Diabetes: Paediatrics Considerations Flashcards
What is the diagnosis for kids?
Fasting plasma glucose >7.0mmol/L
2hr plasma glucose >11.1mmol/L during oral glucose tolerance test
What do you not use routinely in diagnosis?
HbA1c
What are the 4 diagnostic symptoms?
Thin
Tired
Thirsty
Thin
What are other diagnostic tools?
Diabetes associates Abs
C-peptide = breakdown of insulin
Family Hx
Diabetes in 1st 6 months of life
Hx of exposure to harmful drugs of beta cells
What annual report is available?
NPDA
What is the main consideration?
Can’t always look after themselves so it is the parents that your are counselling
What are essential annual checks?
HbA1c
BMI
BP
Urinary albumin
Thyroid screening
Eye screening
Foot examination
What do the guidelines recommend for the checks?
Start at age of 12 except for BMI + thyroid screening
Which checks should be done every 3 months?
BMI
HbA1c
What is HbA1c used for?
Guide treatment + intensification of targets
What is the national mean target for HbA1c in children with T1DM?
67.5mmol/mol
What factors are associated with high HbA1c levels?
Older age
Female
Living in more deprived areas
Having non-white ethnicity
Longer duration of diabetes
What are the complications?
Retinopathy
Nephropathy
HTN
Juvenile cataracts
Addison’s Disease
What are associated conditions?
Coeliac
Thyroid disease
What are the psychological needs?
Increased incidence of depression, anxiety, psychological distress + eating disorders
Repast DKA/poor control = psychological disorders
What are the insulin treatment options?
Basal-bolus dosing
Biphasic insulin
CSII = closed loop
What are the glucose monitoring devices available?
rtCGM
isCGM = only offered when child cannot use rtCGM or prefer isCGM
How do you treat DKA?
NO oral = risk of aspiration
NO IV bolus
Lower than standard rate of fluid maintenance = risk of cerebral oedema
40mmol/L K+
Disconnect pump therapy will on IV insulin + restart 30mins prior to stopping fixed rate insulin
What is there a risk of in DKA?
Cerebral oedema
Hypokalaemia
Venous thromboembolism
What are the T2DM features?
Obese
Family Hx
High risk ethnicity = Afro-Caribbean/south Asian
Undetectable islet
Elevated C-peptide
What must be checked in T2DM annually?
HbA1c - every 3 months
BMI - every 3 months
BP
Urinary albumin
Cholesterol
Eyes
Feet
What is the only approved T2DM treatment?
Metformin + insulin
What is the treatment for HbA1c <8.5%?
T2DM
Metformin
What is the treatment >8.5%?
T2DM
Metformin
Basal insulin
What is the treatment DKA/HHS?
T2DM
Manage DKA
IV insulin till acidosis resolves
What should CYP with diabetes have?
Referred to specialist paediatric diabetes service
Attend clinic at least 4x/year
Ensure continuity of care across adult services
