Page 945 - Saunders Comprehensive Review For NCLEX-RN

diabetes, and risk factors leading to heart disease,
such as hyperlipidemia, can occur.
3. A child who is obese is more likely to be obese as an
adult, which results in the comorbidities associated
with obesity later in life, such as type 2 diabetes, heart
disease, metabolic syndrome, and cancer.

V. Diabetes Mellitus

A. Description (Fig. 32-1)
1. Type 1 diabetes mellitus is characterized by the
destruction of the pancreatic beta cells, which
produce insulin; this results in absolute insulin
deficiency.
2. Type 2 diabetes mellitus usually arises because of
insulin resistance, in which the body fails to use
insulin properly, combined with relative (rather than
absolute) insulin deficiency.
3. The rate of children and teens being diagnosed with
prediabetes and type 2 diabetes is increasing. The
number one risk factor for developing type 2 diabetes
in childhood is being overweight. See Box 32-1 on
prevention strategies for type 2 diabetes in childhood.
4. Insulin deficiency requires the use of exogenous
insulin to promote appropriate glucose use and to
prevent complications related to elevated blood
glucose levels, such as hyperglycemia, diabetic
ketoacidosis, and death.
5. Diagnosis is based on the presence of classic
symptoms and an elevated blood glucose level
(normal blood glucose level is 70 to 99 mg/dL [4 to 6
mmol/L]); based on PHCP preference, normal level
may be a lower range).
6. Children may need to be admitted directly to the
pediatric intensive care unit because of the
manifestations of diabetic ketoacidosis, which may be
the initial occurrence leading to diagnosis of diabetes
mellitus.

B. Assessment

1. Polyuria, polydipsia, polyphagia
2. Hyperglycemia
3. Weight loss
4. Unexplained fatigue or lethargy
5. Headaches
6. Occasional enuresis in a previously toilet-trained child
7. Vaginitis in adolescent girls (caused by Candida, which
thrives in hyperglycemic tissues)

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