Diabetes

Question 1

Define type 1 diabetes

Answer 1

Autoimmune cytotoxic t-cell destruction pancreatic beta cells leading to reduced insulin production

Question 2

Risk factors

Answer 2

Family history and genetic factors

Also associated with other autoimmune diseases such as pernicious anaemia vitiligo thyroid disease and Addison’s

Question 3

What is the peak age of onset? - 2 options

Answer 3

5 to 7 years old

Just before or after the onset of puberty especially during winter

Question 4

Typical presentation

Urine
Energy
Water
Weight
Growth
Ketones

Answer 4

Several weeks of polyuria
Lethargy
Polydipsia
Weight loss +/-  infection
Poor growth
Ketosis

Question 5

Diagnosis

Answer 5

Signs of hyperglycaemia with increased venous blood glucose >11.1 mmol/L(random)/>7 (fasting)

Check autoantibodies - islet-cell autoantibody, anti-insulin antibody etc.

Also screen for autoimmune diseases

Question 6

Treatment

Who provides 24-hour access and who should be involved?

Rx

Meds

Answer 6

Paediatrics diabetic care team

Paediatric endocrinologist

Start insulin
Daily doses with rapid and long acting doses.
Continuous subcutaneous insulin injections might also be needed.

Question 7

Diet - who should be involved?

Answer 7

Paediatric dietician

Question 8

Type 2 DM - who is more at risk?

Answer 8

Asian ethnicity

Question 9

What other things should a newly diagnosed child and his or her family know?
Glucose

Insulin 
Diet
Glucose 
Signs of too much insulin?
etc.

Answer 9

Doses, practise self-injecting skills on oranges

What? When? Why important? What do you do if the child is hungry?

Can blood glucose be monitored accurately? Watch the carers technique.
What should they do if it is not well controlled? Do they know what well controlled mean?

Weakness
Hunger 
Bolshy 
Faintness
Sweating 
Abdo pain 
Vomiting 
Fits 
Coma

Question 10

What does MODY stand for?

What causes MODY?

How many types of MODY’s are there?

Answer 10

Maturity onset diabetes of the young

MODY is caused by a single gene defect whereas Type 1/2 DM are caused by polygenetic and environmental causes.

1-6

Question 11

Hypoglycaemia

Management

• Oral meds
• IV meds
• IM
• What if first aid and no meds around?

Answer 11

Oral glucose - tablets/drinks
Intra-oral glucogel

IV dextrose
Glucagon slowly over IV

Glucagon

Sublingual kitchen sugar