[35] Diabetes Mellitus Flashcards
How many children and young people under 19 are there with diabetes in the UK?
About 30,500
Of what type is most childhood diabetes?
Type 1
What happens in type 1 diabetes?
There is destruction of pancreatic ß-cells by an autoimmune process
What plays a role in the development of type 1 diabetes?
- Genetic predisposition
- Environmental precipitants
What environmental triggers might contribute to the development of diabetes?
- Enteroviral infections
- Diet
- Over nutrition
How do environmental triggers contribute to the development of diabetes?
Molecular mimicry probably occurs between an environmental trigger and an antigen on the surface of the ß-cells of the pancreas
What is the result of molecular mimcry between an environmental trigger and an antigen on the surface of the ß-cell of the pancreas?
In genetically predisposed individuals, this results in an autoimmune process which damages pancreatic ß-cells and leads to increasing insulin deficiency
What is type 2 diabetes caused by?
Insulin resistance, followed later by ß-cell failure
Who does type 2 diabetes usually occur in?
Older children
What is type 2 diabetes related to?
Obesity
Other than type 1/2 of diabetes, what are the other causes of hyperglycaemia?
- Maturity onset diabetes of the young
- Drugs
- Pancreatic insufficiency
- Endocrine disorders
- Genetic/chromosomal syndromes
- Neonatal diabetes
What is maturity onset diabetes of the young caused by?
Genetic defects in ß-cell function
Give an example of a drug that can cause hyperglycaemia
Corticosteoids
Give 2 examples of causes of pancreatic insufficiency leading to hyperglycaemia?
- CF
- Iron overload in thalassaemia
Give an example of an endocrine disorder that can led to hyperglycaemia?
Cushing’s syndrome
Is neonatal diabetes transient or permanent?
Can be either
What is neonatal diabetes secondary to?
Defective ß cell function
What are the risk factors for diabetes?
- Family history
- Other autoimmune disorders in patient or family
What other autoimmune disorders are associated with diabetes?
- Hypothyroidism
- Addisons
- Coeliac
- RA
What are the early symptoms of diabetes?
- Polydipsia
- Polyuria
- Weight loss
- Secondary enuresis
What are the less common early symptoms of diabetes?
Skin sepsis, candida, and other infections
How might diabetes present if it is not diagnosed and managed at an early stage?
Patient may present with diabetic ketoacidosis
How is a diagnosis of type 1 diabetes confirmed in a symptomatic child?
Finding of markedly raised random blood glucose (>11.1mmol/L)
What tests may be helpful in the diagnosis of diabetes if there is any uncertainty?
- Fasting blood glucose (>7mmol/L)
- Raised glycosylated haemoglobin
What are the differential diagnoses for diabetes?
- Diabetes insipidus
- Hyperthyroidism
- Pheochromocytoma
- Psychogenic polydipsia
- Transient hyperglycaemia with illness and other stress
What will the initial management of diabetes depend on?
The child’s condition
What will children presenting with diabetic ketoacidosis require?
Urgent hospital admission
Are most children newly presenting with diabetes alert and able to drink?
Yes
What is the result of most newly presenting children with diabetes being alert and able to drink?
They can therefore be managed with SC insulin alone
What education is given in new diagnoses of diabetes?
An intensive education programme for the parent and child
What does the education programme for new diagnoses of diabetes cover?
- Basic understanding of pathophysiology of diabetes
- Insulin injection technique and sites
- Blood glucose (finger prick) monitoring to allow for insulin adjustment when unwell
- Healthy diet and carbohydrate monitoring
- Sick day rules during illness to prevent ketoacidosis
- Encouragement to exercise regularly, with adjustments of insulin and diet for exercise
- Recognition and treatment of hypoglycaemia
- Where to get advice 24 hours a day
- Help from available voluntary groups
- Psychological impact of a lifelong condition
What is it important to remember when educating a child about their diabetes?
The information provided for the child must be appropriate for their age
What do children with type 1 diabetes require for their management?
Insulin
What insulin regimes are most children with type 1 diabetes started on?
Continuous subcutaneous insulin pump, or multiple daily injection regime
What does a multiple daily injection regime involve in children with type 1 diabetes?
Rapid acting insulin given as bolus before each meal, and a long-acting insulin in the late evening and/or before breakfast to provide background insulin
Give two examples of rapid-acting insulins
- Lispro
- Insulin Aspart
Give an example of a short acting insulin
Glargine
