AR: PEDIATRIC

DIABETES AND T2DM

Sydnie Leroy Case Study Presentation

Patient Information
Female, 9 years old
3rd grade student (full-time)

52, 140 pounds, BMI 36.4

Above the 99th percentile on CDC BMI
for age growth charts

African-American Ethnicity
Lives with mother, grandparents, 3
siblings (sisters ages 14, 12, and
brother age 10)

Medical History: full-term infant with a

birth weight of 10lbs 4oz, 20 in
length
75th-90th percentile for height
Above 98th percentile for weight

Frequent ear infections as

infant/toddler
Mother had GDM during pregnancy
Mother and grandmother both T2DM
Grandfather has hypertension and
high cholesterol

 Etiology- higher energy intake than energy expenditure over

time
Health consequences of Obesity
Premature death
300,000 deaths attributed to obesity

Pediatric
Obesity

Heart Disease
High blood pressure twice as common
Incidence of heart disease increased with obesity

Diabetes
Over 80% of people with type 2 diabetes are overweight/obese

Cancer
Increased risk of cancer including endometrial, colon, gallbladder, prostate,
kidney, and postmenopausal breast cancer

Breathing problems
Sleep apnea and asthma

Arthritis
Reproductive complications
Increased risk of both fetal and maternal death, more likely to have GDM
and birth complications, birth defects, irregular menstrual cycles and
infertility

Rates are rising

significantly.
About 1/3 of the
population in US under
age 18 is now obese
Children who are obese
are more likely to
become obese adults
Long-term health
consequences
Costs

 Type 2 Diabetes Mellitus develops from a combination of insulin

resistance and abnormal insulin secretion
patient still creates insulin, cells become insulin resistant,
cannot uptake the glucose from the blood stream.
signals the pancreas to produce even more insulin

Type 2
Diabetes
Mellitus

Type 2 diabetes can be managed through diet and exercise if

intervention is early enough
Complications lead to decraesed quality of life and premature
death
Factors that increase the risk of T2DM include
overweight/obesity,
sex (with females at a higher risk)
family history
history of gestational diabetes
impaired glucose metabolism
physical inactivity

Accounts for 90-95% of

the cases of Diabetes

T2DM in children used to

account for less than 3%
of Type 2 cases, now
accounts for about 45%

REF RANGE

8/3 0800

8/4 0940

CHEMISTRY

Sodium

136-147

137

Potassium

3.5-5.5

4.1

Glucose

70-110

171

155

Calcium

9-11

9.2

Protein (total)

6-8

6.9

High Blood glucose

Albumin

3.5-5

4.2

High Cholesterol

Prealbumin

16-35

22

High triglycerides

cholesterol

<170

210

High HbA1c

Triglycerides

<150

175

HbA1c

3.9-5.2

6.9

EAG

__

151

c-peptide

.51-2.72

2.75

Urinalysis

Protein

negative

trace

glucose

negative

positive

Prot Chk

negative

positive

Laboratory
Findings

High C-peptide
Trace protein in urine
Glucose in urine
*all are indicative of
diabetes

Dietary Recall
Breakfast- 1 cup fruit punch or Kool-Aid, 2 cups frosted flakes with whole milk
Midmorning snack- 2 slices of toast with butter and jam
Lunch- 2 peanut butter, mayo and banana sandwiches each with 2 Tbs peanut
butter, 1 Tbs mayo, banana plus some potato chips, fruit punch
Other snacks- 2 small bags of Cheetos, multiple chocolate chip cookies, 2 popsicles,
multiple glasses of fruit punch
Dinner- fried pork chop, greens, cornbread with butter, potatoes, ice tea made with
sugar
Bedtime snack- pizza rolls and a coke
Snacks regularly include cookies, candies, chips, crackers, popsicles, fruit punch

Nutrition Care Process

Lack of Nutrition related knowledge related to diabetes as evidenced by poor food
choices as reported in the dietary recall
Intervention would be nutrition education
Imperative to include the entire family based on the fact that AR does not make most of the
dietary decisions for herself.
GOAL- increase knowledge for AR and for family. Demonstrate ability to plan a consistent
carbohydrate diet and ability to make healthier food choices

Nutrition Care Process

Excessive oral intake related to
overeating as evidenced by dietary
recall showing overall calorie
consumption of 250% recommended
calories.
decreased energy or calorie resticted
diet, in order for the patient to get
closer to consuming the appropriate
number of kilocalories per day

Inconsistent carbohydrate intake

related to poor diet choices as
evidenced by consumption of 222%
more carbohydrates than
recommended
Goals- develop a consistent
carbohydrate diet and reduce the
overall amount of carbohydrates in
her diet to within recommended
range of 191 to 276g.