DISORDERS OF CARBOHYDRATE METABOLISM Flashcards
What are the paediatric criteria for the diagnosis of diabetes in terms of blood sugar?
Actually the same as adulthood
Random blood glucose above 11.1 mmol/L
Fasting blood sugar above 7.0 mmol/L
OGTT 2-hour sugar reading above 11.1 mmol/L
What are the other autoimmune conditions associated with type 1 diabetes?
Coeliac disease
Addison’s disease
Rheumatoid arthritis
Thyroiditis
What are the HLA complexes associated with type 1 diabetes?
HLA-DR3
HLA-DR4
What is the average requirement of insulin replacement in a type 1 diabetic?
0.5 - 1.0 unit/kg/day
What are the different types of insulin available as replacement therapy?
Rapid acting
Short acting
Intermediate acting
Long acting
Name a type of rapid acting insulin replacement.
NovoRapid (insulin aspart)
Humalog
What is the time for onset of action of rapid acting insulin replacement such as NovoRapid?
About 15 mins
What is the duration of action of rapid acting insulin replacement such as NovoRapid?
1 - 5 hours
Name a type of short acting insulin replacement.
Actrapid
Humulin (soluble insulin)
What is the time for onset of action of short acting insulin replacement such as Actrapid?
30 - 60 minutes
What is the duration of action of short acting insulin replacement such as Actrapid?
Up to 8 hours
Name a type of intermediate acting insulin replacement.
Insulatard
Isophane insulin
What is the time for onset of action of intermediate acting insulin replacement such as Insulatard?
1 - 2 hours
What is the duration of action of intermediate acting insulin replacement such as Insulatard?
16 - 35 hours (peak 4 - 12 hours)
Name a type of long acting insulin replacement.
Levemir (insulin detemir)
Lantus (insulin glargine)
What is the time for onset of action of long acting insulin replacement such as Levemir?
Steady state in 3-4 days
What is the duration of action of long acting insulin replacement such as Levemir?
Constant
What is a standard insulin regimen for a type 1 diabetic?
Biphasic regimen of normally two injections (one in the morning and one before the evening meal): these are usually injections of short-acting insulin or rapid-acting insulin analogue mixed with intermediate-acting insulin
Name a type of biphasic insulin replacement.
NovoMix 30
Humalog 25 or 50
Apart from biphasic insulin replacement regimen, what other options are available as insulin replacement therapy?
Multiple daily injections of rapid acting with meals (before or after)
Continuous subcutaneous insulin infusion using a pump
What are the sites of injection usually chosen for administering insulin replacement?
Upper arms
Outer thighs
Abdomen
All subcutaneous
What are the local complications of insulin injections?
Fat atrophy
When in a child’s life would the amount of insulin needed tend to increase?
Puberty - multiple injections or continuous pump may be better at this point for glycaemic control
Name the members of the MDT team that will be utilised in the care of a child with newly diagnosed type 1 diabetes.
Endocrine doctors
Specialist diabetes nurse
Dietician
GP
Pharmacists
Clinical psychologists
Support groups
Schools
Parents
What dietary advice must be given to the parents of a child who has recently been diagnosed with type 1 diabetes?
Avoid foods containing refined carbohydrates such as sweets and ice cream
Try and stick to a regime to match up insulin with diet
Food intake should be increased before or after heavy exercise to avoid hypoglycaemic episodes
At what sugar level do patients tend to experience symptoms of hypoglycaemia?
Below 4 mmol/L
What are the initial midler symptoms of hypoglycaemia?
Feeling faint, dizzy or wobbly
Sweating
Tremulousness
Hunger
What are the more severe later symptoms of hypoglycaemia?
Lethargy
Bizarre behaviour
Coma
Seizures
What can diabetic children be prescribed as rescue kits for hypoglycaemia?
Dextragel
Glucagon (1 mg IM) in severe cases
What are the non-iatrogenic (not related to insulin replacement) causes of hypoglycaemia in children?
Ketotic hypoglycaemia
Liver disease
Inborn errors of metabolism eg glycogen storage disorders
Adrenocortical insufficiency eg Addison’s or congenital adrenal hyperplasia
Panhypopituitarism
Growth hormone deficiency
Hyperinsulinism - islet cell adenoma
On examination, what are the signs that might be seen in a hypoglycaemic child?
Tachycardia
Sweating
Pallor
Seizures
Decreased consciousness
What is the precise definition of hypoglycaemia?
Blood glucose less than 2.6 mmol/L. This corresponds to changes on the EEG.
What investigations should be done in a child that presents with hypoglycaemia?
Plasma insulin
Plasma growth hormone
Plasma cortisol
Beta-hydroxybutyrate
Urine tested for ketones
How do we treat a child with hypoglycaemia regardless of the cause?
If conscious: give sugary drink
If unconscious or unable to drink: 2ml/kg IV 10% dextrose
Glucagon can be given in cases where glycogen stores are not deplete. Eg insulin overdose.
What are the clinical features of ketotic hypoglycaemia?
Recurrent episodes of:
Vomiting - ketosis
Abdominal pain - ketosis
Lethargy and malaise - hypo
Seizures - hypo
What can precipitate ketotic hypoglycaemia?
A short period of starvation such as a slightly elongated time between evening meal and breakfast.
Viral infection
What age group is most commonly affected by ketotic hypoglycaemia?
1 - 4 year olds
