diabetes and endocrinology Flashcards
what causes type 1 diabetes?
pancreatic B-cells being destroyed by autoimmune processes
what are the risk factors for type 2 diabetes in children?
- older children
- obese
- family history
- being Black or Asian
which drugs could lead to developing diabetes?
corticosteroids
which conditions could lead to developing diabetes? give 5
- CF
- thalassaemia (if there’s iron overload)
- Cushing syndrome (due to steroid production)
- Down syndrome
- Turner syndrome
which conditions is diabetes associated with in children? give 4
- hypothyroidism
- Addison disease
- coeliac disease
- FH of rheumatoid arthritis
presentation of type 1 diabetes?
- few weeks of symptoms
- polyuria
- polydipsia
- weight loss
- younger children might get secondary nocturnal enuresis
what skin change might develop in insulin resistance?where?
acanthosis nigricans (velvety dark patches with white lines), in axilla or on neck
how is type 1 diabetes diagnosed in children?
- random blood glucose > 11.1 mmol/L
- OR raised HbA1c >48 mmol/mol
- OGTT not usually used
how is type 2 diabetes diagnosed in children?
same as type 1 but look for risk factors:
- family history
- obese
- acanthosis nigricans
- skin tags
- PCOS phenotype in girls
dietary advice for a child with type 1 diabetes?
- same as non-diabetic
- 5 a day
- “carb counting” - lets parent estimate how much insulin is needed after each meal
why is it important to rotate insulin injection sites?
risk of lipohypertrophy or lipoatrophy (rarer)
what are the 2 insulin regimens used for most diabetic children?
- continuous subcutaneous insulin pump
- OR short-acting insulin injections pre-prandial and long-acting injection before bed
why is a high fibre diet preferred to refined carbs in diabetic children?
- fibre gives slow-release, sustained energy
- refined carbs cause rapid swings of glucose levels
which factors increase blood glucose?
- insufficient insulin
- any type of food but esp carbs
- illness
- menstruation
- growth hormone
- corticosteroids (hence Cushing gives DM)
- sex hormones at puberty
- stress
which factors decrease blood glucose?
- insulin
- exercise
- alcohol
- some drugs
- marked anxiety or excitement
- hot weather
what are the 2 acute complications of diabetes?
- hypoglycaemia
- DKA
symptoms of hypoglycaemic attack?
- hunger
- pallor
- tummy ache
- sweatiness
- faint/dizziness
- “wobbly” feeling in legs
how does hypoglycaemia progress untreated
coma then death
what is the treatment of:
a) mild hypoglycaemia?
b) severe hypoglycaemia?
a) easily absorbed glucose from a snack
b) glucagon injection
investigations in DKA?
- blood glucose >11.1 mmol/L
- blood ketones >3.0 mmol/L
- U+Es (raised creatinine)
- ECG monitor (changes in hypokalaemia)
- weight (shows level of dehydration)
5 steps of DKA management?
- fluids (saline and glucose)
- insulin
- potassium
- re-establish oral fluids, SC insulin + diet
- treat any underlying cause
what is the fluid rate needed to resuscitate a child in shock?
0.9% saline, 10ml/kg
which other two conditions get screened for in any child newly diagnosed with diabetes?
- thyroid function (checked annually)
- coeliac
why does insulin requirement go up as the child enters puberty?
GH, oestrogen and testosterone all counteract insulin
consequence of chronically poor diabetic control in childhood?
- growth delay
- delayed puberty
why is insulin dosage reduced towards the end of puberty for girls?
- prone to weight gain
- can become obese in this period
what is the target glucose in diabetics?
below 48mmol/mol
features of hypoglycaemia?
- sweating
- pallor
- irritability
- headache
- seizures (go on to develop epilepsy)
- coma
long-term neurological problems in diabetes?
- epilepsy
- learning difficulties
- microcephaly
commonest cause of hypoglycaemia?
insulin excess in diabetes
management of acute hypoglycaemia?
- ABCDE
- IV glucose, max 5ml/kg
causes of congenital hypothyroidism?
- maldescent of thyroid (commonest in UK) - remains as a linguinal mass
- iodine deficiency (commonest worldwide)
when is congenital hypothyroidism usually picked up?
- antenatal screening
- heel-prick test on day 5
signs of congenital hypothyroidism? there’s a LOT
- usually asymptomatic
- faltering growth
- feeding problems
- prolonged jaundice
- pale, cold, mottled, dry skin
- coarse facies
- large tongue
- hoarse cry
- goitre
- umbilical hernia
- delayed development
signs of acquired hypothyroidism?
- F>M
- short stature
- learning difficulties
- same signs as adult hypothyroidism
main cause of acquired hypothyroidism?
autoimmune thyroiditis
risk factors of acquired hypothyroidism?
- Down syndrome
- Turner syndrome
pathophysiology of congenital adrenal hyperplasia?
- adrenal failure
- no cortisol + aldosterone secretion
- low Na, high K
- excess ACTH secreted
- overproduction of androgens from adrenals
features of congenital adrenal hyperplasia?
- virilisation of external genitalia in females (hypertrophied clit, fused labia)
- in male, enlarged penis, pigmented scrotum
- salt-losing adrenal crisis at 1-3 weeks (vomiting and weight loss)
- tall stature in both sexes
- muscular build
- adult body odour
- pubic hair and acne
key blood result in diagnosis of congenital adrenal hyperplasia?
raised 17-alpha-hydroxy-progesterone
other than the raised hormone, what else is seen on blood results in CAH?
- low Na
- high K
- metabolic acidosis
- low glucose (hypoglycaemia)
prognosis for females with CAH?
- may need corrective surgery in late puberty
- full fertility
management of CAH in both sexes?
- lifelong hydrocortisone
- fludrocortisone if there is salt loss
- monitor growth, skeletal maturity and testosterone
- additional hormone therapy following other illness/surgery
a) what is the proper name for Addison disease?
b) which disease is it the “opposite” of?
a) primary adrenal insufficiency
b) Cushing syndrome
which conditions might Addison disease be associated with?
- other autoimmune disease (e.g. DM, Graves)
- neonatal infection
- secondary to pituitary dysfunction
acute presentation of Addison disease?
- low Na
- high K
- low glucose
- low BP
- dehydrated
- growth failure
- shock
chronic presentation of Addison disease?
- vomiting
- lethargy
- brown pigmentation of gums, scars and skin creases
in Addison disease, what is:
a) plasma cortisol?
b) plasma ACTH?
a) low
b) high unless there is pituitary dysfunction
