan,Pituitary MRI,Serum ACTH (Adrenocorticotropic hormone),Serum Cortisol,,Serum Estradoil,Serum FSH (Follicle stimulating hormone),Serum Lutinizing Hormone,Serum testerone level,Serum TSH( Thyroid stimulating hormone),S .Free thyroxine (FT4 ),Vision test.

Treatment for Hypopituitarism Disease:

There are different numbers of treatment for hypopituitarism disease, those are mentioned in the following:

Treatment of underlying cause,Hormone therapy:Corticosteroids (cortisol) for adrenal insufficiency,Growth hormone,thyroid hormone-Levothyroxine for hypothyroidism,Sex hormone-Testosterone for male hypogonadism, and Estradiol for female hypogonadism (usually with a progestogen to inhibit unwanted effects on the uterus),Antidiuretic hormone can be replaced by desmopressin (DDAVP) tablets or vasopressin nose spray,Somatotropin (recombinant human growth hormone) is used to treat growth hormone deficiency.

Nursing Intervention for Hypopituitarism Disease:

Various nursing interventions for hypopituitarism disease are described in the below:

Monitor vital signs blood pressure, heart rate and rhythm every 2 hours.

Assess lung and heart sounds 4 hourly, be alert for s/s of congestive heart diseaseWatch for chest pain or dyspnea because hypothyroidism can develop chronic arteriosclerosis.

Monitor weight daily because ADH from pituitary gland regulates fluid retention and excretion in the body.

Administer human growth hormone as prescribed.Somatropin should be injected subcutaneously on a daily basis, preferably in the evening.

Teach patients that thyroid replacement therapy must be taken for lifetime and administered in the morning on an empty stomach because thyroid medications can cause insomnia if taken at night.

Teaching patient to never miss any dose of medication without consulting with physician.

Provide high protein, low calorie fibre food.Provide iodine rich diet, which is easily accomplished with iodized salt.

Instruct patient to avoid constipation and provide stool softeners.

Monitor laboratory test for hormonal deficiencies until the patient completes hormone replacement therapy.

Administer replacement fluids, electrolytes, and glucose as prescribed by physician to maintain normal serum levels.

Monitor intake and output to ensure the balance is equal due to hormone regulation.

Monitor physical and mental status and Encourage patient to express their feelings.

Instruct the patient when sleeping with head elevation position to reduce trauma to the eye.

Teach patients to change positions slowly and to notify healthcare provider immediately if they develop an increased or irregular pulse, palpitations, nervousness, heat intolerance, diarrhoea, sweating or irritability.

Encourage clients to ask about the issue of face.Encourage clients to discuss the issue of sexual dysfunction with partner.Generate patient motivation to continue the treatment programme on a regular basis.Give the clients a chance to meet their needs independently.Make a mutual trust relationship with client.

Provide emotional and psychological care that patient feel comfort.

Give skin care and encourage patient to perform regular skin care.If patient have cold sensitivity, keep patient warm and provide extra clothing and avoid the patient getting chilled.

Avoid using heating pads and electric blankets because of the risk of peripheral vasodilation.Refer the family for psychological counselling.

Observe eyelids, nails beds and skin pallor which indicate anemia.

Ensure safety prequitions for patients with impaired visual field.Wet the eye with sterile water to provide comfort to the eye

HYPOKALEMIA MANAGEMENT :

Hypokalemia Disease with Causes, Treatment and Nursing Intervention

Hypokalemia Disease or Hypokalemia Liver Disease:

Hypokalemia disease consists with the three words named hypo, kal and emia. The prefix Hypo- means “Under” Kal- refers to ‘’Kalium, the Neo-Latin for Potassium’’ and Emia- means “Condition of the blood’’. Potassium is one of the crucial primary Electrolytes for cell function and is concentrated within the cells of the body. Small changes in the serum levels of potassium can affect body function. It is necessary for nerve and muscle cell functioning. It is especially important for the functioning of muscle cells in the heart. The kidneys control potassium levels. The most common causes are excess losses from the kidneys or GI tract. Serum Electrolytes is a diagnosis measurement and treatment is supplement of K and managing the cause. Careful monitoring and skilled nursing interventions can help correct potassium level and prevent associated complications.

Hypokalemia disease

Definition of Hypokalemia Disease:

Hypokalemia (Low Potassium) refers to low concentration of potassium level in blood. Normal level of potassium in blood is 3.5-5.2mmol/L.

Less than 3.5mmol/L is considered low potassium (Hypokalemia). If potassium level below 2.5mmol/L is called extreme low potassium (Severe Hypokalemia).

Potassium is very important for proper functioning of nerve and muscle especially heart muscle cells.

Hypokalemia Causes:

There are different types of causes for hypokalemia disease, those are mentioned in the below:

Chronic kidney disease,Diabetic ketoacidssis,Use of diuretics (Water / Fluid pills),Diarrhea / vomiting,Excessive sweating due to heat / exercise,Excessive use of laxative, enema,Eating disorders (Bulimia)/ low consumption of potassium,Magnesium Deficiencies,Antibiotics,Hyperthyroidism,Alcoholism,Coughing syndrome,Prolonged nasogastric suctioning,NPO status,Steroids,Tissue injury,Leukemia,Post ileostomy surgery.

Sign and Symptoms of Hypokalemia Disease:

Various types of sign and symptoms for hypokalemia disease are mentioned in the following:

Arrhythmias,Shallow respirations,Increased urine output,Weakness and fatigue,Muscle cramps and pain,Palpitations,Delirium,Hallucinations,Paralytic ileus,Anxiety,Deep tendon Hyporeflexia,Tingling or numbness,Nausea and vomiting,Hypotension,Anorexia,Thirst,Coma.

Test and Diagnosis of Hypokalemia Disease:

There are different types of test and diagnosis for hypokalemia disease, those are given in the below:

S. Electrolytes / Potassium,Magnesium, Calcium, Phosphorous,TSH,Aldosterone,ECG,Urine Potassium.

Treatment for Hypokalemia Disease:

The most important treatment of hypokalemia disease is to treat underlying causes. Various types of treatments for hypokalemia are mentioned in the following:

Treat diarrhea, vomiting.Stop or changes diuretic (Use potassium sparing diuretic if required. (E.g. Severe heart failure).Discontinue laxatives.Administer H2 blockers to patients receiving nasogastric suction.Control Hyperglycemia if glycosuria is present.In mild Hypokalemia (˃3.0mmol/L) can be treated with oral potassium supplement. (tablet/liquid) and potassium ion rich diet including Leafy green vegetables, Tomatoes, Avocados, Baked potato, Bran, Carrots, Coconut water, Citrus fruits, Oranges, Bananas and Milk.In severe Hypokalemia (<2.5mmol/L) can be treated with both oral and intravenous potassium supplement with close follow-up and continuous ECG monitoring.

Complication of Hypokalemia Disease:

There are different types of complications for hypokalemia, those are mentioned in the below:

Thyrotoxic periodic paralysis,Lung paralysis,Sleepiness and irritability,Dehydration,Hyperglycemia,Kidney damage,Cellular damage,Cardiac arrhythmias,Fainting,Cardiac arrest,Death.

Nursing Intervention for Hypokalemia Disease:

There are different types of nursing interventions for hypokalemia, those are discussed in the following:

Record fluid intake and output hourly and observe for dehydration.Check vitals sign hourly in critical care unit with severe Hypokalemia.Continue monitoring ECG and Identify ECG changes such as depressed T waves, peaking P-waves.Give mouth care to reduce vomiting tendency.Give antiemetic drugs as order.Monitor for any complications such as paralysis, cardiac arrest etc.Check blood sugar 6 hourly and control by hypoglycemic agent.Provide oral potassium diluted in 4-8 oz of water or juice (decreased gastric mucosa irritation).Dilute IV potassium 20-40mEq in 1L of IV fluids and use infusion pump (irritating to blood vessels and myocardium).If central venous line present can be give potassium supplement through syringe pump 20mEq per hour.Be careful that never administer bolus IV potassium.Monitor IV site for phlebitis and infiltration if intravenous cannula present.Provide potassium rich diet and consult with dietician.Check neurological status hourly by GCS scale.Observe for neuromuscular changes such as fatigue and muscular weakness.Teach patient about potassium-rich foods and how to prevent excessive loss (abuse of laxative and diuretics.Provide calm and quite environment so that patient can sleep.Give psychological support to reduce anxiety.

NURSING INTERVENTIONS FOR DENGUE FEVER :

Nursing Interventions for Dengue Fever - Hyperthermia

Nursing Diagnosis for Dengue Fever : Hyperthermia

Dengue fever, also known as breakbone fever, is an infectious tropical disease caused by the dengue virus. Symptoms include fever, headache, muscle and joint pains, and a characteristic skin rash that is similar to measles. In a small proportion of cases the disease develops into the life-threatening dengue hemorrhagic fever, resulting in bleeding, low levels of blood platelets and blood plasma leakage, or into dengue shock syndrome, where dangerously low blood pressure occurs.

Dengue is transmitted by several species of mosquito within the genus Aedes, principally A. aegypti. The virus has four different types; infection with one type usually gives lifelong immunity to that type, but only short-term immunity to the others. Subsequent infection with a different type increases the risk of severe complications. As there is no vaccine, prevention is sought by reducing the habitat and the number of mosquitoes and limiting exposure to bites.

Treatment of acute dengue is supportive, using either oral or intravenous rehydration for mild or moderate disease, and intravenous fluids and blood transfusion for more severe cases. The incidence of dengue fever has increased dramatically since the 1960s, with around 50–100 million people infected yearly. Early descriptions of the condition date from 1779, and its viral cause and the transmission were elucidated in the early 20th century. Dengue has become a global problem since the Second World War and is endemic in more than 110 countries. Apart from eliminating the mosquitoes, work is ongoing on a vaccine, as well as medication targeted directly at the virus.

Hyperthermia

Hyperthermia is an elevated body temperature due to failed thermoregulation. Hyperthermia occurs when the body produces or absorbs more heat than it can dissipate. When the elevated body temperatures are sufficiently high, hyperthermia is a medical emergency and requires immediate treatment to prevent disability or death.

The most common causes are heat stroke and adverse reactions to drugs. Heat stroke is an acute condition of hyperthermia that is caused by prolonged exposure to excessive heat or heat and humidity. The heat-regulating mechanisms of the body eventually become overwhelmed and unable to effectively deal with the heat, causing the body temperature to climb uncontrollably. Hyperthermia is a relatively rare side effect of many drugs, particularly those that affect the central nervous system. Malignant hyperthermia is a rare complication of some types of general anesthesia.

Hyperthermia can be created artificially by drugs or medical devices. Hyperthermia therapy may be used to treat some kinds of cancer and other conditions, most commonly in conjunction with radiotherapy.

Hyperthermia differs from fever in the mechanism that causes the elevated body temperatures: a fever is caused by a change in the body's temperature set-point.

The opposite of hyperthermia is hypothermia, which occurs when an organism's temperature drops below that required for normal metabolism. Hypothermia is caused by prolonged exposure to low temperatures and is also a medical emergency requiring immediate treatment.

Nursing Interventions for Dengue Fever :

Hyperthermia

Hyperthermia Settings
Monitor the temperature as neededMonitor blood pressure, pulse and respirationMonitor the temperature and skin colorMonitor and report signs and symptoms of hyperthermiaEncourage intake of fluids and adequate nutritionTeach clients how to prevent high heatGive antipyretic drugsGive drugs to prevent or control the shivering
Hyperthermia Treatment
Monitor the temperature as neededmonitor IWLMonitor the temperature and skin colorMonitor blood pressure, pulse and respirationMonitor the degree of impairment of consciousnessMonitor the ability of the activityMonitor leukocytes, hematocrit, hemoglobinMonitor intake and outputMonitor cardiac arrhythmiasEncourage increased fluid intakeGive intravenous fluidsIncrease air circulation with a fanPush or do oral hygieneGive antipyretic drugs to prevent the client shivering / seizuresGive antibiotic drugs to treat the cause of feverGive oxygenCold compress on the groin, forehead and axilla.Encourage clients not to wear a blanketEncourage clients to wear clothes made ​​from cold, thin and absorbs perspiration
Environmental Management
Give the room as indicatedGive your bed and cloth / linen, clean and comfortableLimit visitors
Infection Control
Encourage clients to wash their hands before eatingUse soap to wash handsWash hands before and after doing client care activitiesReplace the infusion and clean place in accordance with SOPGive your skin care in the area of edemaEncourage clients to get enough restPerform infusion with aseptic techniqueEncourage clients to take antibiotics according to doctors advice.

Fasting Glucose level :

Type 1 Diabetes vs. Type 2 Diabetes

There are two types of diabetes: Type 1 Diabetes and Type 2 Diabetes. Type 1 Diabetes is almost entirely genetic, whereas Type 2 Diabetes is largely due to poor diet, lack of exercise, and genetic factors.

 

Type 1 Diabetes Mellitus (T1DM)¹

Type 1 Diabetes Mellitus (T1DM) used to be known as “Insulin Dependent Diabetes Mellitus (IDDM),” a term you will still hear used today. The reason for this name is that people with T1DM are completely dependent on insulin to control their blood sugars. Type 1 Diabetes is almost entirely genetic and cannot be controlled by exercise and diet; it must be treated with regular insulin injections.

In T1DM, the body’s immune system attacks the cells in the pancreas that produce insulin, known as beta cells. Once enough of these cells are destroyed, the pancreas can no longer produce enough insulin to maintain blood sugar in the normal range and you become hyperglycemic (high blood sugar). Beta cell destruction and consequent T1DM can occur at any age; however, it most commonly occurs in adolescents followed by men in their 30s to 40s.

Type 1 Diabetes possess the following characteristics: 

Generally occurs in younger individualsRelated primarily to genetic factorsIndividuals usually thin; not related to obesityInsulin dependent for life; must take insulin to maintain normal blood sugarsUsually presents initially with diabetic ketoacidosis, which requires emergent hospitalization and treatment to control extremely high blood sugar levels

 

Type 2 Diabetes Mellitus (T2DM)²

Type 2 Diabetes Mellitus (T2DM) used to be known as “Non-Insulin Dependent Diabetes Mellitus (NIDDM),” a term you will also still hear used today. The reason for this name is that people with T2DM are not completely dependent on insulin to control their blood sugars because their bodies still have the ability to produce insulin, usually just less insulin than a regular person. Unlike individuals with T1DM, people with T2DM also have “insulin resistance,” meaning that cells in their bodies do not react to insulin as strongly as they should. As their ability to produce insulin decreases (which is does progressively over time) and they cannot produce enough insulin to compensate for the insulin resistance of their cells, they become hyperglycemic.

Type 2 Diabetes possess the following characteristics:

Generally occurs in older individualsResults from a combination of insulin resistance and inadequate insulin secretionRelated to obesity, high calorie diet, lack of exercise, and genetic factorsVariety of treatments are available, although most patients eventually require insulin to control blood sugarsUsually presents more slowly than T1DM and is often picked up on screening tests for blood sugar levels

Diabetes mellitus in Children :

Nursing Intervention Nursing Care Plan for Children with Diabetes Mellitus

Nursing Intervention Nursing Care Plan for Children with Diabetes Mellitus

Expected Results:
Prevent injury and infectionEliminate fear when giving insulinMaintenance of adequate nutritionPositive self-conceptDoes not dependTo keep the child's family does not happen hypoglycemia, insulin nutrition for childrenFor children to learn to treat diabetes in order to avoid complications.

Prevent injury
Monitoring blood glucose levels, 2 times a day, before breakfast and dinner.Help express feelings of fear when performed blood glucose test (finger stick).Monitor signs of hyperglycemia

Improve family coping in the management hypoglikemia and hyperglikemia:
Education about the signs and hyperglikemia hypoglikemia and how the handling necessary to overcome.How to handle if blood sugar <60 mg / dl, juice, sugar, non-diet soda, if glucose is not checked give simple carbohydrates if there are signs of hypoglycemia.If the child received therapy glucagon or dextrose from doctors, teach how the intra-muscular administration of glucagon.Encourage children to bring lunch and eat if there are signs of hypoglycemia (his lunch complex carbohydrates such as cakes, crakers, bread, beans).Note the pattern of occurrence of hypoglycemia and create a schedule plan for decision making in order to avoid hypoglycemiaIf the child has a sore (fever, infection, vomiting, nausea, did not eat) call the doctor.Teach how subcutan insulin administration.

Ensuring appropriate and inadequate nutrition
Involve children in planning nutrition.Helping children to get involved in a diet program.If the child will come home late for lunch are encouraged to bring the food complex carbohydrates.Can recommend how to overcome eating in school and social environment.

Prevent infection and skin damage
Teach them how to observe, determine the skin every day (after a shower) typically are susceptible to damage at folds (axilla, groin)Note the use of a good shoe.Observation of both feet for cracked, cut nails according to the line, use clean socks.Infection often is the urinary system and respiratory system of teaching known mark urinary infection; itching, burning sensation in the urinary system in case of medical attention.

Reducing the anxiety of children and families
Suggest to the child and family to express his feelings (guilt, anger, rejection).Encourage a lot of reading to increase understanding about the disease.Give an honest and clear information.

Improve self care and positive self esteem
Encourage child to visit one another among the sick.Explain that children with diabetes can do the same activities as other children.