Paediatric Diabetes and Endocrinology

Question 1

Explain insulin physiology (effects of insulin and lack of insulin)

Answer 1

• Effects of Insulin
  
  • Stimulates glucose uptake into liver and muscle
  • Stimulates liver and muscle to store glucose as glycogen
  • Stops production of glucose in liver (Gluconeogenesis)
• Lack of Insulin
  
  • Stops uptake of glucose from blood into liver and muscle
  • Stimulates breakdown of glycogen into free fatty acids and ketones
  • Stimulates hepatic gluconeogenesis

Question 2

What are the signs and symptoms of diabetes?

Answer 2

• Polyuria / polydyspia
• Weight loss
• DKA
• Unusual infections
• Vomiting, abdo pain, dehydration
• SOB
• Fracture clinic, out pt, testicular pain
• Thrush (common in females)

Question 3

Explain D.K.A

Answer 3

• Children die from DKA
• PH<7.3 ( >7.1 mild-mod / <7.1 severe)
• Ketosis/ketouria
• Glu >11
• And dehydration >5%, drowsy, vomiting, Bicarb <15 (low)
• Cerebral oedema
• Hypoglycaemia

Monitoring and Treatment

• Fluids to rehydrate slowly
  
  • Sodium and potassium are depleted but need careful monitoring
• Insulin needed for resolving acidosis and improving sugar’s
• Don’t stop or turn down Insulin until ketosis and dehydration improved

Question 4

Explain insulin secretion

Answer 4

Question 5

Explain injectable insulins

Answer 5

•Short Acting•Novorapid / Humalog•Onset 15 mins, peak action 2 hours, lasts at most 3-4 hours•Actrapid•Used IV in DKA•Long Acting•Degludec (Tresiba)•Onset 2-4 hours, lasts “24-48” hours•Levimir (Detemir)•Onset 2-4 hours, lasts “24” hours•Glargine (Lantus)•Onset 2-4 hours, lasts “24” hours

Question 6

Basal bolus/M.D.I

Answer 6

uLong acting at nightuDegludec (tresiba)uLevemir uGlargineuShort acting with mealsuonset 15 mins, lasts 3-4 hoursuMore injections, more flexibility

Question 7

Pumps

Answer 7

uVariable basal ratesuBoluses with food and for correction of highsuCan programme temporary rates for e.g. illness, sicknessuNeeds more monitoringuShort onset of DKAuAlways attached