Diabetes Flashcards
What are the 3 most common chronic disease of childhood?
- Asthma
- CP
- DM
What is the classic triad of Sx seen in DM?
- Polydipsia
- Polyuria
- WL
What are the less common Sx of DM?
- Secondary enuresis
- Skin spesis
- Candida - think in children who present with oral candida/balinitis
What are the signs of DKA in a child?
- Ketones on breath
- Vomiting, leading to dehydration (+/- hypovolaemia)
- Abdominal pain
- Kussmaul breathing (hyperventilation due to acidosis)
- Drowsiness/reduced consciousness/coma
How is DM Dx in a child?
Random blood glucose >11.1mmol/L, glycosuria and ketosis
What is the standard dose of insulin at Dx?
0.5IU per kg, split across the day using the ‘multiple daily injection basal-bolus regimen’
What is the multiple daily injection basal-bolus regimen?
When there is at least 1 injection of intermediate or long acting insulin + short/rapid acting insulin before each meal
How may a dietitian help in the glucose control of a newly Dx DM child?
Offering level 3 carbohydrate-counting education
How many times a year will a child be seen by a diabetes consultant?
4x/year
How often should a child with T1DM have their blood glucose checked?
4x day - before each meal and before bed
What is the pre-prandial target for blood glucose in a child with T1DM?
4-7mmol/L
When does the ‘honeymoon period’ occur, and what does this mean?
4-6 weeks after Dx and onset of treatment
Insulin requirement will go down, does not mean they don’t have diabetes, happens to most children. At the end of the honeymoon period, insulin requirement will likely increase
What is the standard insulin dose for AFTER the ‘honeymoon period’?
1.0IU per kg
What is the standard insulin dose in adolescence?
1.5-2.0IU per kg - this should then be decreased down to 1.0IU per kg once growth has stopped to prevent weight gain
At what blood glucose level would additional carbohydrates be required before exercise?
When <7mmol/L
What tests should be performed immediately in ED when a child present with ?DKA?
- Cap blood glucose
- Cap blood ketones
- Cap/venous pH and bicarbonate
When is a child Dx as having DKA?
Acidosis (with blood pH<7.3 or plasma bicarb <18mmol/L) AND ketonaemia (>3mmol/L) OR ketonuria (>/= ++ on a urine dip)
When is a child Dx as having SEVERE DKA?
Blood pH<7.1
What are the facets of DKA management?
- FLUIDS
- INSULIN
- K+
What are the initial re-hydration/resuscitation fluids?
0.9% saline, 10ml/kg bolus
When should insulin be given in DKA?
Insulin infusion should be given after IV maintainance fluids have been running for 1 hour, and DO NOT GIVE BOLUS
At what dose should insulin be given in DKA?
0.1 units/kg per hour
When should insulin AND glucose be given?
When the blood glucose has fallen <14mmol/L, 5% glucose can be used with the maintenance infusion, alongside the insulin
When should K+ replacement start?
When maintenance fluids are started
What are the maintenance fluid recommendations?
0.9% saline with 40mmol/L KCL for first 12 hours
(5% glucose can be added when the blood glucose is <14mmol/L)
0.45% saline/5% glucose with 40mmol/L KCL after 12 hours (again only 5% glucose is blood glucose <14mmol/L)
What are the complications of DKA?
- Cerebral oedema
- Hypokalaemia
- VTE
What are the signs of a hypo?
- Hunger
- Poor concentration
- Sweating and shaking
- Pale
- Irritable
- Dizziness
- Confusion
- Blurred vision
- Palpitations
- Fatigue
How should a hypo at home be managed?
10-15mg of something sweet - e.g. 3-5 glucose tablets
Re-test after 15 mins, give more glucose if still low
Starchy snack once blood glucose at 4mmol/L
How should a severe hypo at home be managed?
IM glucagon or Glucogel
How should a severe hypo in hospital be managed>
10% IV glucose, max dose = 500mg/kg body weight
What is the dose of IM glucagon in a child <8y/o (or<25kg)?
500 micrograms glucagon
What is the dose of IM glucagon in a child >8y/o (or >/=25kg)?
1mg glucagon
What should be covered at 3/12 F/U appointments?
- Main parental/child concerns
- Any admission/DKA/hypos
- Still able to recognise hypos?
- Glucose monitor/diary check
- Diet?
- HbA1c check
- Injection site check
- Injection technique
- Self-relient?/becoming self-relient?
- Chronic disease checks - year thyroid from Dx. Yearly retinopathy; ACR; BP from 12y/o. Any problems with feet?
- Reminder eligible for flu vaccine
- Normal growth/development
- Absences from school/interfering with life/activity etc?
- Diabetes UK?
