Diabetes Mellitus Flashcards
What is Type 1 Diabetes Mellitus?
Total insulin deficiency due to autoimmune destruction of pancreatic beta cells.
What is type 2 Diabetes Mellitus?
Insulin resistance followed later by beta cell failure
What are possible environmental causes for type 1 diabetes?
- Enteroviral infections
- Diet
- Cow’s milk proteins
- Overnutrition
What are the symptoms/signs of diabetes mellitus?
Most common (usually for only a few weeks before presenting):
- Polydipsia
- Polyuria
- Weight loss
Less common:
- Secondary enuresis
- Skin sepsis
- Candida and other infections
What is secondary enuresis?
Child did have bladder control at night for a period of at least 6 months, but lost that control and now wets the bed again.
How is the diagnosis of a symptomatic child confirmed?
- Random blood glucose > 11.1 mmol/L or fasting BG > 7 mmol/L
- Glycosuria
- Ketosis
When should type 2 diabetes be suspected?
- Family Hx
- Severely obese child
- Signs of insulin resistance
- Acanthosis Nigricans
- Skin tags
- PCOS phenotype (in teenage girls)
What is seen in this image?
Acanthosis Nigricans = Velvety dark skin on the neck or armpits
What is the initial management for a patient presenting with DKA?
Urgent hospital admission and treatment (inc. fluid and insulin)
What education is provided to the newly diagnosed child and their parents?
- Basic understanding of the pathophysiology
- Injection of insulin (Technique & sites)
- Blood glucose (Finger prick) monitoring
- Healthy diet & ‘Carb counting’
- Encourage exercise (with adjustment of diet and insulin)
- ‘Sick-day rules’ to prevent ketoacidosis
- Recognition and treatment of hypoglycaemia & hyperglycaemia/DKA
- Where to get 24hr advice (from team)
- Where to access support from voluntary services
- Psychological impact of life-long condition.
How is diabetes typically managed in children?
Either with:
- Continuous subcutaneous insulin pump
- Multiple daily injections (‘basal-bolus’) with rapid-acting insulin (e.g. novorapid) before each meal (bolus) and long-acting insulin (e.g. Glargine) in the evening/before breakfast (basal).
What is the concentration of all insulin used in the UK in children?
100 units/ml (U-100)
What is ‘carb counting’?
A method of calculating likely insulin requirement by estimating the amount of carb in food, while taking into account the pre-meal sugar level and post-meal exercise pattern.
What is the pre-meal blood sugar target?
4 - 7 mmol/L
What factors increase blood glucose levels?
- Insufficient insulin
- Food (esp carbs)
- Illness
- Menstruation
- Growth hormone
- Corticosteroids
- Sex hormones at puberty
- Stress
What factors decrease blood glucose levels?
- Insulin
- Exercise
- Alcohol
- Some drugs
- Marked anxiety/excitement
- Hot weather
What is the target HbA1c in diabetes?
< 48mmol/mol (6.5%)
What is HbA1c and why is it useful to monitor in diabetes?
It is glycated haemoglobin and is used to identify average plasma glucose concentation.
Helpful guide of overall diabetes control over previous 6-12 weeks - should be checked at least 4 times a year.
When can HbA1c levels be misleading?
If RBC lifespan is reduced (e.g. sickle cell anaemia) or if HbA molecule is abnormal (e.g. thalassaemia).
What are the common symptoms of hypoglycaemia?
- Hunger
- Tummy ache
- Sweatiness
- ‘Wobbly feeling’ in legs
- Pallor
- Irritability & ‘unreasonable behaviour’
- Seizures & coma (when untreated/unrecognised)
What blood glucose values indicate hypoglycaemia?
< 4 mmol/L
What can happen with frequent episodes of hypoglycaemia?
The patient can lose awareness of the symptoms.
How is a ‘hypo’ treated at an early stage?
- Glucose tablets
- Sugary drink (e.g. lucozade)
How is a ‘hypo’ managed when the patient can’t cooperate?
Oral glucose gels (e.g. glucogel) are useful because absorbed by buccal mucosa.
How should severe hypoglycaemia be managed at home/school?
Glucagon injection kit (provided to parents and school)
How should hypoglycaemia in an unconscious child be managed in hospital?
IV glucose
What are the symptoms/signs of diabetic ketoacidosis?
- Smell of acetone on breath
- Vomiting
- Dehydration
- Abdo pain
- Hyperventilation due to acidosis (Kussmaul breathing)
- Hypovolaemic shock
- Drowsiness
- Coma & death
What are essential early investigations in DKA?
- Blood glucose > 11.1 mmol/L
- Blood ketones > 3 mmol/L
- U&Es (Possibility of dehydration)
- Blood gas analysis (Severe metabolic acidosis)
- Blood and urine cultures (Infection precipitating cause)
- ECG (T-wave changes of hypokalaemia)
- Weight (compare with recent clinic weight to ascertain level of dehydration)
