Type 1 diabetes mellitus (previously known as Insulin-dependent diabetes mellitus (IDDM) or juvenile DM) 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.
Risk for Injury
- Risk for Injury
May be related to
- [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
- 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.
|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
|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.|
Recommended nursing diagnosis and nursing care plan books and resources.
- Nursing Care Plans: Nursing Diagnosis and Intervention (10th Edition)
An awesome book to help you create and customize effective nursing care plans. We highly recommend this book for its completeness and ease of use.
- Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions and Rationales
A quick-reference tool to easily select the appropriate nursing diagnosis to plan your patient’s care effectively.
- NANDA International Nursing Diagnoses: Definitions & Classification, 2021-2023 (12th Edition)
The official and definitive guide to nursing diagnoses as reviewed and approved by the NANDA-I. This book focuses on the nursing diagnostic labels, their defining characteristics, and risk factors – this does not include nursing interventions and rationales.
- Nursing Diagnosis Handbook, 12th Edition Revised Reprint with 2021-2023 NANDA-I® Updates
Another great nursing care plan resource that is updated to include the recent NANDA-I updates.
- Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5(TM))
Useful for creating nursing care plans related to mental health and psychiatric nursing.
- Ulrich & Canale’s Nursing Care Planning Guides, 8th Edition
Claims to have the most in-depth care plans of any nursing care planning book. Includes 31 detailed nursing diagnosis care plans and 63 disease/disorder care plans.
- Maternal Newborn Nursing Care Plans (3rd Edition)
If you’re looking for specific care plans related to maternal and newborn nursing care, this book is for you.
- Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client Care (7th Edition)
An easy-to-use nursing care plan book that is updated with the latest diagnosis from NANDA-I 2021-2023.
- All-in-One Nursing Care Planning Resource: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health (5th Edition)
Definitely an all-in-one resources for nursing care planning. It has over 100 care plans for different nursing topics.
Other recommended site resources for this nursing care plan:
- Nursing Care Plans (NCP): Ultimate Guide and Database
Over 150+ nursing care plans for different diseases and conditions. Includes our easy-to-follow guide on how to create nursing care plans from scratch.
- Nursing Diagnosis Guide and List: All You Need to Know to Master Diagnosing
Our comprehensive guide on how to create and write diagnostic labels. Includes detailed nursing care plan guides for common nursing diagnostic labels.
Other nursing care plans related to endocrine system and metabolism disorders:
- Acid-Base Balance
- – Respiratory Acidosis Nursing Care Plan
- – Respiratory Alkalosis Nursing Care Plan
- – Metabolic Acidosis Nursing Care Plan
- – Metabolic Alkalosis Nursing Care Plan
- Addison’s Disease | 3 Care Plans
- Cushing’s Disease | 6 Care Plans
- Diabetes Mellitus Type 1 (Juvenile Diabetes) | 4 Care Plans
- Diabetes Mellitus Type 2 | 17 Care Plans
- Diabetic Ketoacidosis (DKA) and Hyperglycemic Hyperosmolar Nonketotic Syndrome (HHNS) | 4 Care Plans
- Eating Disorders: Anorexia & Bulimia Nervosa | 7 Care Plans
- Fluid and Electrolyte Imbalances | 10 Care Plans
- – Fluid Balance: Hypervolemia & Hypovolemia
- – Potassium (K) Imbalances: Hyperkalemia and Hypokalemia
- – Sodium (Na) Imbalances: Hypernatremia and Hyponatremia
- – Magnesium (Mg) Imbalances: Hypermagnesemia and Hypomagnesemia
- – Calcium (Ca) Imbalances: Hypercalcemia and Hypocalcemia
- Gestational Diabetes Mellitus | 4 Care Plans
- Hyperthyroidism | 7 Care Plans
- Hypothyroidism | 3 Care Plans
- Obesity | 4 Care Plans
- Thyroidectomy | 5 Care Plans