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PAEDIATRICS > DISORDERS OF CARBOHYDRATE METABOLISM > Flashcards

DISORDERS OF CARBOHYDRATE METABOLISM Flashcards

1
Q

What are the paediatric criteria for the diagnosis of diabetes in terms of blood sugar?

A

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

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2
Q

What are the other autoimmune conditions associated with type 1 diabetes?

A

Coeliac disease

Addison’s disease

Rheumatoid arthritis

Thyroiditis

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3
Q

What are the HLA complexes associated with type 1 diabetes?

A

HLA-DR3

HLA-DR4

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4
Q

What is the average requirement of insulin replacement in a type 1 diabetic?

A

0.5 - 1.0 unit/kg/day

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5
Q

What are the different types of insulin available as replacement therapy?

A

Rapid acting

Short acting

Intermediate acting

Long acting

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6
Q

Name a type of rapid acting insulin replacement.

A

NovoRapid (insulin aspart)

Humalog

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7
Q

What is the time for onset of action of rapid acting insulin replacement such as NovoRapid?

A

About 15 mins

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8
Q

What is the duration of action of rapid acting insulin replacement such as NovoRapid?

A

1 - 5 hours

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9
Q

Name a type of short acting insulin replacement.

A

Actrapid

Humulin (soluble insulin)

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10
Q

What is the time for onset of action of short acting insulin replacement such as Actrapid?

A

30 - 60 minutes

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11
Q

What is the duration of action of short acting insulin replacement such as Actrapid?

A

Up to 8 hours

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12
Q

Name a type of intermediate acting insulin replacement.

A

Insulatard

Isophane insulin

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13
Q

What is the time for onset of action of intermediate acting insulin replacement such as Insulatard?

A

1 - 2 hours

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14
Q

What is the duration of action of intermediate acting insulin replacement such as Insulatard?

A

16 - 35 hours (peak 4 - 12 hours)

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15
Q

Name a type of long acting insulin replacement.

A

Levemir (insulin detemir)

Lantus (insulin glargine)

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16
Q

What is the time for onset of action of long acting insulin replacement such as Levemir?

A

Steady state in 3-4 days

17
Q

What is the duration of action of long acting insulin replacement such as Levemir?

A

Constant

18
Q

What is a standard insulin regimen for a type 1 diabetic?

A

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

19
Q

Name a type of biphasic insulin replacement.

A

NovoMix 30

Humalog 25 or 50

20
Q

Apart from biphasic insulin replacement regimen, what other options are available as insulin replacement therapy?

A

Multiple daily injections of rapid acting with meals (before or after)

Continuous subcutaneous insulin infusion using a pump

21
Q

What are the sites of injection usually chosen for administering insulin replacement?

A

Upper arms

Outer thighs

Abdomen

All subcutaneous

22
Q

What are the local complications of insulin injections?

A

Fat atrophy

23
Q

When in a child’s life would the amount of insulin needed tend to increase?

A

Puberty - multiple injections or continuous pump may be better at this point for glycaemic control

24
Q

Name the members of the MDT team that will be utilised in the care of a child with newly diagnosed type 1 diabetes.

A

Endocrine doctors

Specialist diabetes nurse

Dietician

GP

Pharmacists

Clinical psychologists

Support groups

Schools

Parents

25
Q

What dietary advice must be given to the parents of a child who has recently been diagnosed with type 1 diabetes?

A

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

26
Q

At what sugar level do patients tend to experience symptoms of hypoglycaemia?

A

Below 4 mmol/L

27
Q

What are the initial midler symptoms of hypoglycaemia?

A

Feeling faint, dizzy or wobbly

Sweating

Tremulousness

Hunger

28
Q

What are the more severe later symptoms of hypoglycaemia?

A

Lethargy

Bizarre behaviour

Coma

Seizures

29
Q

What can diabetic children be prescribed as rescue kits for hypoglycaemia?

A

Dextragel

Glucagon (1 mg IM) in severe cases

30
Q

What are the non-iatrogenic (not related to insulin replacement) causes of hypoglycaemia in children?

A

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

31
Q

On examination, what are the signs that might be seen in a hypoglycaemic child?

A

Tachycardia

Sweating

Pallor

Seizures

Decreased consciousness

32
Q

What is the precise definition of hypoglycaemia?

A

Blood glucose less than 2.6 mmol/L. This corresponds to changes on the EEG.

33
Q

What investigations should be done in a child that presents with hypoglycaemia?

A

Plasma insulin

Plasma growth hormone

Plasma cortisol

Beta-hydroxybutyrate

Urine tested for ketones

34
Q

How do we treat a child with hypoglycaemia regardless of the cause?

A

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.

35
Q

What are the clinical features of ketotic hypoglycaemia?

A

Recurrent episodes of:

Vomiting - ketosis

Abdominal pain - ketosis

Lethargy and malaise - hypo

Seizures - hypo

36
Q

What can precipitate ketotic hypoglycaemia?

A

A short period of starvation such as a slightly elongated time between evening meal and breakfast.

Viral infection

37
Q

What age group is most commonly affected by ketotic hypoglycaemia?

A

1 - 4 year olds

PAEDIATRICS (41 decks)

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