Diabetes mellitus

Question 1

Clinical features of diabetes mellitus

Answer 1

High level of glucose in the blood increases its osmolarity

1. Glycosuria
2. Polyuria
3. Polydypsia
   ( may present with nocturnal bedwetting )

Question 2

What two systematic symptoms are found in a child with diabetes mellitus?

Answer 2

1. Lethargy

2. Weight loss

Question 3

What investigations are done when a child is suspected to have diabetes mellitus?

Answer 3

1. Hb1ac

2. Blood gas measurements - assesment of ketones in bloor or urine as it is mandatory to exclude diabetic ketacidosis

Question 4

What is the criteria for diagnosis of diabetes mellitus?

Answer 4

1. > 11.1 on random blood glucose test

2. > 7 on fasting plasma glucose

Question 5

How is type 1 diabetes managed in terms of lifestyle?

Answer 5

1. Diet - controlled intake of carbohydrates and its effect on blood glucose
2. Educate - on symptoms of hypoglycaemia and consequence of use of exogenous insulin
3. Medication
   how to use injections and different regiments
4. Monitoring - careful monitoring via finger prick to find HB1AC, target is <7.5% to avoid complications.

Question 6

How are complications of diabetes screened for?

Answer 6

ANNUAL REVIEW

Question 7

What tests are carried out at the ‘Annual review’?

Answer 7

1. Patient’s blood pressure is measured
2. Urinalysis - microabulinuria for diabetic nephropathy
3. Thyroid function tests
4. Eye examination - diabetic retinopathy

Question 8

What happens when a diabetic child is ill?

Answer 8

1. Child’s insulin requirement is usually increased during illness even if they are not eating this is due to the effect of cortisol on the body.

Question 9

Rapid acting insulin

onset / peak / duration

Answer 9

1. Onset : 10 - 20 mins
2. Peak action : 1 -2 hour
3. Duration : 2 - 4 hours

Question 10

Intermediate acting insulin

Answer 10

1. Onset : 1 - 2 hour
2. Peak : 4 - 12 hour
3. Duration of action : 16 - 35 hours

Question 11

short acting insulin

Answer 11

1. Onset : 30 - 60 mins
2. Peak :2 - 4 hours
3. Duration of action : up to 8 hours

Question 12

Name 3 regimen types of insulin?

Answer 12

1. Basal bolus regiment
2. Twice daily injection
3. Continuous subcutaneous infusion via an insulin pump

Question 13

Basal bolus requirement (most common

Answer 13

(Injections 4 times a day)

Short acting insulin at meal times and long acting insulin at bed time.

Question 14

Twice daily injections

Answer 14

biphasic insulin ( mixture of short and intermediate acting insulin )

Question 15

Continous subcutaneous insulin via insulin pump

Answer 15

Delivers a continous background dose of short or rapid acting insulin and additional boluses with food