Diabetes Mellitus

Question 1

Presentation of children with diabetes

Answer 1

25-50% present in DKA

Polyurua

Polydipsia

Weight loss

Question 2

Pathophysiology of diabetess

Answer 2

Pancreas not producing insulin so cells cannot take glucose from blood for fuel

When there is no insulin, cells think there is no glucose in the blood and that the body is being fasted

Cells cannot use glucose, so level of glucose in blood keeps rising → hyperglycaemia

Question 3

Investigations in diabetes

Answer 3

Take bloods to exclude other associated pathology

FBC, U&E, glucose

Blood cultures (if fever)

HbA1c

TFTs and TPO to test for associated autoimmune thyroid disease

Anti-TTF antibodies for associated coeliac disease

Question 4

Management of diabetes

Answer 4

Patient and family education

Subcutaneousinsulin regimes

Monitoringdietary carbohydrateintake

Monitoringblood sugarlevels on waking, at each meal and before bed

Monitoring for and managingcomplications, both short and long term

Question 5

Short-term complications of diabetes

Answer 5

Hypoglycaemia

Hyperglycaemia (and DKA)

Question 6

Long-term complications of diabetes

Answer 6

Microvascular

Macrovascular

Infection-related

Question 7

Macrovascular complications of diabetes

Answer 7

Coronary artery diseaseis a major cause of death in diabetics

Peripheral ischaemia causes poor healing, ulcers and “diabetic foot”

Stroke

Hypertension

Question 8

Infection-related complications of diabetes

Answer 8

Peripheral neuropathy

Retinopathy

Kidney disease, particularlyglomerulosclerosis

Question 9

Infection-related complications of diabetes

Answer 9

UTIs

Pneumonia

Skin and soft tissue infections, particularly in the feet

Fungal infections, particularly oral and vaginalcandidiasi

Question 10

Monitoring in diabetes

Answer 10

HbA1c

Capillary blood glucose

Flash glucose monitoring