Paediatric Aspects of Diabetes Flashcards
diagnostic criteria for type 1 diabetes in children?
fasting BG >7
random BG >11
how does DKA management differ in children and adults?
children:
- based on weight
- careful fluid resuscitation
- risk of cerebral oedema highlighted
- insulin commenced 1 hr after IV fluids started
what should all children with diabetes receive?
attend diabetes clinics registered with SCI normal growth and development shouldn't affect school attendance be aware of protocols for treatment of emergency events achieve best possible HbA1c avoid readmission to hospital, DKA etc support for independence in teenage years
why is tight control important in children?
to achieve targets
easier to understand
how can poor glycaemic control affect children?
social and emotional disruption
sub-optimal growth
biophysical changes of micro-vascular disease
what early changes can indicate vascular disease in children?
microalbuminaemia cardio autonomic neuropathy sensory nerve damage retinopathy cheiroarthropathy skin vascular changes vascular endothelial pathology
what is a risk with tight glycaemic control in children?
hypoglycaemia
social effects esp in teenage years
what is the insulin carb ratio?
amount of insulin needed per amount of carbs in meals
e.g - 1 unit per 10g
what 3 factors influence amount of insulin needed?
blood glucose
insulin carb ratio
insulin sensitivity factor
risk with insulin pumps?
if theyre giving continuous short acting insulin, then if it stops and you don’t realise blood glucose will rise rapidly and can result in DKA
what is SCI-diabetes?
national database
individuals data is used to drive improvement and monitor improvement over time
what can cause primary congenital thyroid disease?
dysplastic gland +/- abnormal site of gland (e.g sublingual)
inborn error of thyroid hormone metabolism
what can cause secondary/tertiary congenital thyroid disease?
congenital pituitary disease
- usually hypopituitarism
what are the clinical features of congenital thyroid disease?
delayed jaundice poor feeding but normal weight gain hypotonia - umbilical hernia, constipation skin and hair changes
how can congenital thyroid disease be screened for?
Guthrie test
heel prick - capillary blood spot on to dry blotting paper on day 5 of life
measurement of TSH and/or T4 levels
how is congenital thyroid disease managed?
early therapy (
- target = 2 weeks
- window for treatment = 2-3 months
how does congenital thyroid disease present and why?
“cretinism”
foetus protected by placental thyroid hormones, absence of thyroxine after 3 months leads to cretinism features
what can cause acquired thyroid disease in the young?
delayed congenital post infection autoimmune iodine deficiency and nutrition other autoimmune diseases (e.g type 1 diabetes)
what are the symptoms of hypothyroidism in the young?
slow progress growth failure, delayed puberty poor general health educational difficulties goitre high TSH and low T3/T4 high thyroid antibody titres
how is hypothyroidism managed in the young?
thyroxine replacement in the young
dose related to size of child
what are the symptoms of hyperthyroidism in the young?
behaviour problems sleep disturbance eating difficulties goitre high pulse rate precocious puberty low TSH, high T3/T4 high thyroid antibodies
how is hyperthyroidism managed in the young?
beta blockers
suppressant therapy
- first 2 years = carbimazole +/- thyroxine
permanent cure = radioiodine or surgery
what can cause primary underactive adrenal glands in the young?
adenal hypoplasia (absent/dysplastic/destroyed)
inborn error of metabolism
congenital adrenal hyperplasia
what can cause secondary underactive adrenal glands in the young?
pituitary disease (congenital/acquired) suppression secondary to steroid therapy (high and long dose)
what can cause overactive production of steroids in the young?
high dose cortisol therapy cushings disease (primary adrenal, secondary pituitary)
what are possible features of congenital adrenal hyperplasia?
absent cortisol and aldosterone - can lead to an Addison crisis
virilisation
- ambiguous genitalia in females
- precocious puberty in males
what is an Addison crisis and how is it managed?
hyponatraemia, hyperkalaemia and hypotension
management = salt and cortisol
what can assist initial diagnosis of ambiguous genitalia?
CAH or other steroid abnormalities
gene and other chromosomal abnormalities
congenital defects
name 3 substances produced in the adrenal cortex and list 3 possible problems
aldosterone cortisol testosterone 21 hydroxylase deficiency absent cortisol high testosterone conversion
what hormones are involved in determination of sex?
MIS
androgens
- no MIS or androgens = female development
- MIS and androgens present = male development
