Childhood diabetes

Question 1

What are the symptoms of straightforward diabetic ketoacidosis (DKA).

Answer 1

• Ill appearance, rapid breathing, nausea/vomiting/belly pain, dehydration
• Hyperglycemia, ketones in blood/urine, acidosis (low pH and HCO3-)
• History of weight loss and polyuria/polydipsia

Question 2

Describe the major metabolic disturbances in DKA:

Answer 2

• Elevated blood sugar (hyperglycemia) (>200 mg/dL)
• Acidosis (low pH and HCO3-)
• Potassium derangements (may be high or low – typically normal to elevated blood levels early on, but risk of falling off potassium levels during treatment)
• Dehydration

Question 3

Describe the stimulus for insulin release.

Answer 3

Glucose enters the beta cells of the pancreas -> increased ATP/ADP ratio -> closes a channel to cause rising intracellular potassium -> increasing intracellular potassium depolarizes the membrane -> calcium ions influx -> leads to insulin exocytosis

Question 4

Describe at least three target-site actions of insulin.

Answer 4

Liver- store glucose (as glycogen) and lipid, top lipid and glycogen breakdown
Muscle – store glucose and make protein
Adipose – store glucose and triglyceride (incorporated into chains of fats)

Question 5

Describe the risk for cerebral edema in DKA.

Answer 5

• Cerebral edema is the major cause of morbidity and mortality in DKA
• May be present even before treatment starts but some treatment factors can cause/exacerbate it:
• Rapid drops in glucose and sodium from too much or too hypotonic IV fluid
• Presents with mental status changes, headache, Cushing’s triad, fixed/dilated pupils
• Treatment is to raise the osmolality of the blood