Paediatric Aspects of Diabetes

Question 1

diagnostic criteria for type 1 diabetes in children?

Answer 1

fasting BG >7

random BG >11

Question 2

how does DKA management differ in children and adults?

Answer 2

children:

• based on weight
• careful fluid resuscitation
• risk of cerebral oedema highlighted
• insulin commenced 1 hr after IV fluids started

Question 3

what should all children with diabetes receive?

Answer 3

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

Question 4

why is tight control important in children?

Answer 4

to achieve targets

easier to understand

Question 5

how can poor glycaemic control affect children?

Answer 5

social and emotional disruption
sub-optimal growth
biophysical changes of micro-vascular disease

Question 6

what early changes can indicate vascular disease in children?

Answer 6

microalbuminaemia
cardio autonomic neuropathy
sensory nerve damage
retinopathy
cheiroarthropathy
skin vascular changes
vascular endothelial pathology

Question 7

what is a risk with tight glycaemic control in children?

Answer 7

hypoglycaemia

social effects esp in teenage years

Question 8

what is the insulin carb ratio?

Answer 8

amount of insulin needed per amount of carbs in meals

e.g - 1 unit per 10g

Question 9

what 3 factors influence amount of insulin needed?

Answer 9

blood glucose
insulin carb ratio
insulin sensitivity factor

Question 10

risk with insulin pumps?

Answer 10

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

Question 11

what is SCI-diabetes?

Answer 11

national database

individuals data is used to drive improvement and monitor improvement over time

Question 12

what can cause primary congenital thyroid disease?

Answer 12

dysplastic gland +/- abnormal site of gland (e.g sublingual)

inborn error of thyroid hormone metabolism

Question 13

what can cause secondary/tertiary congenital thyroid disease?

Answer 13

congenital pituitary disease

- usually hypopituitarism

Question 14

what are the clinical features of congenital thyroid disease?

Answer 14

delayed jaundice
poor feeding but normal weight gain
hypotonia
- umbilical hernia, constipation
skin and hair changes

Question 15

how can congenital thyroid disease be screened for?

Answer 15

Guthrie test
heel prick - capillary blood spot on to dry blotting paper on day 5 of life
measurement of TSH and/or T4 levels

Question 16

how is congenital thyroid disease managed?

Answer 16

early therapy (

• target = 2 weeks
• window for treatment = 2-3 months

Question 17

how does congenital thyroid disease present and why?

Answer 17

“cretinism”

foetus protected by placental thyroid hormones, absence of thyroxine after 3 months leads to cretinism features

Question 18

what can cause acquired thyroid disease in the young?

Answer 18

delayed congenital
post infection
autoimmune
iodine deficiency and nutrition
other autoimmune diseases (e.g type 1 diabetes)

Question 19

what are the symptoms of hypothyroidism in the young?

Answer 19

slow progress
growth failure, delayed puberty
poor general health
educational difficulties
goitre
high TSH and low T3/T4
high thyroid antibody titres

Question 20

how is hypothyroidism managed in the young?

Answer 20

thyroxine replacement in the young

dose related to size of child

Question 21

what are the symptoms of hyperthyroidism in the young?

Answer 21

behaviour problems
sleep disturbance
eating difficulties
goitre
high pulse rate
precocious puberty
low TSH, high T3/T4
high thyroid antibodies

Question 22

how is hyperthyroidism managed in the young?

Answer 22

beta blockers
suppressant therapy
- first 2 years = carbimazole +/- thyroxine
permanent cure = radioiodine or surgery

Question 23

what can cause primary underactive adrenal glands in the young?

Answer 23

adenal hypoplasia (absent/dysplastic/destroyed)
inborn error of metabolism
congenital adrenal hyperplasia

Question 24

what can cause secondary underactive adrenal glands in the young?

Answer 24

pituitary disease (congenital/acquired)
suppression secondary to steroid therapy (high and long dose)

Question 25

what can cause overactive production of steroids in the young?

Answer 25

high dose cortisol therapy
cushings disease (primary adrenal, secondary pituitary)

Question 26

what are possible features of congenital adrenal hyperplasia?

Answer 26

absent cortisol and aldosterone - can lead to an Addison crisis
virilisation
- ambiguous genitalia in females
- precocious puberty in males

Question 27

what is an Addison crisis and how is it managed?

Answer 27

hyponatraemia, hyperkalaemia and hypotension

management = salt and cortisol

Question 28

what can assist initial diagnosis of ambiguous genitalia?

Answer 28

CAH or other steroid abnormalities
gene and other chromosomal abnormalities
congenital defects

Question 29

name 3 substances produced in the adrenal cortex and list 3 possible problems

Answer 29

aldosterone
cortisol
testosterone
21 hydroxylase deficiency
absent cortisol
high testosterone conversion

Question 30

what hormones are involved in determination of sex?

Answer 30

MIS
androgens
- no MIS or androgens = female development
- MIS and androgens present = male development