Paediatric Endocrine Flashcards
How is hyperglycaemia in a child managed?
Insulin
Dietician referral
Advice on hypoglycaemia
Advice of changing regime if sick
What insulin regimes can be offered to children?
Twice daily - long acting
Multiple - rapid acting - good if active lifestyle
How often should diabetic children be testing their BM?
At least 4x a day
How regularly should diabetic children have a review assessment?
Minimum once annually
What should be done in a diabetic review?
HbA1C Lipid profile Urinary albumin excretion Renal and thyroid function Eye examination Examine injection sites Blood pressure
What level of plasma glucose is considered to be hypoglycaemia?
<3mmol/L
What triad do you need to diagnose hypoglycaemia?
Whipples triad
Signs and symptoms
Low blood glucose level
Relief of symptoms with increasing blood glucose
What causes hypoglycaemia?
Increased insulin Increased activity Low sugar intake Alcohol and paracetamol Insulinoma Insulin like growth factor secreting tumour (adrenal) Starvation
How does hypoglycaemia present?
Lethargic Shaking Paraesthesia in lips Hungry Difficulty concentrating Confusion and LOC
At what ages do ketotic hypo’s occur?
Between 18 months and 5 years
Generally self resolve by 9yo
What do you see in ketotic hypos?
Same symptoms +
N&V
Fainting
Seizures
How are ketotic hypos managed?
Advice of regular snacking
What investigations are done to assess hypoglycaemia?
Insulin radioimmunoassay 72 hour fasting C peptide plasma conc Pro-insulin measurements Pituitary and adrenal function Blood and urine sulphonylureas
What would a raised c-peptide indicate?
Hypoglycaemia due to increased endogenous insulin
If c peptide is low/normal, what would this indicate?
Hypoglycaemia due to exogenous insulin
