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B - Paediatrics MANAGEMENT > Diabetes Mellitus > Flashcards

Diabetes Mellitus Flashcards

1
Q

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

A

About 30,500

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2
Q

Of what type is most childhood diabetes?

A

Type 1

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3
Q

What happens in type 1 diabetes?

A

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

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4
Q

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

A
  • Genetic predisposition

- Environmental precipitants

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5
Q

What environmental triggers might contribute to the development of diabetes?

A
  • Enteroviral infections
  • Diet
  • Over nutrition
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6
Q

How do environmental triggers contribute to the development of diabetes?

A

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

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7
Q

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

A

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

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8
Q

What is type 2 diabetes caused by?

A

Insulin resistance, followed later by ß-cell failure

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9
Q

Who does type 2 diabetes usually occur in?

A

Older children

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10
Q

What is type 2 diabetes related to?

A

Obesity

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11
Q

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

A
  • Maturity onset diabetes of the young
  • Drugs
  • Pancreatic insufficiency
  • Endocrine disorders
  • Genetic/chromosomal syndromes
  • Neonatal diabetes
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12
Q

What is maturity onset diabetes of the young caused by?

A

Genetic defects in ß-cell function

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13
Q

Give an example of a drug that can cause hyperglycaemia

A

Corticosteoids

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14
Q

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

A
  • CF

- Iron overload in thalassaemia

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15
Q

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

A

Cushing’s syndrome

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16
Q

Is neonatal diabetes transient or permanent?

A

Can be either

17
Q

What is neonatal diabetes secondary to?

A

Defective ß cell function

18
Q

What are the risk factors for diabetes?

A
  • Family history

- Other autoimmune disorders in patient or family

19
Q

What other autoimmune disorders are associated with diabetes?

A
  • Hypothyroidism
  • Addisons
  • Coeliac
  • RA
20
Q

What are the early symptoms of diabetes?

A
  • Polydipsia
  • Polyuria
  • Weight loss
  • Secondary enuresis
21
Q

What are the less common early symptoms of diabetes?

A

Skin sepsis, candida, and other infections

22
Q

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

A

Patient may present with diabetic ketoacidosis

23
Q

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

A

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

24
Q

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

A
  • Fasting blood glucose (>7mmol/L)

- Raised glycosylated haemoglobin

25
Q

What are the differential diagnoses for diabetes?

A
  • Diabetes insipidus
  • Hyperthyroidism
  • Pheochromocytoma
  • Psychogenic polydipsia
  • Transient hyperglycaemia with illness and other stress
26
Q

What will the initial management of diabetes depend on?

A

The child’s condition

27
Q

What will children presenting with diabetic ketoacidosis require?

A

Urgent hospital admission

28
Q

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

A

Yes

29
Q

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

A

They can therefore be managed with SC insulin alone

30
Q

What education is given in new diagnoses of diabetes?

A

An intensive education programme for the parent and child

31
Q

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

A
  • 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
32
Q

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

A

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

33
Q

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

A

Insulin

34
Q

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

A

Continuous subcutaneous insulin pump, or multiple daily injection regime

35
Q

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

A

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

36
Q

Give two examples of rapid-acting insulins

A
  • Lispro

- Insulin Aspart

37
Q

Give an example of a short acting insulin

A

Glargine

B - Paediatrics MANAGEMENT (106 decks)

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