Diabetes in a Child Flashcards
Define diabetes in a child.
Chronic metabolic disorder characterised by hyperglycaemia secondary to an absolute or relative deficiency of insulin secretion.
Explain the aetiology of diabetes in a child.
Insulin production in the pancreas by the b-cell of the islets of Langerhans is disrupted by their absence or destruction. There is a strong genetic influence (>50% concordance in monozygotic twins).
What are the risk factors for diabetes in a child?
Autoimmune: 85% of patients have circulating islet cell antibodies; majority directed against glutamic acid decarboxylase (GAD) within pancreatic beta-cells.
Environmental: Viral infections initiate or modify the autoimmune process (mumps, rubella, coxsackie B4, increased incidence with cow’s milk protein exposure in infancy).
Non-type 1 pediatric diabetes: Neonatal diabetes (transient/permanent), maturity-onset diabetes of youth (MODY), obesity-associated paediatric type 2.
Associated: HLA DR-3, HLA-DR4, other autoimmune conditions, viral infections in pregnancy.
Summarise the epidemiology of diabetes in a child.
15 per 10,000 children incidence.
What are the presenting signs and symptoms of diabetes in a child?
General: Polyuria (nocturnal enuresis/persistently wet nappies/nappy rash), polydipsia, weight loss, recurrent infections, necrobiosis lipoidica (well-demarcated, red atrophic area, usually on lower leg), blurred vision, fatigue.
Diabetic ketoacidosis (DKA): Abdominal pain, vomiting, dehydration, drowsiness progressing to coma, Kussmaul breathing (rapid deep breathing) secondary to acidosis, acetone smelling breath.
Hypoglycaemia (secondary to insulin treatment): Sweating, tremor, palpitations, irritability. Late (progressive) symptoms seizures, coma.
What investigations are appropriate for diabetes in a child?
Urine dipstick: Glucose, nitrites, leucocytes and protein and ketones.
Bloods: Glucose (fasting, or OGTT). OGTT above 11.1 is gold standard diagnosis.
HbA1c and fasting c-peptide.
What is the management plan for diabetes in a child?
Education about lifestyle changes and dietary modifications. Refer to dietician and diabetes nurse.
Insulin therapy: Teach adults and older children how to administer. Multiple daily regimen. Usually a mixture of long-acting and short-acting insulin. -Insulin pump can be considered.
Monitor blood glucose (avoid hypos less than 2.5), ketones and complications of diabetes.
What are the complications associated with diabetes in a child?
Hypoglycaemia events, DKA, microvascular (retinopathy, neuropathy, nephropathy), macrovascular complications (IHD, CVA) and diabetic foot.
What is the prognosis for diabetes in a child?
Increased mortality with DKA.
Reduced due to macrovascular complications.
What is the initial management for DKA?
ABCDE approach
Take Capillary blood glucose, pH, pCO2, bicarbonate, urea, K+.
Measure ketones beta-hydrobutyrate.
What is the fluid management for DKA?
IV fluid bolus (10ml/kg 0.9% saline)
<10kg give 2ml/kg/hour
Maintenanc:
- <10kg give 2ml/kg/hour
- 10-40kg give 1ml/kg/hour
- >40kg give fixed volume: 40ml per hour
What is replacement therapy for DKA?
Use only 0.9% saline until plasma glucose <14.
Add potassium chloirde to any fluid replacement or maintenance.
What is the rate of insulin infusion?
0.05-0.1 units/kg/hour
