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 Unstable Blood Glucose Level
May be related to
- Deficient knowledge of diabetes management
- Developmental level
- Inadequate blood glucose monitoring
- Lack of adherence to diabetes management
Possibly evidenced by
- [not applicable]
- Client will maintain a blood glucose reading of less than 180 mg/dL; fasting blood glucose levels of less than <140 mg/dL; hemoglobin A1C level <7%.
|Monitor for signs of hyperglycemia such as fatigue, blurred vision, dry mouth.||Hyperglycemia happens due to an inadequate amount of insulin to glucose. Excess glucose in the blood creates an osmotic effect that results in polyuria, polydipsia, polyphagia.|
|Monitor for signs of hypoglycemia such as sweating, lightheadedness, weakness, nausea, tachycardia.||Manifestations of hypoglycemia may depend on every individual but are consistent in the same individual. The signs are the result of both increased adrenergic activity and decreased glucose delivery to the brain.|
|Assess feet for temperature, pulses, color, and sensation.||Monitors peripheral perfusion and neuropathy|
|Monitor blood glucose level prior meals and at bedtime.||Blood glucose should be between 140 to 180 mg/dL. Non-intensive care patients should be maintained at pre-meal levels <140 mg/dL.|
|Review client’s HbA1c-glycosylated hemoglobin.||Measures blood glucose levels over the past 2 to 3 months. A level of 6.5% to 7% is acceptable.|
|Assess child’s and parent’s current knowledge and understanding about the prescribed diet.||Noncompliance to dietary guidelines can result in hyperglycemia. An individualized diet plan is recommended.|
|Assess the pattern of physical activity.||Regular exercise is a core part of diabetes management and reduces the risk for cardiovascular complications.|
|Instruct the proper use of insulin as directed:|
||Have an onset of action within 15 minutes of administration. The duration of action is 2 to 3 hours for Humalog and 3 to 5 hours for aspart.|
||Has an onset of action within 30 minutes of administration; duration of action is 4 to 8 hours.|
||Onset of action for the intermediate-acting is one hour after administration; duration of action is 18 to 26 hours.|
||Premixed concentration has an onset of action similar to that of rapid-acting insulin and a duration of action similar to that of intermediate-acting insulin.|
||Have an onset of one hour after administration. Duration of action is 36 hours for Ultralente is 36 hours and for glargine is at least 24 hours.|
|Instruct the patient on the proper preparation and administration of insulin.|
||Absorption of insulin is more consistent when insulin is always injected in the same anatomical site. Absorption if fastest in the abdomen, followed by the arms, thighs, and buttocks. It is recommended by the American Diabetes Association to administer insulin into the subcutaneous tissue of the abdomen.|
||Injection of insulin in the same site over time will result in lipoatrophy and lipohypertrophy with reduced insulin absorption.|
||Insulin should be refrigerated at 2º to 8º C (36º to 46º F). Unopened vials may be stored until their expiration date. To prevent irritation from “cold insulin,” vials may be stored at temperatures of 15º to 30ºC (59º to 86ºF) for 1 month. Opened vials are to be discarded after that time.|
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