4 Diabetes Mellitus Type 1 (Juvenile Diabetes) Nursing Care Plans

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Insulin-dependent diabetes mellitus (IDDM) also known as type 1 diabetes or juvenile diabetes, is a metabolic disorder caused by a lack of insulin. The deficiency is believed to happen in people who are genetically prone to the disease and who have experienced a precipitating event, commonly a viral infection or environmental change, that causes an autoimmune response affecting the insulin-producing cells (beta cells) of the pancreas.

It is treated by injection of insulin and regulation of diet and activity that maintain body functions. Complications that occur from improper coordination of these include hypoglycemia and hyperglycemia which, if untreated, lead to insulin shock or ketoacidosis. Long-term effects of the disease include neuropathy, nephropathy, retinopathy, atherosclerosis, and microangiopathy.

Nursing Care Plans

Nurses have an essential role and responsibilities when caring for a client with diabetes such as providing child and family with education about the management of hyperglycemia and hypoglycemia including insulin administration, dietary regimen, and exercise needs for the child, helping the family to adjust to having a chronic disease, and preventing short-term and long-term complications of diabetes.

Here are four (4) nursing care plans (NCP) and nursing diagnosis (NDx) for diabetes mellitus type 1:

  1. Deficient Knowledge
  2. Compromised Family Coping
  3. Risk for Injury
  4. Risk for Unstable Blood Glucose
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Risk for Injury

Risk for Injury: Vulnerable for injury as a result of environmental conditions interacting with the individual’s adaptive and defensive resources, which may compromise health.

May be related to

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  • [not applicable]

Possibly evidenced by

  • Hyperglycemia— headache, confusion, blurred vision, irritability, fatigue, dry mouth, abdominal pain, weight loss, polyuria, polydipsia, polyphagia
  • Hypoglycemia— sweating, shakiness, nervousness, lightheadedness, weakness, hunger, nausea, palpitations, moodiness, pale skin, loss of consciousness

Desired Outcomes

  • Client’s blood glucose levels will maintain between 60 mg/dL and 120 mg/dL.
  • Client’s urine will be free from ketones and glucose.
Nursing InterventionsRationale
Assess for signs and symptoms of
hyperglycemia; Monitor serum glucose level, urine for glucose and ketones, pH and electrolyte levels.
Provides information about the effect of increased blood glucose levels caused by an illness, inappropriate diet, stress or failure to administer insulin; glucose is unable to enter the cells, and protein is broken down and converted to glucose by the liver, causing the hyperglycemia; fat and protein stores are depleted to provide energy for the body when carbohydrates are not able to be used for energy.
Assess for signs and symptoms of
hypoglycemia, serum glucose level.
Provides information about the occurrence of hypoglycemia caused by an increased
activity without additional food intake
or failure or incomplete ingestion of
meals, improper insulin administration, illness.
Administer insulin subcutaneously as prescribed, increase dosage depending on the glucose levels; rotate injection sites,  minimize food intake during an infection or illness and modify the dosage of insulin during an illness.Provides insulin replacement to maintain normal blood glucose levels without causing hypoglycemia; two or more injections may be given daily subcutaneous (SC) using a portable syringe pump or by intermittent bolus injections with a syringe and needle.
Encourage a diet with calories that balance
with the energy requirements and paired with the type and action of insulin, and snacks between meals and at bedtime as appropriate.
Provides nutritional needs of the child for proper growth and development using the exchange system or by carbohydrate
counting— monitoring carbohydrate intake only, maintaining consistent level at meals and snacks, and adjusting insulin as needed (requires close supervision
of a physician).
Promote exercise program compatible with insulin regimen; instruct to increase
carbohydrate intake prior a strenuous
activities.
Guides in the utilization of dietary intake, regular activity may decrease the amount of insulin required; an insulin reduction and increased carbohydrate intake prior to a strenuous exercise may avoid hypoglycemia.
Encourage rest periods and provide a quick source of a simple carbohydrate such as fruit juice, milk products followed by a
complex carbohydrate such as bread in
amounts of 15 gm; repeat intake in 10
minutes for an expected response of a
reduced pulse rate; administer 50 percent glucose per IV or glucagon IM if
hypoglycemia is severe.
Relieves the symptoms of hypoglycemia as soon as observed; glucagon releases the glycogen stored in the liver to assist in restoring glucose levels; Administration of IV glucose is done when the condition is severe and child is unable to take glucose source orally. Glucagon, a hormone, releases stored glycogen from the liver and increases blood glucose within 5 to 15 minutes.
Educate parents and child about signs and symptoms, reasons why they happen, and measures to take.Provides information about abnormal blood glucose levels causing complications of hyperglycemia, hypoglycemia, and the consequences.
Educate parents and child to regulate
insulin, control dietary intake, and
exercise to accommodate needs of an individual child.
Supports the child’s growth and development needs while avoiding complications.
Educate parents and child to modify administration of insulin depending on
the blood glucose testing and glycosuria, during an illness or after changes in food
intake or activities.
Prevents and treats hyperglycemia;  Prevents serious complication of ketoacidosis.
Instruct parents and child to take a
quick-acting carbohydrate followed by a longer-acting carbohydrate and to have Lifesavers, sugar cubes, Instaglucose on hand at all times; instruct parents that, in the case of severe hypoglycemia, if the child is unconscious or unable to take oral
fluids, to rub honey or syrup on the child’s buccal surface until alert enough to take fluids/foods by mouth.
Prevents and/or treats hypoglycemia.
Instruct parents and child to notify
irregular blood and urine test results,  difficulty in managing blood glucose levels, presence of an infection or illness.
Avoids more severe complications and long-term effects of the disease; poor control leads to serious and severe consequences in a few hours.
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See Also

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