Diabetes in a Child

Question 1

Define diabetes in a child.

Answer 1

hyperglycaemia secondary to an absolute or relative deficiency of insulin

Question 2

Aetiology of T1DM in a child.

Answer 2

Insulin production in pancreas by b-cell of islets of Langerhans disrupted by their absence/ destruction.

AI: Islet cell antibodies; majority against glutamic acid decarboxylase (GAD) within pancreatic beta-cells.

May be environmental involvement e.g. infection that triggers/ modulates AI response.

Strong genetic influence

Question 3

What are the classical triad of signs and symptoms of diabetes in a child?

Answer 3

Polyuria (nocturnal enuresis/ persistently wet nappies/ nappy rash)

Polydipsia

Weight loss

Question 4

Recall the diagnostic criteria for DM in a child

Answer 4

1. Sx + fasting >7 OR random >11.1
2. No Sx + fasting >7 AND random >11.1
3. No Sx + OGTT >11.1
4. HbA1c >6.5% / >48mmol/mol

Question 5

What is the management plan for diabetes in a child?

Answer 5

Education about lifestyle changes + dietary modifications. Refer to dietician + diabetes nurse.

Insulin therapy: Teach adults + older children how to administer. Multiple daily regimen. Usually a mixture of long-acting + short-acting insulin. Insulin pump can be considered.

Monitor blood glucose (avoid hypos <2.5), ketones + complications of diabetes.

Question 6

What are the complications associated with diabetes in a child?

Answer 6

Hypoglycaemia events

DKA

Microvascular (retinopathy, neuropathy, nephropathy)

Macrovascular complications (IHD, CVA)

Diabetic foot.

Question 7

What is the prognosis for diabetes in a child?

Answer 7

Increased mortality with DKA.

Reduced due to macrovascular complications.

Question 8

What is the initial management for DKA?

Answer 8

ABCDE approach

Take Capillary blood glucose, pH, pCO2, bicarbonate, urea, K+.

Measure ketones beta-hydrobutyrate.

Question 9

What is the fluid management for DKA?

Answer 9

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

Question 10

What is replacement therapy for DKA?

Answer 10

Use only 0.9% saline until plasma glucose <14.

Add potassium chloirde to any fluid replacement or maintenance.

Question 11

What is the rate of insulin infusion?

Answer 11

0.05-0.1 units/kg/hour

Question 12

List 3 forms of non-type 1 paediatric diabetes

Answer 12

Neonatal diabetes (transient/permanent)

Maturity-onset diabetes of youth (MODY)

Obesity-associated paediatric type 2.

Question 13

List 3 less common signs/ Sx of T1DM in a child

Answer 13

Secondary enuresis

Skin sepsis

Candida (+ other infections)

Question 14

What 6 signs and symptoms would DKA present with?

Answer 14

Abdo pain

Vomiting

Dehydration

Drowsiness progressing to coma

Kussmaul breathing (rapid deep breathing) secondary to acidosis

Acetone smelling breath.

Question 15

What signs and symptoms would a diabetic child with Hypoglycaemia secondary to insulin tx present with?

Answer 15

Sweating

Tremor

Palpitations

Irritability

Pallor

Late Sx: seizures, coma.

Question 16

Give 3 signs specific to T2DM in a child

Answer 16

Acanthosis nigricans (insulin resistance)

Skin tags

PCOS

Question 17

What would signify neonatal hypoglycaemia?

Answer 17

Jittery, hypotonic baby

Question 18

Give 7 risk factors for neonatal hypoglycaemia

Answer 18

IUGR

Maternal DM

Prematurity

Hypothermia

Neonatal sepsis

Inborn errors of metabolism

Labetalol (pre-eclampsia)

Question 19

What constitutes impaired glucose tolerance?

Answer 19

Fasting <7.0 mmol/L

OGTT 7.8-11.1 mmol/L

Question 20

What constitutes impaired fasting glucose?

Answer 20

Fasting 6.1-7.0 mmol/L