Pancreatic disorders in the newborn.

Except for the hyperinsulinism associated with the infant of a diabetic mother (accounting for about 5 percent of NICU admissions annually), pancreatic disorders of the newborn are rare. Congenital anomalies (such as annular pancreas) and endocrine disorders (such as hyperinsulinism of nesidioblastosis or hyperglycemia of neonatal diabetes mellitus) present many challenges to the personnel caring for these infants and their families. The potential mortality and morbidity of these disorders make it imperative for nurses and nurse practitioners working with infants to recognize and understand pancreatic dysfunction so that appropriate and timely intervention can prevent complications of brain injury and developmental delay. The home care needs of these infants and the extensive teaching needs of their parents require skilled nursing care to ensure a safe discharge.

Hyperinsulinemia and cardiovascular risk.

Tissue insulin resistance and compensatory hyperinsulinemia cause early atherosclerosis and an increased cardiovascular risk for the non-insulin dependent diabetic individual. Evidence now indicates that a large and likely unrecognized number of individuals are insulin resistant and hyperinsulinemic and therefore share this risk. Ongoing investigation of this phenomenon may produce changes in the methods for earlier identification of these individuals and in the treatment of obesity, diabetes, and cardiovascular disease and may expand the areas in which nursing intervention can alter outcome.

Assessment of patients with acanthosis nigricans skin lesion for hyperinsulinemia, insulin resistance and diabetes risk.

Acanthosis nigricans is a skin lesion characterized by thickening and apparent darkening of the keratin layer of the skin, usually on the neck and axillae. Recent studies reveal that this disorder is directly associated with hyperinsulinemia. A major implication of hyperinsulinemia is insulin resistance--a primary factor in the development of type II diabetes mellitus. Prolonged hypersecretion of insulin presumably leads to pancreatic exhaustion and subsequent glucose intolerance that can progress to type II diabetes. Prospective studies of individuals with acanthosis nigricans have shown very high prevalence rates of type II diabetes. Prevalence studies among adolescents have shown that the lesion appears early in life and is a common finding in some ethnic groups. These data suggest that acanthosis nigricans is an easily detected empirical marker for elevated risk of type II diabetes. The lesion can appear long before the onset of glucose intolerance. Thus, including acanthosis nigricans screening in a comprehensive disease-prevention program can help identify people at risk for type II diabetes prior to the actual onset of glucose intolerance, as well as individuals with undiagnosed diabetes. Interventions that reduce insulin resistance include weight loss and regular physical activity.