Diabetes: Paediatrics Considerations

Question 1

What is the diagnosis for kids?

Answer 1

Fasting plasma glucose >7.0mmol/L
2hr plasma glucose >11.1mmol/L during oral glucose tolerance test

Question 2

What do you not use routinely in diagnosis?

Answer 2

HbA1c

Question 3

What are the 4 diagnostic symptoms?

Answer 3

Thin
Tired
Thirsty
Thin

Question 4

What are other diagnostic tools?

Answer 4

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

Question 5

What annual report is available?

Answer 5

NPDA

Question 6

What is the main consideration?

Answer 6

Can’t always look after themselves so it is the parents that your are counselling

Question 7

What are essential annual checks?

Answer 7

HbA1c
BMI
BP
Urinary albumin
Thyroid screening
Eye screening
Foot examination

Question 8

What do the guidelines recommend for the checks?

Answer 8

Start at age of 12 except for BMI + thyroid screening

Question 9

Which checks should be done every 3 months?

Answer 9

BMI
HbA1c

Question 10

What is HbA1c used for?

Answer 10

Guide treatment + intensification of targets

Question 11

What is the national mean target for HbA1c in children with T1DM?

Answer 11

67.5mmol/mol

Question 12

What factors are associated with high HbA1c levels?

Answer 12

Older age
Female
Living in more deprived areas
Having non-white ethnicity
Longer duration of diabetes

Question 13

What are the complications?

Answer 13

Retinopathy
Nephropathy
HTN
Juvenile cataracts
Addison’s Disease

Question 14

What are associated conditions?

Answer 14

Coeliac
Thyroid disease

Question 15

What are the psychological needs?

Answer 15

Increased incidence of depression, anxiety, psychological distress + eating disorders
Repast DKA/poor control = psychological disorders

Question 16

What are the insulin treatment options?

Answer 16

Basal-bolus dosing
Biphasic insulin
CSII = closed loop

Question 17

What are the glucose monitoring devices available?

Answer 17

rtCGM
isCGM = only offered when child cannot use rtCGM or prefer isCGM

Question 18

How do you treat DKA?

Answer 18

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

Question 19

What is there a risk of in DKA?

Answer 19

Cerebral oedema
Hypokalaemia
Venous thromboembolism

Question 19

What are the T2DM features?

Answer 19

Obese
Family Hx
High risk ethnicity = Afro-Caribbean/south Asian
Undetectable islet
Elevated C-peptide

Question 20

What must be checked in T2DM annually?

Answer 20

HbA1c - every 3 months
BMI - every 3 months
BP
Urinary albumin
Cholesterol
Eyes
Feet

Question 21

What is the only approved T2DM treatment?

Answer 21

Metformin + insulin

Question 22

What is the treatment for HbA1c <8.5%?
T2DM

Answer 22

Metformin

Question 23

What is the treatment >8.5%?
T2DM

Answer 23

Metformin
Basal insulin

Question 24

What is the treatment DKA/HHS?
T2DM

Answer 24

Manage DKA
IV insulin till acidosis resolves

Question 25

What should CYP with diabetes have?

Answer 25

Referred to specialist paediatric diabetes service
Attend clinic at least 4x/year
Ensure continuity of care across adult services