Paediatrics Flashcards
What percentage of children with Type 1 diabetes present in Diabetic Ketoacidosis (DKA)?
25%
What symptoms do parents notice their children developing prior to a diagnosis of T1D?
Drinking more
Peeing more
Bedwetting (when this is atypical for the child)
Weight loss
How would you ask a parent if they had noticed their child losing weight?
Have their clothes/school uniform been hanging off them or felt looser lately?
often parents don’t notice chlidren getting slimmer
What symptoms are experienced by kids who present in DKA?
Vomiting
Stomach pains
Sighing breathing
“Pear drops” smell on breath
Above what values in a fasting or random blood glucose may indicate Type 1 diabetes?
fasting blood glucose >7.0 mmol/l
random blood glucose >11.0 mmol/l
If a child presents clinically well with polyuria, polydipsia, nocturnal enuresis and weight loss. Their blood sugar is markedly raised (>17mmol/L). How should they be referred?
- Urgent phone contact with duty Paediatric team
- Clinical review arranged within 24 hours
A child presents clinically well with polyuria, polydipsia, nocturnal enuresis and weight loss, and when tested has a raised blood glucose and ketones in their urine. How should they be referred?
- Urgent phone referral to duty Paediatric Team
- same day review
A child presents clinically unwell with symptoms of DKA. How should they be referred?
Emergency referral to Paediatrics
How should fluids be given in DKA?
CAREFULLY (don’t fluid overload)
based on child’s weight
What are children at risk of if they are fluid overloaded in DKA?
Risk of cerebral oedema
When should insulin be started in DKA?
1 hour after iv fluids started
What are the 4T’s of Type 1 Diabetes to make the public aware of the presenting symptoms?
Toilet
Tired
Thirsty
Thinner
What is the name of the national diabetes database used to store patient’s information to be used at each follow up appointment?
SCI diabetes Database
What are the main aims of the Children’s Diabetic team?
- Normal growth and development
- Minimal effects on school attendance.
- Local protocols for emergency events
- Best HbA1c for each individual child
- Microvascular screening from age 12
- Avoid hospital readmission <1year after diagnosis
- Avoid Hypoglycaemic fit/ Episode of DKA
- Transitional care through teenage years
What are the targets for children’s blood sugars during the day (pre-meal, post-meal and bedtime)?
Pre-meal (inc. breakfast) = 4-7 mmol/L
2 hrs post-meal = 5-9 mmol/L
Bedtime = 4-7 mmol/L