Essential Information:Check blood glucose level.If blood glucose is below 70 mg/dL, rapidly give one of the following sources of carbohydrates (about 10–15 grams each), in the right amount to treat hypoglycemia:½ to ¾ cup of orange or grape juice (a juice box is good when one is away from home)2 glucose tablets or 2 doses of glucose gel2–4 pieces of hard candyGumdrops1–2 tablespoons of honey1 small box of raisins6 oz regular (not diet) soda (about half a can)2 tablespoons of cake icingRecheck blood glucose in 15 minutes. If reading is still below 70 mg/dL, then:Give another glass of juice, etc.Recheck blood glucose again after another 15 minutes.When blood glucose returns to at least 80 mg/dL, a more substantial snack (non-concentrated sugar) may be given (i.e., cheese and crackers, bread and peanut butter, etc.) if the next meal is more than 30 minutes away or if a physical activity/exercise is planned.If the child is unconscious, glucagon should be given either subcutaneously or intramuscularly (ADA, 2017a,b).Safety Note:If the child is conscious, a 4-oz glass of orange juice will help increase blood sugar levels. When a childis severely hypoglycemic and unable to take glucose tablets by mouth due to confusion or loss ofconsciousness, a dose of glucagon must be given IM or IV. In most cases the drug is administered IM inthe home or school setting to reverse the effects of severe hypoglycemia. The recommended dose toadminister for children <20 kg is 0.5 mg and for children >20 kg is 1.0 mg. Doses may be repeated in 15minutes if needed.Source: Ward, S. L., & Hisley, S. M. (2015).Maternal-child nursing care: Optimizing outcomes for mothers, children, & families>(2nd ed.). Philadelphia: F.A. Davis.TYPE 2 DIABETES MELLITUS
Type 2 diabetes mellitus (T2DM) occurs when the body becomes resistant to insulin production from thepancreas. T2DM is also termed “adult-onset” diabetes; however, pediatric obesity has led to a sharp increase intype 2 diabetes among children and adolescents. Risk factors for the development of T2DM are obesity,sedentary lifestyle, family history of diabetes, and poor dietary intake (especially high-carbohydrate, simple-sugar foods). Children with T2DM usually have no symptoms, and the condition is diagnosed with routinewell-check visits. Any child with a BMI more than the 85th percentile for weight and age should be monitoredfor early signs of T2DM, because obesity is a key predisposing factor, followed by hypertension and highcholesterol levels.AssessmentThe following measures are used to assess for T2DM among pediatric patients.Clinical PresentationThe initial symptom will be an elevated blood glucose level or complications such as DKA.Acanthosis nigricans (dark pigmented areas of the skin on the back of the neck, axilla, and arms) is evidence of insulin resistance.