CASE 6 - Mother Of 10yo F Recently Diagnosed With DM

Question 1

Doctor, I have no history of diabetes in my family. Why is this happening to my daughter?

Answer 1

1. Your daughter probably had a genetic tendency to develop diabetes. Then certain unknown environmental factors led her to get full-blown diabetes.
2. Your daughter may have either type 1 or type 2 diabetes. In type 1 diabetes, the immune system attacks the pancreas and destroys the cells that are responsible for making insulin.
3. Since insulin regulates and maintains blood sugar, an insulin deficiency will lead to high levels of blood sugar.
4. On the other hand, if your child is overweight and is not physically active, she may have type 2 diabetes, which is a combination of insulin deficiency and resistance to the action of insulin resulting from being overweight.
5. In either case, it is not necessary to have a family history of diabetes.
6. With regard to sweets being the cause of your daughter’s diabetes, this is a myth.
7. In fact, your daughter can still eat sweets, but in moderation. She will need to see a dietician to develop healthy meal plans as well as to learn to recognize which foods contain carbohydrates and how much.

Question 2

Specific questions to ask:

Answer 2

1. Type — onset — presenting Sx at time of Dx.
2. Effect on child — depression/irritability.
3. Effect on parents.
4. Site of injection — insulin injector — compliance.
5. Schedule of insulin.
6. Measuring glucose at home.
7. Ranges of blood glucose readings.
8. Recent level of blood glucose.
9. Hypoglycemia.
10. Abnl thirst or extreme hunger.
11. Urination.

Question 3

Sample closure:

Answer 3

1. Mrs. Johnson, I can understand how you have felt since your daughter was diagnosed with diabetes. Diabetes may alter the dynamics of the entire family and affects everyone, so your life is going to be a little different now.
2. We can manage this disease very well through a combination of insulin, a balanced diet, and regular exercise.
3. First of all, you should understand the disease and know how to manage it. You will need to attend diabetes classes with your daughter.
4. Second, everyone in your family, including your daughter, should learn to recognize sign of low glucose levels, such as confusion, disorientation, or fainting, and should know how to provide appropriate care.
5. Your daughter should always carry a snack or juices as an “emergency kit”. Her teachers and friends should also be aware of her disease.
6. I hope you understood what we discussed today.

DYHAQFM

Question 4

DDx 1 — DM I:

Answer 4

1. Polyuria, polidipsia.
2. Recent weight loss.
3. Hyperglycemia.

Question 5

DDx 2 — DM 2:

Answer 5

1. Polyuria, polydipsia.
2. Obesity.
3. Hyperglycemia.

Question 6

DDx 3 — 2o causes of DM (Cushing):

Answer 6

1. Obesity.

Question 7

Workup:

Answer 7

1. Insulin + C peptide levels.
2. Islet cell abs.
3. HbA1C.
4. Electrolytes, glucose.
5. UA and urine microalbumin.
6. 24h urine free cortisol.

Question 8

Forgot to ask:

Answer 8

1. Effect on child — depression — irritability.
2. Effect on parents.
3. Urination — thirst right now.
4. Patient’s weight and height.
5. Infections of skin or gums.
6. Itchy skin.
7. LoC while playing.
8. Hypoglycemia specifically.

Question 9

Forgot in the workup:

Answer 9

1. Islet cell abs.
2. Insulin and c-peptide.
3. UA and microalbumin.
4. 24h free cortisol.