Diabetes Mellitus

Question 1

How many children and young people under 19 are there with diabetes in the UK?

Answer 1

About 30,500

Question 2

Of what type is most childhood diabetes?

Answer 2

Type 1

Question 3

What happens in type 1 diabetes?

Answer 3

There is destruction of pancreatic ß-cells by an autoimmune process

Question 4

What plays a role in the development of type 1 diabetes?

Answer 4

• Genetic predisposition

- Environmental precipitants

Question 5

What environmental triggers might contribute to the development of diabetes?

Answer 5

• Enteroviral infections
• Diet
• Over nutrition

Question 6

How do environmental triggers contribute to the development of diabetes?

Answer 6

Molecular mimicry probably occurs between an environmental trigger and an antigen on the surface of the ß-cells of the pancreas

Question 7

What is the result of molecular mimcry between an environmental trigger and an antigen on the surface of the ß-cell of the pancreas?

Answer 7

In genetically predisposed individuals, this results in an autoimmune process which damages pancreatic ß-cells and leads to increasing insulin deficiency

Question 8

What is type 2 diabetes caused by?

Answer 8

Insulin resistance, followed later by ß-cell failure

Question 9

Who does type 2 diabetes usually occur in?

Answer 9

Older children

Question 10

What is type 2 diabetes related to?

Answer 10

Obesity

Question 11

Other than type 1/2 of diabetes, what are the other causes of hyperglycaemia?

Answer 11

• Maturity onset diabetes of the young
• Drugs
• Pancreatic insufficiency
• Endocrine disorders
• Genetic/chromosomal syndromes
• Neonatal diabetes

Question 12

What is maturity onset diabetes of the young caused by?

Answer 12

Genetic defects in ß-cell function

Question 13

Give an example of a drug that can cause hyperglycaemia

Answer 13

Corticosteoids

Question 14

Give 2 examples of causes of pancreatic insufficiency leading to hyperglycaemia?

Answer 14

• CF

- Iron overload in thalassaemia

Question 15

Give an example of an endocrine disorder that can led to hyperglycaemia?

Answer 15

Cushing’s syndrome

Question 16

Is neonatal diabetes transient or permanent?

Answer 16

Can be either

Question 17

What is neonatal diabetes secondary to?

Answer 17

Defective ß cell function

Question 18

What are the risk factors for diabetes?

Answer 18

• Family history

- Other autoimmune disorders in patient or family

Question 19

What other autoimmune disorders are associated with diabetes?

Answer 19

• Hypothyroidism
• Addisons
• Coeliac
• RA

Question 20

What are the early symptoms of diabetes?

Answer 20

• Polydipsia
• Polyuria
• Weight loss
• Secondary enuresis

Question 21

What are the less common early symptoms of diabetes?

Answer 21

Skin sepsis, candida, and other infections

Question 22

How might diabetes present if it is not diagnosed and managed at an early stage?

Answer 22

Patient may present with diabetic ketoacidosis

Question 23

How is a diagnosis of type 1 diabetes confirmed in a symptomatic child?

Answer 23

Finding of markedly raised random blood glucose (>11.1mmol/L)

Question 24

What tests may be helpful in the diagnosis of diabetes if there is any uncertainty?

Answer 24

• Fasting blood glucose (>7mmol/L)

- Raised glycosylated haemoglobin

Question 25

What are the differential diagnoses for diabetes?

Answer 25

- Diabetes insipidus - Hyperthyroidism - Pheochromocytoma - Psychogenic polydipsia - Transient hyperglycaemia with illness and other stress

Question 26

What will the initial management of diabetes depend on?

Answer 26

The child's condition

Question 27

What will children presenting with diabetic ketoacidosis require?

Answer 27

Urgent hospital admission

Question 28

Are most children newly presenting with diabetes alert and able to drink?

Answer 28

Yes

Question 29

What is the result of most newly presenting children with diabetes being alert and able to drink?

Answer 29

They can therefore be managed with SC insulin alone

Question 30

What education is given in new diagnoses of diabetes?

Answer 30

An intensive education programme for the parent and child

Question 31

What does the education programme for new diagnoses of diabetes cover?

Answer 31

- Basic understanding of pathophysiology of diabetes - Insulin injection technique and sites - Blood glucose (finger prick) monitoring to allow for insulin adjustment when unwell - Healthy diet and carbohydrate monitoring - Sick day rules during illness to prevent ketoacidosis - Encouragement to exercise regularly, with adjustments of insulin and diet for exercise - Recognition and treatment of hypoglycaemia - Where to get advice 24 hours a day - Help from available voluntary groups - Psychological impact of a lifelong condition

Question 32

What is it important to remember when educating a child about their diabetes?

Answer 32

The information provided for the child must be appropriate for their age

Question 33

What do children with type 1 diabetes require for their management?

Answer 33

Insulin

Question 34

What insulin regimes are most children with type 1 diabetes started on?

Answer 34

Continuous subcutaneous insulin pump, or multiple daily injection regime

Question 35

What does a multiple daily injection regime involve in children with type 1 diabetes?

Answer 35

Rapid acting insulin given as bolus before each meal, and a long-acting insulin in the late evening and/or before breakfast to provide background insulin

Question 36

Give two examples of rapid-acting insulins

Answer 36

- Lispro | - Insulin Aspart

Question 37

Give an example of a short acting insulin

Answer 37

Glargine