DIABETES IN CHILDREN Flashcards
The most common type of diabetes in children and adolescents is ________
type 1 diabetes.
Classification
Type 1 diabetes
_______
________
_________
Type 2 diabetes
autoimmune
LADA
idiopathic
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
Decreased
Increased
Increased
Increased
Decreased
Increased
Increased
Pathogenesis of type 1 diabetes
_____________ activation
Progressive _____________
Insufficient _____________
Dependent on _____________
Risk of _____________
Immunological activation
Progressive beta-cell destruction Insufficient beta-cell function
Dependent on exogenous insulin
Risk of ketoacidosis
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
15; lower
environmental
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
bovine serum albumin
nitrosamines
vacor (rat poison)
Idiopathic type 1 diabetes
•Non-autoimmune type 1 diabetes
No ______________
Permanent insulinopenia
Ketoacidosis
People of _______ and _________ origin
autoimmune markers
African and Asian
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
Multiple; hyper
fetal nutrition
Thrifty
Risk factors for type 2 diabetes
List 6
Hypertension
Dyslipidaemia
Abdominal obesity
Overweight
Polycystic ovary disease
Acanthosis nigricans
Schizophrenia
SGA or LGA babies
Epidemiology of type 1 diabetes
Age of onset peaks
– _________
– ___________
Wet (June-July) /Dry (late Oct – early Dec.) peaks
preschool; puberty
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.
suddenly; flu
Signs and symptoms of type 1 diabetes
_________
_________
_________
_________ disturbance
Fatigue
Weight ________l
Infections
Nausea and vomiting
_________ pain
Irritability and mood changes
Polydipsia ;Polyuria
Nocturia; Visual
loss; Abdominal
Diagnosing diabetes
HbA1C
Normal
Impaired fasting glucose*
Diabetes
Nil
5.8 -6.5
> 6.5
Diagnosing diabetes
2hr PG
Normal
Impaired fasting glucose*
Diabetes
<7.8mmol/L ; <126mg/dL
7.8 to 11mmol/L** 126 to 200mg/dL
≥11.1mmol/L ≥200mg/dL
Diagnosing diabetes
FPG
Normal
Impaired fasting glucose*
Diabetes
<6.1mmol/L ; <110mg/dL
6.1 to 6.9mmol/L* 110 to 126mg/dL
≥7.0mmol/L ≥126mg/dL
Prevention of type 1 diabetes
Early exposure to ______________
_____________
cows milk protein
Nicotinamide
Prevention of type 1 diabetes
Insulin
• Diabetes ___________
• Diabetes ___________ and ____________
Prevention Trial
Prediction and Prevention Project
Prevention of type 2 diabetes
______________
Da Qing Study
Finnish Diabetes Prevention Study
Lifestyle modification
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
beta; glucose; amino acids
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
2-3
hypoglycaemia; fasting
What is DKA?
__________,__________,________ and ________
High blood glucose, ketones, acidosis and dehydration
Incidence of DKA
Varies
Death mainly from ___________
Most common at onset in type —— diabetes
Recurrent episodes
Can occur in type 2 diabetes
cerebral oedema
1
Earlier clinical symptoms and signs of DKA
____________
____________
____________
Tiredness
Muscle _________
__________ facial appearance
Polyuria
Polydipsia
Polyphagia
Tiredness
Muscle cramps
Flushed facial appearance
Later clinical symptoms and signs of DKA
Weight ———-
Nausea and vomiting
Abdominal pain
_______
_________ breath
Hypotension
Shock
Altered consciousness Coma
loss
Dehydration ; Acidotic
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
Capillary blood glucose, urinary glucose and ketones
Cardiac
DKA treatment
1) ____________
2)give ____________
3) ____________ infusion
4)monitoring
1) Rehydration
2)give potassium
3)insulin infusion
4)monitoring
DKA – complications
•_______________ +/- ____________
•Acidosis not improving – consider ______________ or _________
•______________________
•Headache +/- falling level of awareness – consider _____________ and urgent treatment with __________
Hypoglycaemia; hypokalaemia
continuing dehydration or infection
Aspiration pneumonia
cerebral oedema; Mannitol
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
falls; periphery
brain
Symptoms of hypoglycaemia
Mild:
List 5
Tremors, palpitation, sweating, hunger, fatigue
Symptoms of hypoglycaemia
Moderate:
List 3
Headache, mood changes, low attentiveness
Symptoms of hypoglycaemia
Severe:
List 2
Conscious or unconscious
Consequences of hypoglycaemia
Severe
– injury
–________
– transient _________
–__________ impairment
– death
seizures; paralysis
cognitive
Consequences of hypoglycaemia
Mild-Moderate
fear
anxiety
affects self-care
social stigma
prejudice
Huh?
Management Mild or moderate hypoglycemia
Test if possible
____g glucose; re-test
__________ tablets
Fruit juice
Soft drink
Sugar
Re-treat if level remains low
• • • • • • •
15 g
Glucose
Management of Severe hypoglycemia
____g glucose
glucagon
intravenous ______
Manage _________ – place person on their side if not too agitated
20
dextrose; seizure
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
subcutaneously or intramuscular
1; 0.5
25-50
2-3 minutes
