NurseSavvy Cheat SheetDisease
Type 1 Diabetes in Children
Pathophysiology & Risk Factors
Autoimmune destruction of pancreatic beta cells produces absolute insulin deficiency. Unlike type 2 diabetes, it is not related to obesity or lifestyle. Without insulin, cells cannot use glucose, so the body catabolizes fat and protein — driving hyperglycemia, ketone production, and weight loss. Many children present at diagnosis already in diabetic ketoacidosis (DKA).
Signs & Symptoms
EarlyProgresses →
Polyuria Hallmark
Polydipsia Hallmark
Polyphagia Hallmark
Secondary enuresis
new bedwetting in a toilet-trained childUnexplained weight loss
despite eating moreLate / Severe
Fruity breath
ketosisKussmaul respirations
deep, rapid breathing to blow off CO2Lethargy
Vomiting
Diagnostics & Labs
Diagnostic
Blood glucose>300 mg/dL in DKA
Venous pH<7.30 in DKA
Serum bicarbonate<15 mEq/L in DKA
Urine ketones
Monitor
Serum potassium
guides K+ replacement timing during insulin dripInterventions & Priorities
IV fluid resuscitation first
0.9% NS 20 mL/kg bolus before insulinContinuous low-dose insulin drip
start after fluid bolus; ~0.1 units/kg/hrNever IV insulin bolus push
bolus risks fatal cerebral edema in childrenAdd dextrose to IV fluids
when glucose reaches 250-300 mg/dLStart potassium replacementK+ < 5.5 mEq/L
only after urine output confirmed; insulin shifts K+ intracellularlyMonitor neurologic status
earliest sign of cerebral edemaTreatments & Medications
Basal-bolus insulin regimen
or insulin pump for long-term controlInsulin-to-carbohydrate ratio
matches dose to carb intake; allows varied foodsGlucagon
IM for severe hypoglycemia when unconscious or unable to swallowAvoid routine sodium bicarbonate
rapid acidosis correction causes paradoxical CNS acidosis / cerebral edemaPatient Teaching
Never skip insulin
basal insulin required even when not eating or sickSick-day rules
continue insulin, monitor glucose and ketones, hydrateRule of 15 for hypoglycemia
15 g fast-acting carb, recheck in 15 minutesKeep fast-acting glucose accessible
juice or glucose tablets at home, school, outingsCheck glucose before and after exercise
activity lowers blood glucoseTrain school staff
recognize hypoglycemia, locate glucagon kitStore insulin temperature-controlled
degrades in a hot carDevelopmentally appropriate self-care
school-age child checks glucose and recognizes lows; adults supervise insulin dosingComplications
Hypoglycemia
most common acute complication of insulin treatmentDiabetic ketoacidosis
Cerebral edema
leading cause of pediatric DKA mortalityReport Nowescalate immediately
Treat low / rule of 15
Upper fasting target
300 · DKA range (>300)
Hypoglycemia
Target (fasting ~80-130)
Hyperglycemia
40
70
130
350
mg/dL
Kussmaul respirations
deep, rapid breathing — DKAFruity breath
ketoacidosisAltered level of consciousness
earliest sign of cerebral edema in DKAHypertension with bradycardia
Cushing's response — rising intracranial pressureHypoglycemia with unconsciousness
give IM glucagon, do not give oral carbsBlood glucose below 70 mg/dLglucose < 70 mg/dL
treat hypoglycemia immediatelyClinical Pearl
Fruity breath, fast (Kussmaul) breathing, and a formerly dry child now wetting the bed — think DKA until proven otherwise: fluid first, drip insulin second, watch the potassium, and never bolus insulin in a child.