DISORDERS OF CARBOHYDRATE METABOLISM Flashcards by

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

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

Coeliac disease

Addison’s disease

Rheumatoid arthritis

Thyroiditis

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What are the HLA complexes associated with type 1 diabetes?

HLA-DR3

HLA-DR4

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

0.5 - 1.0 unit/kg/day

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

Rapid acting

Short acting

Intermediate acting

Long acting

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Name a type of rapid acting insulin replacement.

NovoRapid (insulin aspart)

Humalog

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

About 15 mins

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

1 - 5 hours

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Name a type of short acting insulin replacement.

Actrapid

Humulin (soluble insulin)

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

30 - 60 minutes

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

Up to 8 hours

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Name a type of intermediate acting insulin replacement.

Insulatard

Isophane insulin

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

1 - 2 hours

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

16 - 35 hours (peak 4 - 12 hours)

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Name a type of long acting insulin replacement.

Levemir (insulin detemir)

Lantus (insulin glargine)

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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

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