Endocrinology Flashcards
What is the most common type of diabetes in children?
Type 1 diabetes
What is the normal ranges of glucose in a child?
Fasting = 3.5-5.6 mmol/l
Post prandial = <7.8 mmol/l
How do you diagnose type 1 diabetes in children?
Oral Glucose tolerance test or random plasma glucose
What are the values needed to diagnose diabetes in an OGTT?
Diabetes
Fasting = ≥7.0mmol/L
Random = ≥11.1mmol/l
HbA1c = > 6.5%
What are the main symptoms of T1 Diabetes?
Toilet, thirst, tired, thinner
What genes have been indentified to be linked with Type 1 diabetes?
HLADR3
HLADR4
What are the relative risks associated with having a family history of diabetes?
Mother - 2% risk
Father - 8% risk
Both parents - 30% risk
How does diabetes present in the late stages?
Ketoacidosis
Are ketones are normally found in the blood?
<0.6 in blood
Why would you do a blood gas in a newly diagnosed type 1?
IE. pH 7.06 pCO2 2.8 BE – 15 HC03 13
Shows Metabolic Acidosis
(CO2 low - HCO3 High)
What are the steps to manage DKA?
Fluid!!! Insulin Monitor glucose hourly Monitor electrolytes, especially K+ and ketones - 2 hourly Very strict fluid balance - hourly I/O Hourly neuro obs
What are the dangerous complications in DKA after treatment ?
cerebral oedema shock hypokalaemia aspiration thrombus
What are the fluid deficit assumptions for a child in varying degrees of DKA?
Assume a 5% fuid defcit in mild DKA (indicated by a
blood pH 7.2-7.29 &/or bicarbonate <15)
Assume a 7% fuid defcit in moderate DKA (indicated by a
blood pH of 7.1- 7.19 &/or bicarbonate <10)
Assume a 10% fuid defcit in severe DKA (indicated by a
blood pH <7.1 &/or bicarbonate <5
What is the Fluid management for DKA?
Do not subtract boluses given for shock
Give normal maintenance fuids + correct the
defcit
Correct for dehydration over 48 hours
Calculate the fluid needed for a 26kg male child after boluses of fluid are given?
Replacement:
26 kg = 26L x 10% = 2.6L
dehydrated (2600 ml)
2600 / 48 hours = 54 ml/hr
Maintenance
1620ml (Using 100,50,20 rule)
68 ml/hr
Total
122 ml/hr
What are the symptoms of a Hypo?
Irritable • Hungry • Nauseous • Shakey • Pallor • Anxious • Sweaty • Palpitations • Pallor
What is the management for a mild Hypo?
Check blood glucose to confirm
3-5 glucose tablets
100-200ml fizzy drink (not diet) or juice
60-100mls lucozade
Wait 10 minutes - if no improvement repeat
FU with longer acting carb (bread/biscuit)
Check BG in 15 minutes
What is the management for a moderate Hypo?
As for mild if possible
If too unwell - 0.5-1 tube glucogel
Wait 10 minutes - if no improvement repeat
FU with longer acting carb (bread/biscuit)
Check BG in 15 minutes
What is the management for a severe Hypo?
Do not attempt to give anything by mouth Glucagon - s/c or i/m injection if < 5 years = 0.5mg if > 5 years = 1mg Wait 10 minutes When conscious give sugary
What are the main goals fo Type 1 management?
Normal growth and development As normal a childhood as possible Transition with optimal HbA1c to help prevent complications Avoidance of XS or severe hypos
what is the normal carbohydrate to insulin ration?
1 unit for every 15 grams. (Correction factor 1 unit to bring blood glucose down by 8 (aiming for a BG of 6))
If Current blood
glucose: 14.2
About to eat 50g of fusilli (With 17 grams carbs)
How much insulin will be needed?
17g = 1 units Correction = 1 unit
Want to bring it down by 8 aswell
so +1 unit
Total = 2 units
What do we monitor in patients with T1D
HbA1c - 3-month profile
BG log book/download
AI screen
CHANCE TO EDUCATE • Alcohol • Contraception • Knowledge - exercise, sick day rules
What should you always examine in a T1D?
Eyes • Urine • Feet • Blood pressure • Injection sites
