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paediatrics > diabetes and endocrinology > Flashcards

diabetes and endocrinology Flashcards

1
Q

what causes type 1 diabetes?

A

pancreatic B-cells being destroyed by autoimmune processes

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2
Q

what are the risk factors for type 2 diabetes in children?

A
  • older children
  • obese
  • family history
  • being Black or Asian
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3
Q

which drugs could lead to developing diabetes?

A

corticosteroids

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4
Q

which conditions could lead to developing diabetes? give 5

A
  • CF
  • thalassaemia (if there’s iron overload)
  • Cushing syndrome (due to steroid production)
  • Down syndrome
  • Turner syndrome
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5
Q

which conditions is diabetes associated with in children? give 4

A
  • hypothyroidism
  • Addison disease
  • coeliac disease
  • FH of rheumatoid arthritis
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6
Q

presentation of type 1 diabetes?

A
  • few weeks of symptoms
  • polyuria
  • polydipsia
  • weight loss
  • younger children might get secondary nocturnal enuresis
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7
Q

what skin change might develop in insulin resistance?where?

A

acanthosis nigricans (velvety dark patches with white lines), in axilla or on neck

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8
Q

how is type 1 diabetes diagnosed in children?

A
  • random blood glucose > 11.1 mmol/L
  • OR raised HbA1c >48 mmol/mol
  • OGTT not usually used
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9
Q

how is type 2 diabetes diagnosed in children?

A

same as type 1 but look for risk factors:

  • family history
  • obese
  • acanthosis nigricans
  • skin tags
  • PCOS phenotype in girls
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10
Q

dietary advice for a child with type 1 diabetes?

A
  • same as non-diabetic
  • 5 a day
  • “carb counting” - lets parent estimate how much insulin is needed after each meal
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11
Q

why is it important to rotate insulin injection sites?

A

risk of lipohypertrophy or lipoatrophy (rarer)

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12
Q

what are the 2 insulin regimens used for most diabetic children?

A
  • continuous subcutaneous insulin pump

- OR short-acting insulin injections pre-prandial and long-acting injection before bed

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13
Q

why is a high fibre diet preferred to refined carbs in diabetic children?

A
  • fibre gives slow-release, sustained energy

- refined carbs cause rapid swings of glucose levels

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14
Q

which factors increase blood glucose?

A
  • insufficient insulin
  • any type of food but esp carbs
  • illness
  • menstruation
  • growth hormone
  • corticosteroids (hence Cushing gives DM)
  • sex hormones at puberty
  • stress
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15
Q

which factors decrease blood glucose?

A
  • insulin
  • exercise
  • alcohol
  • some drugs
  • marked anxiety or excitement
  • hot weather
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16
Q

what are the 2 acute complications of diabetes?

A
  • hypoglycaemia

- DKA

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17
Q

symptoms of hypoglycaemic attack?

A
  • hunger
  • pallor
  • tummy ache
  • sweatiness
  • faint/dizziness
  • “wobbly” feeling in legs
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18
Q

how does hypoglycaemia progress untreated

A

coma then death

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19
Q

what is the treatment of:

a) mild hypoglycaemia?
b) severe hypoglycaemia?

A

a) easily absorbed glucose from a snack

b) glucagon injection

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20
Q

investigations in DKA?

A
  • 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)
21
Q

5 steps of DKA management?

A
  1. fluids (saline and glucose)
  2. insulin
  3. potassium
  4. re-establish oral fluids, SC insulin + diet
  5. treat any underlying cause
22
Q

what is the fluid rate needed to resuscitate a child in shock?

A

0.9% saline, 10ml/kg

23
Q

which other two conditions get screened for in any child newly diagnosed with diabetes?

A
  • thyroid function (checked annually)

- coeliac

24
Q

why does insulin requirement go up as the child enters puberty?

A

GH, oestrogen and testosterone all counteract insulin

25
Q

consequence of chronically poor diabetic control in childhood?

A
  • growth delay

- delayed puberty

26
Q

why is insulin dosage reduced towards the end of puberty for girls?

A
  • prone to weight gain

- can become obese in this period

27
Q

what is the target glucose in diabetics?

A

below 48mmol/mol

28
Q

features of hypoglycaemia?

A
  • sweating
  • pallor
  • irritability
  • headache
  • seizures (go on to develop epilepsy)
  • coma
29
Q

long-term neurological problems in diabetes?

A
  • epilepsy
  • learning difficulties
  • microcephaly
30
Q

commonest cause of hypoglycaemia?

A

insulin excess in diabetes

31
Q

management of acute hypoglycaemia?

A
  • ABCDE

- IV glucose, max 5ml/kg

32
Q

causes of congenital hypothyroidism?

A
  • maldescent of thyroid (commonest in UK) - remains as a linguinal mass
  • iodine deficiency (commonest worldwide)
33
Q

when is congenital hypothyroidism usually picked up?

A
  • antenatal screening

- heel-prick test on day 5

34
Q

signs of congenital hypothyroidism? there’s a LOT

A
  • usually asymptomatic
  • faltering growth
  • feeding problems
  • prolonged jaundice
  • pale, cold, mottled, dry skin
  • coarse facies
  • large tongue
  • hoarse cry
  • goitre
  • umbilical hernia
  • delayed development
35
Q

signs of acquired hypothyroidism?

A
  • F>M
  • short stature
  • learning difficulties
  • same signs as adult hypothyroidism
36
Q

main cause of acquired hypothyroidism?

A

autoimmune thyroiditis

37
Q

risk factors of acquired hypothyroidism?

A
  • Down syndrome

- Turner syndrome

38
Q

pathophysiology of congenital adrenal hyperplasia?

A
  • adrenal failure
  • no cortisol + aldosterone secretion
  • low Na, high K
  • excess ACTH secreted
  • overproduction of androgens from adrenals
39
Q

features of congenital adrenal hyperplasia?

A
  • 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
40
Q

key blood result in diagnosis of congenital adrenal hyperplasia?

A

raised 17-alpha-hydroxy-progesterone

41
Q

other than the raised hormone, what else is seen on blood results in CAH?

A
  • low Na
  • high K
  • metabolic acidosis
  • low glucose (hypoglycaemia)
42
Q

prognosis for females with CAH?

A
  • may need corrective surgery in late puberty

- full fertility

43
Q

management of CAH in both sexes?

A
  • lifelong hydrocortisone
  • fludrocortisone if there is salt loss
  • monitor growth, skeletal maturity and testosterone
  • additional hormone therapy following other illness/surgery
44
Q

a) what is the proper name for Addison disease?

b) which disease is it the “opposite” of?

A

a) primary adrenal insufficiency

b) Cushing syndrome

45
Q

which conditions might Addison disease be associated with?

A
  • other autoimmune disease (e.g. DM, Graves)
  • neonatal infection
  • secondary to pituitary dysfunction
46
Q

acute presentation of Addison disease?

A
  • low Na
  • high K
  • low glucose
  • low BP
  • dehydrated
  • growth failure
  • shock
47
Q

chronic presentation of Addison disease?

A
  • vomiting
  • lethargy
  • brown pigmentation of gums, scars and skin creases
48
Q

in Addison disease, what is:

a) plasma cortisol?
b) plasma ACTH?

A

a) low

b) high unless there is pituitary dysfunction

paediatrics (10 decks)

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