Child Health - Diabetes

Question 1

what, in really basic terms, is the issue with not producing insulin?

Answer 1

without insulin, the cells of the body cant take glucose from the blood and use it for fuel
ie - when there is no insulin, the cells think there is no glucose in the blood and the body is being fasted
the cells cannot use the glucose so it stays in the blood and glucose levels keep increasing in the blood causing hyperglycaemia

Question 2

normal glucose level?

Answer 2

4.4 - 6.1 (more like 5.6 in real life though)

Question 3

where is insulin produced?

Answer 3

beta cells in islets of langerhans in the pancreas

Question 4

what type of hormone is insulin?

Answer 4

anabolic hormone (building hormone)

Question 5

how does insulin level change?

Answer 5

increases when blood sugars rise so rises after eating

Question 6

insulin reduces blood glucose levels via what 2 methods?

Answer 6

1. causes cells to absorb glucose from blood and use it as fuel
2. causes muscle and liver cells to absorb glucose from the blood and store it as glycogen

Question 7

where is glucagon produced?

Answer 7

alpha cells in islets of langerhans in the pancreas

Question 8

what type of hormone is glucagon?

Answer 8

catabolic hormone (breaks stuff down)

Question 9

what does glucagon do?

Answer 9

increases blood glucose levels by telling the liver to break down the stored glycogen into glucose (called glycogenolysis)
also tells liver to convert proteins and fats into glucose (called gluconeogenesis)

Question 10

when is glucagon released?

Answer 10

released in response to low blood glucose levels and stress

Question 11

when does ketogenesis occur?

Answer 11

when there is insufficient supply of glucose and glycogen stores are exhausted (eg in prolonged fasting)

Question 12

what happens in ketogenesis?

Answer 12

liver takes fatty acids and converts them into ketones which can be used as fuel
ketones cross the blood brain carrier and can be used by the brain

Question 13

is ketogenesis always dangerous?

Answer 13

no

normal and not harmful in healthy patients when under fasting conditions or on a very low carbohydrate, high fat diet

Question 14

main characteristic of people in ketosis?

Answer 14

acetone smell on breath

Question 15

how do most kids first present with diabetes?

Answer 15

25-50% present in DKA
other present with characteristic symptoms
- polyuria
- polydipsia 
- weight loss

Question 16

other less typical presentations of diabetes in kids?

Answer 16

secondary enuresis (new bedwetting in a previously normal child)
recurrent infections

Question 17

what bloods should be taken in a new diagnosis of type 1 diabetes to rule out other pathology?

Answer 17

baseline bloods (FBC, renal profile, lab glucose etc)
blood cultures (if suspected infection)
HbA1c
TFTs
thyroid peroxidase antibodies 
anti-TTG (coelic)
diabetes antibodies

Question 18

what antibodies are associated with type 1 diabetes?

Answer 18

insulin antibodies
anti-GAD
anti-islet cell

Question 19

what are the 4 components of long term management of type 1 diabetes?

Answer 19

sub-cut insulin regimes
monitoring daily carbohydrate intake
monitoring blood glucose on waking, at each meal and before bed
monitoring for and managing any complications

Question 20

most common insulin regime?

Answer 20

basal-bolus
- background long acting insulin given once a day + short acting insulin given 30 mins before carbohydrate intake
insulin can also be given via insulin pump

Question 21

what is the most common problem with injecting insulin into the same spot repeatedly?

Answer 21

lipodystrophy
- where sub-cut fat hardens and prevents normal absorption of insulin when further doses are injected into this area
(patients should therefore cycle their injection sites)

Question 22

example of long and short acting insulin?

Answer 22

long acting = lantus

short acting = actrapid

Question 23

short term complications of type 1 diabetes?

Answer 23

hypoglycaemia

hyperglycaemia (and DKA)

Question 24

how can hypoglycaemia occur in type 1 diabetes?

Answer 24

too much insulin
not enough carbs for insulin prescription
not processing the carbs properly (eg in malabsorption, diarrhoea, vomiting, sepsis etc)

Question 25

typical symptoms of hypoglycaemia?

Answer 25

hunger
tremor
sweating
irritability
dizziness
pallor
can lead to reduced consciousness, coma and death in severe cases if not treated

Question 26

basics of managing hypoglycaemia?

Answer 26

combination of rapid acting glucose and a slower acting carbohydrate to maintain blood sugar level when rapid acting glucose is used up

Question 27

options for treating hypoglycaemia in someone who is unconscious?

Answer 27

oral glucose not safe
IV dextrose
intramuscular glucagon (doesnt require a cannula)

Question 28

how can hyperglycaemia (not in DKA) be managed?

Answer 28

may need insulin dose to be increased
patient will get to know their own response to insulin and learn to administer an appropriate dose to keep glucose at good levels

Question 29

types of long term complications of type 1 diabetes?

Answer 29

macrovascular (CVD, stroke, hypertension etc)
microvascular (peripheral neuropathy, nephropathy, retinopathy)
infection related complications

Question 30

how do vascular problems develop in type 1 diabetes?

Answer 30

chronic exposure to hyperglycaemia causes damage to endothelial cells of blood vessels
this leads to leaky malfunctioning vessels that are unable to regenerate

Question 31

how does diabetes increase infection risk?

Answer 31

high glucose levels causes suppression of immune system

high sugar environment is also optimum conditions for organisms to grow

Question 32

how can type 1 diabetes be monitored?

Answer 32

HbA1c
capillary blood glucose
flash glucose monitoring

Question 33

how is HbA1c used?

Answer 33

measure of glycated haemoglobin which is how much glucose is attached to the haemoglobin molecules inside RBCs
reflects average blood glucose level over past 3 months (bc RBCs have a lifespan of around 3-4 months)

Question 34

how often is HbA1c measures?

Answer 34

every 3-6 months