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Paediatrics > Diabetes > Flashcards

Diabetes Flashcards

1
Q

What are the types of DM

A 
Type 1 = 99% 
Type 2 
MODY 
CF RD
Neonatal - transient or permanent
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2
Q

What is the aetiology of type 1

A

Genetics - usually FH
Trigger / environment - vit D?
Autoimmune destruction of beta cells
Can still have type 1 if obese but more likely type 2

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3
Q

How much destruction till symptomatic

A

90%

Possible role of detecting Ab before destroyed?

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4
Q

How does DM present

A 
Polyuria
Polydipsia
New onset nocturnal enuresis = red flag 
Fatigue
Weight loss 
\+- recurrent infection 
25% present in DKA
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5
Q

How does DM present in <5

A 
Heavier nappy
Blurred vision
Oral / vulval candidiasis
Constipation
Skin infection
Behaviour change
Irritable
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6
Q

How do you Dx DM

A

THINK, TEST, TELEPHONE TODAY

Test = finger prick capillary >11.1mol

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7
Q

What are other tests but don’t wait to get back to refer

A

Fasting BG >7
Venous BG increased on 2 occasions
OGTT - rare
Check AB - GAD +Ve if present = 100% type 1
Screen other autoimmune - TFT / coeliac - anti-TTG
FBC + U+E + formal lab glucose
HbA1c

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8
Q

How do you Rx new diagnosis of DM

A

Admit to hospital to start insulin and education

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9
Q

What education needs to be given

A 
Life-long 
BG testing 4x daily 
Injection technique 
Insulin regimen
Diet / carb counting
High low sugars
Sick day rules
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10
Q

What is sick day rule

A

Continue insulin when sick as liver produces glucose and insulin resistant when ill

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11
Q

What insulin regimen most popular

A 
Basal bolus 
1x LA
3x RA before meals
Need to work out insulin to carb ratio by carb counting
Correction doses if too high
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12
Q

What is new way to manage DM

A

Pump therapy

Programmed basal rate + bolus through the day

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13
Q

What is HbA1c

A

Glycoslated Hb
Shows control over 3 months as RBC 120 day life span
Aim <48 (NICE) or 58

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14
Q

What are symptoms with hypoglycaemia <4

A 
Dizzy
Weakness
Blurred vision
Sweating
Increased HR 
Anxious 
Headache
Hungry
Irritable
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15
Q

How do you Rx hypoglycaemia

A 
Fast acting sugar - tablets/ drink
Recheck after 10 min
Repeat if <4
If >10 give extra carb depending on weight
Glucogel if unable to swallow
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16
Q

How do you treat severe hypo e.g. unconscious / seizure

A 
IM glucagon to mobilise hepatic glucose
999
IV dextrose  
If low / still no return = IV steroid 
If normal BG but no return may be in post-octal state from seizure
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17
Q

What is hyperglycaemia

A

> 11

18
Q

What is important in hyperglycaemia

A

Teach sick day rules
Test ketones
Avoid DKA

19
Q

What are the symptoms of hyperglycaemia

A 
Same as Dx
Blurry
Drowsy
Dry skin
Hungry
20
Q

What causes DKA

A

Insulin omission leads to increased glucose, osmotic diuresis, increased FA and ketones
Poor compliance
Increased demand - illness / trauma

21
Q

What are symptoms of DKA

A 
N+V
Abdo pain
Sweet ketotic breath 
Dehydration
Kausmaul resp - rapid + deep
Drowsy
Coma 
Shock - RR, HR, cold periphery but with no focal chest/ abdominal reason
22
Q

What is the biochemical triad of DKA

A

Hyperglycaemia
Ketones > 1 in blood or urine
Acidosis - mild = 7.3, severe = 7.1, HCO3 <15

23
Q

What is the algorithm for hyperglycaemia

A

If BG >17 check ketones
If not elevated - keep rechecking till BG settles
If up give extra dose of RA insulin, repeat after 4 hours and if not improving = 999

24
Q

When do you call 999 instantly

A 
SYmptomatic
Vomiting 4 hours
Heavy rapid breathing
Abdominal pain
Dehydration
25
Q

What should you remember with DM

A

Never stop insulin

Extra doses insulin + regular carb even if BG high

26
Q

How do you Dx DKA

A

Beside glucose + ketone
Capillary gas
Urine dip

27
Q

What is Ddx for DKA

A

Sespsi
Cardiac
Respiratory infection / TB

28
Q

How do you manage DKA

A 
ABCDE
Senior 
True coma rare so must exclude 
May also have sepsis 
Treat shock
29
Q

How do you treat DKA

A

If shock / decreased GCS / coma or vomiting

  • IV access +- 0.9% saline bolus (no K)
  • Caution as risk of cerebral oedema so only if shock

IV insulin 1 hour after IV fluid

  • 0.1 unit / kg / hrRA
  • Switches of ketogenesis

Maintenance

  • Over 48 hours
  • Calculare maintenace plus dehydration dose
  • K correction (KCL) + dextrose when BG falls <12
30
Q

How do you monitor DKA

A 
Monitor GCS as risk of cerebral oedema
Look for signs of dehydration 
Blood gas + U+E 4 hourly 
BG + ketones hourly
ECG 
Fluid inut 
Neuro obs 1 hour 
If headache / odd behaviour = REPOTT
Infection screen - may have no fever
31
Q

What are the symptoms of cerebral oedema

A 
Headache = beware if this 
Vomit
Irritable
Decreased conscious 
Raised ICP
Focal neuro
Decreased HR
Increased BP
32
Q

What is the treatment of cerebral oedema

A 
Senior
Exclude hypo
Mannitol 1g/kg IB 
Elevate head
Restrict IV fluid 
CT 
PICU
33
Q

What is important in the Hx

A

FH autoimmune / symptoms of DM when Dx

Drinking - amount, type of fluid, timing, nocturnal?

Micturition - how often, how much, nocturnal, wetting?

Assocatied Sx - weight loss, FTT, lethargy, N+V, abdominal pain, irritable, fever, vision, coordination

34
Q

What is nocturnal enuresis

A

Involuntary discharge ofurine in the absence of acquired defects of nervous / urinary system
Primary - never continent
Secondary - had been content for 6 months
Majority reach continence by age 4
Abnormal if not by 5

35
Q

What could be the underlying cause

A 
Overactive bladder
Constipated
DM
UTI
Abuse
36
Q

How do you treat / primary

A

Advise fluid / toilet
Reward system - for toiling before bed
Enuresis alarm <7
Desmopressiin >7 or failed alam (synthetic ADH)

37
Q

What is the most common reason for polydipsia / uria

A 
Habitual drinking 
Usually toddler 
Amount passed = amount drank 
Must exclude DM + URI
Morning urine osmolarity may help
38
Q

How do you treat habitual drinking

A

Offer only water
Limit milk to 500ml
Decreased flavoured drinks + sugar

39
Q

What are most rarer reasons

A

Central diabetes inspidus

Nephrogenic DI

40
Q

What is mild acidosis

A

7.3

41
Q

Moderate acidosis

A

7.2

42
Q

Severe acidosis

A

7.1

HCO3 <15

Paediatrics (35 decks)

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