Denielle Saitta

NCP
Pediatric and Diabetes
I.

Introduction: Patient Profile

8 year old white female diagnosed with type 1 diabetes.

II.

Disease Process
Diabetes mellitus is the most common endocrine system disorders in todays
society. It affects over 25.6 million individuals in the United States. Hyperglycemia is
a result from all forms of diabetes. Hyperglycemia is correlated with organ
dysfunction and damage, progressing to failure of numerous organs, particularly the
eyes, kidneys, nerves, heart, and blood vessels.
Type 1 diabetes in children is a condition in which the pancreas no longer
produces the insulin needed to survive, and insulin must be replaced. Type 1 diabetes
in children used to be known as juvenile diabetes or insulin-dependent diabetes.
Signs and symptoms of type 1 diabetes in children usually develop quickly, over a
period of weeks. Some symptoms include increased thirst and frequent urination,
extreme hunger, weight loss, fatigue, irritability or unusual behavior, and blurred
vision.
Normally the hormone insulin helps glucose enter cells to provide energy to the
muscles and tissues. Insulin comes from the pancreas. When everything is working
properly, the pancreas secretes insulin into the bloodstream. Insulin lowers the
amount of sugar in the bloodstream. When insulin levels are low the liver releases the
stored glycogen, which is then converted to glucose to keep your blood glucose level
within a normal range. In type 1 diabetes, none of this occurs because there's no or
very little insulin to let glucose into the cells. Instead of being transported into cells,
the sugar builds up in the bloodstream, where it can cause life-threatening
complications.
Treatment for type 1 diabetes is a lifelong commitment of blood sugar monitoring,
insulin, healthy eating and regular exercise. A diabetic care plan will change over
time to account for growing and aging. Depending on what type of insulin therapy
needed, blood sugar levels may need to be checked at least four times a day. This
requires frequent finger sticks. Insulin is often injected using a fine needle and
syringe or an insulin pen. An insulin pump also may be an option.
Nutrition therapy for diabetes is individualized. There needs to be a
comprehensive assessment, a self-care treatment plan, and patients health status,
learning ability, readiness for change, and current lifestyle should be the foundation of
nutrition therapy. Intervention for diabetes is individualized as well, there is no one
diabetic diet. Nutrition education is the basis to understand the food- and nutritionknowledge deficit. The primary goals for nutrition therapy are the following:
HbA1c <7%
Blood pressure < 140/80 mmHg
LDL cholesterol <100 mg/dl; triglycerides <150 mg/dl; HDL cholesterol
>40 mg/dl (men); HDL cholesterol >50 mg/dl (women)
Achieve and maintain body weight

 Delay or prevent complications of diabetes

Nutrition prescription should be based on an individuals eating pattern,
preferences, and metabolic goals. The general foundation for macronutrient
distribution for diabetes is: 45% kcals from carbohydrates (fruits, vegetables, wholegrains, legumes, and low-fat dairy products are highly encouraged) and <30% kcals
from fat.
Early signs and symptoms of low blood sugar include sweating, shakiness,
drowsiness, hunger, dizziness, irritability, headaches, dramatic behavior changes,
confusion, and loss of consciousness. It is important to teach these symptoms
especially to children to avoid any major medical issue.
III.

IV.
V.

Patient History
Patient describes extreme thirst and polyuria I have been thirsty thirstier than I
have ever been in my whole life and then I have to use the bathroom a lotI even
have to get up at night to go to the bathroom. Patient was admitted to the ER after
fainting at soccer practice. Her serum glucose was 724 mg/dL Patient stated her
original weight was 55 lbs, this is a 9% loss of weight.
Course of Hospital Treatment - N/A
Nutrition Care
a. Assessment
Weight: 50 lbs = 22.7 kg
Height: 4 = 48 = 1.2192 m
BMI: ((50)/(48)(48))x703= 15.3 kg/m2
Growth Chart: 25th percentile

Lab Values:
Blood Glucose (683/250 mg/dl)
HbA1C (14.6%)
C-peptide (0.10 ng/mL)
Sodium (126/131 mEq/L)
Osmolality (295.3/304 mmol/kg/H2O)
Ketones- Positive
Specific Gravity (1.035)
Protein- Positive (100 mg/dL)
Glucose- Positive
pH (4.9)

Drugs:
Apidra insulin
Glargine insulin

Nutrient Needs
o [(135.3-30.8) x 8y + [1.56 x [(10x23kg) + (934x1.2192m)]] = 2,333.5
kcals/d

o Protein: 23 kg x 1.1g= 25 g PRO

o Fluids: 1500 mL + 20 x 3= 1560 cc
b. Diagnosis (PES) Statement
Food- and nutrition-related knowledge deficit related to lack of prior diabetes
education as evidenced by new diagnosis of type 1 diabetes.
Unintended weight loss related to inadequate insulin as evidenced by recent
rapid 9% body weight loss.
c. Intervention Plan & Implementation
Consult with diabetes education team for self-management training for patient
and parents. Key focus on providing comprehensive nutrition education for
both the patient and the family on recommended modifications. Provide
adequate energy distribution of food and nutrients within meals at specified
times dependent upon integration of insulin regimen and physical activity.
Emphasize carbohydrate choices in relation to intake overall effect on blood
glucose levels. Implement daily blood glucose monitoring at specific
intervals.
Prevent further weight loss and promote normal growth through coordination
of insulin with carbohydrate intake. Nutrition education implementation
through demonstration of proper insulin to carbohydrate ratios and insulin
correction doses.
d. Monitoring/Evaluation
Will continue to monitor weights, fasting blood glucose levels, HbA1c levels,
daily fasting blood glucose levels, physical activity, and energy intake.
e. Documented
Completed.