Endocrine 1 Flashcards
What are the clinical features of hypoglycaemia?
• Hypoglycaemia is defined as plasma glucose <2.2-2.6mmol/L o Sweating o Pallor o CNS signs Irritability Headache Seizures Coma • The neurological sequelae may be permanent if hypoglycaemia persists- include epilepsy, severe learning difficulties and microcephaly
What are the causes of hypoglycaemia?
Endocrine: Hyperinsulinism Hypopituitarism Growth hormone insufficiency Hypothyroidism Congenital adrenal hyperplasia Metabolic: Glycogen storage disease Glactosaemia Organic acidaemia Ketotic hypoglycaemia Carnitine deficiency Acyl-CoA dehydrogenase deficiency Toxic: Salicylates Alcohol Insulin Valporate Hepatic: Hepatitis Cirrhosis Reye syndrome Systemic: Starvation Malnutrition Sepsis Malabsorption
When should blood glucose be checked in a child?
o Becomes septicaemic or appears seriously ill
o Has a prolonged seizure
o Develops an altered state of consciousness
What is ketotic hypoglycaemia?
children readily become hypoglycaemic following a short period of starvation, probably due to limited reserves for gluconeogenesis
Short and low insulin levels
Condition resolves spontaneously in later life
What is persistent hypoglycaemia hyperinsulinism of infancy (PHHI)?
rare disorder of infancy, where there are gene mutations of various pathways leading to
dysregulation of insulin release by the islet cells of the pancreas leading to profound non-ketotic hypoglycaemia
Treated with dextrose and diazoxide
40% of cases are caused by localized lesions in the pancreas amenable to partial resection
Majority of cases either require long-term medication or total pancreatectomy with the attendant risk of diabetes and exocrine pancreatic insufficiency
What are the fasting causes go hypoglycaemia insulin excess?
Excess exogenous insulin eg DM or administered insulin
Beta cell tumours/disorders- PHHI or insulinoma
Drug-induced- sulphonylurea
Autoimmune- insulin receptor antibodies
Beckwith syndrome
What are the fasting causes of hypoglycaemia Non insulin excess?
Liver disease
Ketotic hypoglycaemia of childhood
Inborn errors of metabolism eg. glycogen storage disorders
Hormonal deficiency- GH, ACTH, Addison disease, congenital adrenal hyperplasia
What are the reactive/non-fasting causes of hypoglycaemia?
o Galactosaemia o Leucine sensitivity o Fructose intolerance o Maternal diabetes o Hormonal deficiency o Aspirin/Alcohol poisoning
What are the investigations for hypoglycaemia?
U+Es, LFTs, osmolality and blood glucose GH IGF-1 Cortisol Insulin C-peptide Fatty acids Ketones Glycerol o Branched- chained AA o Acylcarnitine profile o Lactate o Pyruvate Organic acids in urine Blood and urine for toxicology
What is the treatment for hypoglycaemia?
IV infusion of glucose- 2ml/kg of 10% dextrose followed by 10% dextrose infusion
• Care must be taken to avoid giving an excess volume as the solution is hypertonic and could causes cerebral oedema
• If there is delay in establishing an infusion or failure to respond- glucagon is give IM (0.5-1mg)
• If a higher concentration than a 10% solution is required in a neonate- the low sugar is highly likely to be secondary to hyperinsulinaemia
• Corticosteroids may also be used if there is a possibility of hypopituitarism or hypoadrenalism
How do children with diabetes present?
o Polyuria o Excessive thirst o Weight loss o Nocturnal enuresis- young children o Skin sepsis o Candida infection
What is the intensive education given when a diabetes diagnosis is made?
o The basic understanding o Injection techniques o Diet o Adjustments of insulin for sickness or exercise o Blood glucose check o Recognition of hypoglycaemia o Where to get help o Support groups & psychological support
Which insulin regime is normally given to children?
insulin pump or 3-4 times/day injection regimen (basal bolus) with a short acting insulin before snacks (bolus) and a long acting insulin in the evening (basal)
• Normally, requirements are 0.5-1U/kg in children, but this can increase to >2U/kg/day in puberty
What diet should be given to children with diabetes?
- Should be matched to the insulin regimen- the aim is to maintain control whilst getting good growth
- High complex carbohydrates are recommended and relatively low fat content <30% of calories
- The diet should be high in fibres- avoidance of food that will cause rapid sugar highs
How should blood glucose levels be measured?
the aim is to maintain blood glucose at 4-6mmol/L, but in practice this is 4-10 in children and 4-8 in adults, to avoid hypoglycaemia
measuring HbA1c is useful to check long term control over 6-12 weeks and should be checked at least x3 per year
• The aim is to keep the levels below 7.5% or <58mmol/L
