Diabetes

Question 1

Diabetes Mellitus in children: What is the antibody marker?

Answer 1

Antibody marker : Glutamic Acid Decarboxylase (GAD) antibodies

Question 2

Diabetes Mellitus in children: Early and late symptoms

Answer 2

Early symptoms: The earliest symptom is nocturia. Polyuria, polydipsia, weight loss, bed wetting, fungal infections, tiredness
• Late symptoms: diabetic ketoacidosis (DKA)
Vomiting, dehydration, abdominal pain, kussmaul breathing,
drowsiness, and shock are features of DKAKetotic breath

Question 3

Diabetes Mellitus in children: a child has a random BM of 25. What will you do now?

Answer 3

• A raised blood sugar in a child requires urgent attention and is a same day referral to the paediatric team
• Children can start on basal bolus or insulin pump therapy
• Buttocks and thighs are used for basal insulin; arms and abdomen are used for rapid acting insulin

Question 4

The Paediatric Diabetes team consists of:

Answer 4

• Consultant Paediatrician with a special interest in diabetes • Paediatric Diabetes Specialist Nurse
• Paediatric dietician
• Clinical Psychologist
• Adult transition teams
• Parent support groups work closely with the diabetes team

Question 5

Paediatric Diabetes: What checks/ tests are done in the out patient clinic?

Answer 5

• Children have their height and weight measured and plotted in clinic
• HbA1c is done at every clinic visit
• Smart meter, pump/ handset, CGM is downloaded to review
data
• Injection sites are checked
• Children and their parents meet the different members of the team who then explore their knowledge and understanding
• Trouble shooting: psychosocial aspects, exercise, hypos

Question 6

Paediatric Diabetes: At annual review the following are done

Answer 6

• Blood tests: TFT, coeliac screen, lipid profile
• Urine for microalbuminuria if > 12 years
• Retinopathy screen if > 12 years
• BP if > 12 years
• Feet are examined
• Flu vaccine reminder
• Reflexes and vibration sense

Question 7

Paediatric Diabetes: challenges at school

Answer 7

• The psychological impact, she may feel different from her peers • Her teachers may not understand her condition
• Hypos at school
• Carbohydrate counting for school dinners
• School trips
• Injections at school
• School discos, sweets and parties
• PE and exercise

Question 8

Paediatric Diabetes: challenges transitioning to adolescence

Answer 8

• Biological factors: Growth spurt and increasing insulin requirements
• Psychological factors: low self esteem, disordered eating
• Social factors: Feel different to peer group, fear of hypos, increased risk from alcohol, smoking and recreational drugs, conflict within families, vocational plans