Life Care Planning for Children with Diabetes

Contents Pathophysiology of Diabetes Mellitus ...................................................................................... 504

Type 1 Diabetes Mellitus .................................................................................................... 504 Insulin ’erapy .............................................................................................................. 505 Nutrition ’erapy .......................................................................................................... 505 Physical Activity ............................................................................................................. 506 Blood Glucose Monitoring ............................................................................................. 506 Other ’erapy ............................................................................................................... 507 Self-Management Training ............................................................................................. 507 Team Care ...................................................................................................................... 507

Type 2 Diabetes Mellitus .................................................................................................... 508 Lifestyle ’erapy ............................................................................................................ 508 Drug ’erapy for Type 2 Diabetes in Youth ................................................................... 509 Blood Glucose Monitoring ............................................................................................. 509

Diabetes Complications .......................................................................................................... 509 Acute Complications ...........................................................................................................510 Microvascular Complications ...............................................................................................510 Nephropathy .......................................................................................................................511 Neuropathy .........................................................................................................................511 Macrovascular Disease .........................................................................................................511 Psychosocial Complications .................................................................................................512

Life Care Planning Issues ..........................................................................................................512 Projected Evaluations ...........................................................................................................512

Conclusion ...............................................................................................................................514 Acknowledgment .....................................................................................................................514 References ................................................................................................................................514

Diabetes mellitus (DM) is a group of disorders that share the characteristics of hyperglycemia, absolute or relative deciency of insulin, and a spectrum of microvascular and macrovascular complications. None of the forms of DM are presently curable by routinely available treatments, though appropriate management can prolong health and freedom from complications among those a•ected. ’e transplantation of pancreatic tissue a•ects a cure for type 1 diabetes, but this approach requires immune suppression that excludes its use in otherwise healthy individuals. ’us, DM is a chronic disorder that requires lifelong daily management. Treatment strategies and technologies introduced in the past decade have substantially improved health outcomes and increased management costs. ’e disease’s multiple forms complicate life care planning for children with diabetes, as does the variable course of the disease and its costly complications, and the continuously evolving treatment methods. In this chapter, the authors will dene DM and its pathophysiology and describe its typical clinical course and potential complications. Following that, standard management strategies and life care planning issues for children with diabetes will be described.