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 Unstable Blood Glucose Level

Risk for Unstable Blood Glucose Level: Risk for variation of blood glucose/sugar levels from the normal range.

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]

Desired Outcomes

  • 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%.
Nursing InterventionsRationale
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:
  • Rapid-acting insulin analogs: lispro insulin (Humalog), insulin aspart
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.
  • Short-acting insulin: regular
Has an onset of action within 30 minutes of administration; duration of action is 4 to 8 hours.
  • Intermediate-acting insulin: neutral protamine Hagedorn (NPH), insulin zinc suspension (Lente)
Onset of action for the intermediate-acting is one hour after administration; duration of action is 18 to 26 hours.
  • Intermediate and rapid: 70% NPH/30% regular.
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.
  • Long-acting insulin: Ultralente, insulin glargine (Lantus)
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.
  • Injection procedures.
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.
  • Rotation of injection within one anatomical site.
Injection of insulin in the same site over time will result in lipoatrophy and lipohypertrophy with reduced insulin absorption.
  • Storage of insulin.
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.
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See Also

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