Endocrine and metabolic disorders Flashcards
What are some triggers for T1DM?
Enteroviral infections (accounting for more frequent diagnoses in spring and autumn), and diet (possibly cows milk proteins) and overnutrition
What are some markers of pancreatic beta cell destruction?
Islet cell antibodies and antibodies to glutamic acid decarboxylase (GAD), the islet cells and insulin.
What other disease is T1DM associated with?
Other autoimmune diseases such as hyperthyroidism, Addison disease, coeliac disease and RA.
When does T1DM present?
There are two peaks of presentation, preschool and teenagers. It is commoner to present in spring or autumn
How do children often present with T1DM?
Only a few weeks of polyuria, excessive thirst and weight loss; young children may develop secondary nocturnal enuresis.
What are the symptoms of DKA in children?
Acetone breath Vomiting Dehydration Abdo pain Kussmal breathing Hypovolaemic shock Drowsiness Coma and death
What is diabetic blood glucose (random and fasting) in children?
Random - >11.1mmol/L
Fasting - >7mmol/L
How do you diagnose DM?
Raised glucose
Glycosuria
Ketonuria
Raised HbA1c
What does the diabetes educational programme involve for newly diagnosed children?
Understanding pathophysiology
Injection of insulin: technique and sites
Diet: reduce refined carbs - carb counting
Adjustments of diet and insulin for exercise
‘Sick-day rules’ to prevent DKA
Blood glucose monitoring
Hypoglycaemia recognition
Where to get help
What are the different types of insulin?
Human insulin analogues - rapid-acting analogues (faster onset and shorter duration than soluble regular insulin) and very long-acting analogues.
Short acting soluble human regular insulin
Intermediate acting insulin
What are the time frames of short acting soluble human regular insulin?
Onset - 30-60 minutes
Peak - 2-4 hours
Duration - up to 8 hours
Given 15-30 minutes before meals
What are the time frames of intermediate acting soluble human regular insulin?
Onset - 1-2 hours
Peak - 4-12 hours
How can insulin be given?
Continuous infusion of rapid-acting insulin from a pump
Injections
Pen-like devices with insulin-containing cartridges
Jet injectors that inject insulin needle-free as a fine stream into the subcutaneous tissue
Where can insulin be injected?
Upper arm, the anterior and lateral aspect of the thigh, the buttocks and the abdomen
How is insulin fitted into a normal day?
An insulin pump or 3-4 times/day injection regimen with short acting insulin being given before each meal and snack plus long-acting insulin in the late evening and/or before breakfast to provide insulin background
What is the ‘honeymoon period’ of diabetes diagnosis?
Shortly after presentation, when some pancreatic function is preserved, insulin requirements often become minimal.
What nutrition is recommended?
A healthy diet with high complex carbohydrate and fibre and relatively low fat content
What blood glucose levels are you aiming to maintain?
4-6mmol/L
When would you monitor blood ketones?
It is mandatory during infection or the control is poor to try to avoid severe ketoacidosis
What sort of things increase blood glucose levels?
Omission of insulin Food (esp. refined carbs) Illness Menstruation (shortly before onset) GH Corticosteroids Sex hormones at puberty Stress of an operation
What sort of things decrease blood glucose levels?
Insulin Exercise Alcohol Some drugs Marked anxiety/excitement
What disease can affect HbA1c levels?
Sickle cell or thalassaemia
What do you want the HbA1c levels to be?
<58mmol/mol
Below what blood glucose would hypo symptoms normally start?
4mmol/L
