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Senoir paeds > DIABETES IN CHILDREN > Flashcards

DIABETES IN CHILDREN Flashcards

1
Q

The most common type of diabetes in children and adolescents is ________

A

type 1 diabetes.

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2
Q

Classification
Type 1 diabetes
_______
________
_________

Type 2 diabetes

A

autoimmune
LADA
idiopathic

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3
Q

Insulin deficiency in type 1 diabetes

_______ Glucose uptake
_______ Glycogenolysis
_______ Gluconeogenesis (amino acids)
_______ Ketone production (fatty acid
_______ Glucose uptake
_______ Protein degradation  amino acids
_______ Triglyceride degradation  fatty acids

A

Decreased
Increased
Increased
Increased
Decreased
Increased
Increased

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4
Q

Pathogenesis of type 1 diabetes

_____________ activation
Progressive _____________
Insufficient _____________
Dependent on _____________
Risk of _____________

A

Immunological activation
Progressive beta-cell destruction Insufficient beta-cell function
Dependent on exogenous insulin
Risk of ketoacidosis

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5
Q

Pathogenesis of type 1 diabetes
Genetic susceptibility-
Siblings of a person with type 1 diabetes are about ______ times more likely to develop diabetes than the general population. Children in families with a mother with type 1 diabetes have a (lower or higher?) risk (~3%) than children in families with a father who has type 1 diabetes; the reasons for this are unknown.
Identical (monozygotic) twins are more likely to both have type 1 diabetes than non-identical (dizygotic) twins. But concordance rates in identical twins are less than 50%, supporting the hypothesis that __________ factors are also important in the development of type 1 diabetes

A

15; lower

environmental

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6
Q

Pathogenesis of type 1 diabetes

Environmental trigger

•Viruses -The epidemiological patterns of type 1 diabetes, including geographic, seasonal, and temporal variations in incidence suggest that viruses may be important risk factors. Viruses are thought to act as initiators, accelerators or precipitators of the disease. These may attack and destroy the beta cells of the pancreas and directly cause diabetes.

•________________-casein, cow’s milk protein and gluten.
•___________ : cured meats
•chemicals: _________, streptozotin

Immune factors
•
other autoimmune disease
antigen-specific antibodies

A

bovine serum albumin

nitrosamines

vacor (rat poison)

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7
Q

Idiopathic type 1 diabetes

•Non-autoimmune type 1 diabetes

No ______________
Permanent insulinopenia
Ketoacidosis
People of _______ and _________ origin

A

autoimmune markers

African and Asian

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8
Q

Pathogenesis of type 2 diabetes

(Single or Multiple?) genes involved
Hyperinsulinaemia

Poor ___________ leads to reduced beta- cell formation
Low birth weight/weight
change
“__________ gene”
7% beta-cell loss

A

Multiple; hyper

fetal nutrition

Thrifty

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9
Q

Risk factors for type 2 diabetes

List 6

A

Hypertension
Dyslipidaemia
Abdominal obesity
Overweight
Polycystic ovary disease
Acanthosis nigricans
Schizophrenia
SGA or LGA babies

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10
Q

Epidemiology of type 1 diabetes

Age of onset peaks
– _________
– ___________

Wet (June-July) /Dry (late Oct – early Dec.) peaks

A

preschool; puberty

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11
Q

Signs and symptoms

Type 1 diabetes often appears ________.
In children, Type 1 diabetes symptoms may resemble ____ symptoms.

The following are the most common symptoms for type 1 diabetes.
However, each child may experience symptoms differently.

A

suddenly; flu

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12
Q

Signs and symptoms of type 1 diabetes

_________
_________
_________
_________ disturbance
Fatigue
Weight ________l
Infections
Nausea and vomiting
_________ pain
Irritability and mood changes

A

Polydipsia ;Polyuria

Nocturia; Visual

loss; Abdominal

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13
Q

Diagnosing diabetes

HbA1C

Normal
Impaired fasting glucose*
Diabetes

A

Nil

5.8 -6.5

> 6.5

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14
Q

Diagnosing diabetes

2hr PG

Normal
Impaired fasting glucose*
Diabetes

A

<7.8mmol/L ; <126mg/dL

7.8 to 11mmol/L** 126 to 200mg/dL

≥11.1mmol/L ≥200mg/dL

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15
Q

Diagnosing diabetes

FPG

Normal
Impaired fasting glucose*
Diabetes

A

<6.1mmol/L ; <110mg/dL

6.1 to 6.9mmol/L* 110 to 126mg/dL

≥7.0mmol/L ≥126mg/dL

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16
Q

Prevention of type 1 diabetes

Early exposure to ______________
_____________

A

cows milk protein

Nicotinamide

17
Q

Prevention of type 1 diabetes
Insulin

• Diabetes ___________
• Diabetes ___________ and ____________

A

Prevention Trial

Prediction and Prevention Project

18
Q

Prevention of type 2 diabetes
______________
Da Qing Study
Finnish Diabetes Prevention Study

A

Lifestyle modification

19
Q

Insulin

A hormone secreted by the ______ cells
Secreted in response to __________ or other stimuli, such as __________

Normal response characterized by low basal levels of insulin, with surges of insulin triggered by a rise in blood glucose

A

beta; glucose; amino acids

20
Q

Adjusting insulin
Pattern management

Watch levels for ______ days
Address _____________ first
Aim for target ________ levels next
Adjust by 2-4 units or 10%
Wait 2-3 days

A

2-3

hypoglycaemia; fasting

21
Q

What is DKA?

__________,__________,________ and ________

A

High blood glucose, ketones, acidosis and dehydration

22
Q

Incidence of DKA

Varies
Death mainly from ___________
Most common at onset in type —— diabetes
Recurrent episodes
Can occur in type 2 diabetes

A

cerebral oedema

1

23
Q

Earlier clinical symptoms and signs of DKA
____________
____________
____________
Tiredness
Muscle _________
__________ facial appearance

A

Polyuria
Polydipsia
Polyphagia
Tiredness
Muscle cramps
Flushed facial appearance

24
Q

Later clinical symptoms and signs of DKA
Weight ———-
Nausea and vomiting
Abdominal pain
_______
_________ breath
Hypotension
Shock
Altered consciousness Coma

A

loss

Dehydration ; Acidotic

25
Q

DKA – investigations Immediate for diagnosis
_________,___________, and _________

Urgent for assessment and treatment
Blood glucose
Blood gases
Electrolytes, urea, creatinine WBC

Consider
_______ monitor
Blood culture, urine culture Chest X-ray

A

Capillary blood glucose, urinary glucose and ketones

Cardiac

26
Q

DKA treatment

1) ____________
2)give ____________
3) ____________ infusion
4)monitoring

A

1) Rehydration
2)give potassium
3)insulin infusion
4)monitoring

27
Q

DKA – complications

•_______________ +/- ____________

•Acidosis not improving – consider ______________ or _________

•______________________

•Headache +/- falling level of awareness – consider _____________ and urgent treatment with __________

A

Hypoglycaemia; hypokalaemia

continuing dehydration or infection

Aspiration pneumonia

cerebral oedema; Mannitol

28
Q

Definition of hypoglycaemia

When the level of glucose ______ in the blood so that the cells in the ___________ , and eventually the _______ cells, do not get adequate glucose to function

A

falls; periphery

brain

29
Q

Symptoms of hypoglycaemia

Mild:

List 5

A

Tremors, palpitation, sweating, hunger, fatigue

30
Q

Symptoms of hypoglycaemia

Moderate:

List 3

A

Headache, mood changes, low attentiveness

31
Q

Symptoms of hypoglycaemia

Severe:

List 2

A

Conscious or unconscious

32
Q

Consequences of hypoglycaemia

Severe
– injury
–________
– transient _________
–__________ impairment
– death

A

seizures; paralysis

cognitive

33
Q

Consequences of hypoglycaemia

Mild-Moderate

fear
anxiety
affects self-care
social stigma
prejudice

A

Huh?

34
Q

Management Mild or moderate hypoglycemia

Test if possible
____g glucose; re-test
__________ tablets
Fruit juice
Soft drink
Sugar
Re-treat if level remains low
• • • • • • •

A

15 g

Glucose

35
Q

Management of Severe hypoglycemia

____g glucose
glucagon
intravenous ______
Manage _________ – place person on their side if not too agitated

A

20

dextrose; seizure

36
Q

Glucagon/IV dextrose options If unable to treat orally:
Glucagon ___________ or ____________
–___ml for adult (___ml for child)
–blood glucose 3.0 to 11.8 in 45 min
– vomiting
–severe headache

IV dextrose:
–______ ml IV over __________ –immediate response

A

subcutaneously or intramuscular

1; 0.5

25-50

2-3 minutes

Senoir paeds (15 decks)

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