Family Guidance and Diabetes Mellitus Overview

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Questions and Answers

What is the maximum concentration ratio mentioned for combinations?

30/70

50/50 (correct)

70/30

10/90

Combinations are only available in a single concentration mixture.

False

What is the concentration of a mixture that consists of 10% regular and 90% isophane?

10/90

Combinations can vary in concentrations from _ to _ mixtures.

10/90, 50/50 Signup and view all the answers

Match the following concentration mixtures with their ratios:

10/90 = 10% regular, 90% isophane 50/50 = Equal parts of both components 30/70 = 30% regular, 70% isophane 20/80 = 20% regular, 80% isophane Signup and view all the answers

What can be said about the carbohydrate intake for children?

It can vary for each child. Signup and view all the answers

The carbohydrate intake for a child should remain constant every day.

False Signup and view all the answers

Can a child’s carbohydrate intake vary, and if so, in what ways?

Yes, it can vary from child to child and even from day to day for the same child. Signup and view all the answers

The recommended carbohydrate intake for children can differ from _____ to day.

day Signup and view all the answers

Match the following statements about carbohydrate intake for children:

Recommended intake differs = Amount varies from child to child Daily variations = Can change day to day for the same child No single right amount = There is no fixed amount of carbohydrates recommended Signup and view all the answers

What is the primary purpose of measuring glycosylated hemoglobin (hemoglobin A1c)?

To identify the average plasma glucose concentration over prolonged periods Signup and view all the answers

Glycosylated hemoglobin is a result of an enzymatic reaction between glucose and hemoglobin.

False Signup and view all the answers

What does a high level of hemoglobin A1c indicate?

It indicates poorly controlled blood glucose levels over time. Signup and view all the answers

Glycosylated hemoglobin A1c provides information about plasma glucose concentration over a period of _____ months.

3 Signup and view all the answers

Match the following terms with their descriptions:

Hemoglobin A1c = Average plasma glucose over three months Glucose = A simple sugar that serves as energy Nonenzymatic reaction = Reaction not involving enzymes Plasma = The liquid component of blood Signup and view all the answers

Study Notes

Family Guidance During Adolescence

Accept adolescence as a human being
Respect adolescent ideas and dislikes
Allow increasing independence within safety limits
Respect adolescent privacy
Be available to answer questions, provide information, and communicate clearly

Diabetes Mellitus

Definition: Diabetes mellitus (DM) is an autoimmune disease leading to chronic metabolic disorders due to insufficient insulin. Abnormal metabolism of carbohydrates, proteins, and fats occurs.
Incidence: Affects approximately 1 in 500 children and adolescents.
Etiology: Most cases (95%) of type 1 diabetes result from environmental factors (viral infections, bacterial/viral mumps, chickenpox, cytomegalovirus, hepatitis, congenital rubella) and genetic factors (increased risk with father and both parents). beta cells destruction is also a major cause.
Pathophysiology: Insulin is vital for processing carbohydrates, fats, and proteins. It lowers blood glucose levels by enabling glucose entry into cells and promoting glycogen (carbohydrate storage) synthesis. Insulin also inhibits the release of stored glucose, breakdown of fat, and protein breakdown for glucose production.

Hyperglycemia

Causes: Infections, insulin under dosage in a diabetic child, trauma, and psychological disturbances.
Pathophysiology: High blood glucose causes protein/fat breakdown, prevents the body's use and storage of circulating glucose. Excess glucose exceeds the kidney's filtering ability, resulting in glycosuria (glucose in urine), polyuria (excessive urination), dehydration, and polydipsia (excessive thirst). Proteolysis (protein breakdown) contributes to polyphagia(increased hunger), abdominal pain, vomiting, and weight loss. Excessive fat breakdown leads to ketone bodies, ketoacidosis, and ketonuria. Blood glucose levels are critical to erythrocytes, kidney and brain function.

Symptoms of Hyperglycemia

Glycosuria (glucose in urine), polyuria (excessive urination), nocturia (night urination), polydipsia (excessive thirst), dehydration, Weight loss (although appetite may remain the same), excess ketone body formation (ketoacidosis), smell of ketones, metabolic acidosis, abdominal pain, vomiting, drowsiness, and coma.

Investigations (Hyperglycemia)

Fasting blood glucose >126 mg/dL
Two post-prandial readings >200 mg/dL
Urine glucose
Urine ketones
Random blood glucose levels above 200 mg/dL on two different occasions, when the child is not infected, not under stress, and is not fasting, along with classical symptoms.

Blood Glucose Test Methods (Hyperglycemia)

Glycosylated hemoglobin A1c (HbA1c): Measures average plasma glucose over 3 months.
Renal function tests: Typically not required if the child is otherwise healthy.
Oral glucose tolerance test (OGTT): Not necessary for diagnosing type 1 diabetes, involves a fasting blood sugar test followed by glucose administration and a glucose level check after 2 hours. Glucose levels (fasting / 2 hours after glucose ingestion) above 120mg/dL or 200 mg/dL indicate possible diabetes. However, mild elevations may not always result in diabetes diagnosis.
Lipid profiles: Usually abnormal at diagnosis due to increased circulating triglycerides.

Long-term Complications of Diabetes

Retinopathy
Cataracts
Hypertension
Progressive renal failure
Early coronary artery disease
Peripheral vascular disease
Neuropathy (peripheral and autonomic)
Increased risk of infection

Diabetes Management

Nutritional therapy: Balanced diet high in carbohydrates and fiber, low in fat (55-60% carbohydrates, 25% fats, 15-20% protein)
Insulin therapy: Various types of insulin (short-acting, intermediate-acting, long-acting) available with different mixing ratios depending on needs.
Exercise adjustments: Encourage physical activity for improved glucose metabolism, mental and cardiovascular function.
Psychological aspects: Support and education for the child and family.

Aim of Dietary Management

Maintain normal growth, healthy weight, and overall health.
Balance food intake with insulin and activity to maintain blood glucose as close to reference ranges as possible to avoid extreme hyperglycemia and hypoglycemia.
Intake of complex carbohydrates, such as cereals, before bedtime to avoid nocturnal hypoglycemia.

Infection Prevention

Frequent skin care, good observation
Clean wounds with water and antiseptic solution, avoiding sticky adhesives
Foot care (daily cleaning, trimming nails)
Wear suitable clothes and shoes to protect from infection, avoid tight socks
Regular dental care and check-ups

Crisis Management (Hypoglycemia)

Symptoms occur suddenly and can be mild (blood glucose 40-50 mg/dL), moderate (blood glucose 20-40), or severe (blood glucose <20 mg/dL).
Causes: Delayed/missed meals, excess exercise, excessive insulin dosage.
First aid: Mild- give food or candy; Moderate- 3 teaspoons of sugar with a cup of water ; Severe- hospitalization/ medical treatment required

Crisis Management (Diabetic Ketoacidosis)

Cause: Infection, missed insulin doses, emotional stress.
Symptoms: Thirst, vomiting, stomach upset, increased urination, weight loss, dehydration, rapid breathing, confusion, and disorientation.
Treatment: Needs medical attention.

Accident Prevention

Factors related to the child, mother, and environment.
Child- curiosity, lack of experience, short memory span, poor attention.
Mother- ability to supervise, carelessness.
Environment- furniture arrangements, sharp objects, hazardous materials.

Prevention of Choking

Choose age-appropriate toys; avoid toys with detachable small parts.
Ensure small objects are out of reach of children
supervise children eating

Prevention of Burns/Scalds

Ensure that food and drink is at appropriate temperatures to avoid burns when feeding a child.
Install safety gates in kitchens, and ensure adults take care not to hold hot drinks and children simultaneously.
Ensure all hot objects are kept at a safe distance from the child and not near the edge of a table to avoid accidental scalds.

Prevention of Poisonings

Keep medications/chemicals securely stored in designated, closed, cabinet.
Label containers with clearly understandable names/information.
Never use sweets or similar terms to describe medication
Avoid use of tablecloths
Warn children to never play with fire

Exercise in Diabetes

Diabetic patients can participate in daily physical activity.
Exercise improves glucose metabolism and can enhance mental and cardiovascular function.
Exercise can lead to hypoglycemia (low blood sugar) so blood glucose levels need monitoring before, during, and after exercise

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Description

Explore the critical aspects of family guidance during adolescence and gain an understanding of diabetes mellitus. This quiz covers strategies for supporting adolescents and the key details of diabetes, including its etiology and impact. Learn how to balance independence and safety while considering the health implications of diabetes.