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**Y4 CBLs edited > Peads: Diabetes in children > Flashcards

Peads: Diabetes in children Flashcards

1
Q

Types of diabetes in childhood

A

Type 1 Diabetes

  • 92-99% of all diabetes in children
  • Approx 50% is genetic- polygenic

Type 2 Diabetes

  • 1-5 %
  • about 40% is genetic-polygenic

MODY

  • <1%
  • 100 % genetic- monogenic

Secondary

  • CF Related Diabetes (CFRD)
  • Steroid induced
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2
Q

Simple pathophysiology of Type 1 Diabetes Mellitus

A

Absolute insulin deficiency secondary to beta -cell destruction

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3
Q

Diagnostic criteria fr T1DM

A
  • Elevated random sugar (>11.1 mmol/l) + presence of symptoms
  • Polyuria
  • Polydipsia
  • Weight loss
  • Lethargy
  • Fasting glucose of >7.0 mmol/l
  • Positive OGTT
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4
Q

Possible aetiology of T1DM

A
  • Genetic
  • Immune mediated
  • Islet cell, insulin, GAD auto-antibodies →positive in children with T1DM
  • Various other hypothesis
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5
Q

Prevalence of diabetes mellitus in children in the UK

A
  • Affects 1 in 450 children in the UK
  • 26,500 affected children in the UK
  • Incidence in the UK is increasing by 4% per year
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6
Q

Functions of glucose

A
  • Primary cellular fuel
  • Glucose metabolism via mitochondria generates ATP which is cellular form of energy
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7
Q

Sources of glucose

A
  • Gut absorption
  • Glycogen
  • Gluconeogenesis
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8
Q

What are the cells in the pancreas?

A

Exocrine and Endocrine functions:

  • Islets of Langerhans(1-2% of mass)
  • Beta cells (70%)- insulin
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9
Q

Insulin actions on the liver

A

Liver

  • Promotes glucose storage as glycogen
  • Prevents glycogen breakdown
  • Reduces Alanine (gluconeogenic precursor)
  • Prevents ketonogenesis
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10
Q

Insulin actions on the muscle

A

Muscle

  • Promotes Glucose uptake
  • Inhibits glycogenolysis and promotes glycogen synthesis
  • Increases uptake of Alanine (amino acid)
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11
Q

Insulin action on Adipose tissue

A

Adipose Tissue

  • Promotes glucose uptake and conversion to triglyceride
  • Prevents lipolysis of triglyceride into FFA and Glycerol
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12
Q

Ketogenesis in the liver

A
  • FFA → ketones (acetoactate and 3 oH butyrate)
  • Ketones makes you sick →DKA
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13
Q

Insulin Regime options

A
  • MDI (Multiple daily Insulin)
  • SCII (Sub-cutaneous Insulin infusion)
  • Twice daily premixed insulin
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14
Q

Aims of insulin treatments

A
  • Mimicking of physiological insulin secretion
  • Normal or near normal blood glucose
  • Minimisation of symptoms
  • Prevention of complications
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15
Q

Normal levels of insulin delivery (in a healthy pancreas)

A

In the normal pancreas:

  • low background level (basal) secretion of insulin throughout the day and night
  • spikes of increased secretion of insulin with meals and snacks to deal with the carbohydrate from that meal
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16
Q

Advantages and disadvantages of Basal Bolus

A

Advantages

  • Much more flexibility
  • Can alter doses according to size of meal
  • Less need to have between meal snacks
  • If child unwell & not eating can omit doses of fast insulin

Disadvantages

  • At least 4 injections a day
  • Need injection at school
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17
Q

Components of insulin pump

A
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18
Q

Advantages of SC insulin infusion (insulin pump)

A

Advantages

  • No need for injections
  • Fine tuning of doses
  • Picky eaters/grazers
  • Boluses in school
  • Sport
  • Independence
  • Easier to bolus in company
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19
Q

Disadvantages of SC insulin pump

A

Disadvantages

  • Expensive
  • Need to wear all the time
  • Visible sign of diabetes
  • Intensive treatment
  • Risk of DKA
20
Q

Advantages and disadvantages of BD mixtures regimen

A

Advantages

  • Convenient
  • Only 2 injections a day
  • No injections in school

Disadvantages

  • Lack of flexibility
  • Have to be up & injected by 9am at latest
  • Have to have 3 snacks a day & 3 meals a day
  • Difficult to adjust
21
Q

Education for a child with DM

A
  • Dietary education and healthy food behaviours
  • Understanding carbohydrate intake
  • Support and understanding and advice on child and families habits and activities
  • Education on the insulins used, administration options, and their actions
  • Continuing education and support to facilitate good glycaemic control whilst avoiding significant hypoglycaemia
22
Q

What’s carbohydrate counting?

A

Adjusting insulin dose based on the carbohydrate content of the food eaten

23
Q

How often to monitor blood sugar levels?

A
  • very important to monitor regularly
  • ideally pre meals + 2 hours after + waking + bedtime
  • New NICE recommendation is to monitor 6-8 times a day
24
Q

What are the target blood sugar levels?

A
  • 4-7 pre-meals
  • 5-9 post meals
  • >5 driving
25
Q

What’s HbA1C?

A
  • HbA1c refers to glycated haemoglobin
  • It provides the average blood sugar level over 3 month period
26
Q

What’s target HbA1C?

A

HbA1c target

  • ≤6.5% or ≤ 48mmol/mol
  • Or as close as can be achieved without disabling hypoglycaemia
27
Q

Microvascular complications of DM

A
  • Microvascular
  • Microangiopathy
  • Retinopathy
  • Nephropathy
  • Neuropathy
28
Q

microvascular complications of DM

A

Microvascular

  • Microangiopathy
  • Retinopathy
  • Nephropathy
  • Neuropathy
29
Q

macrovascular complication of diabetes

A

• atherosclerosis

30
Q

Risk factors that increase the probability of complications in DM

A
  • Duration of diabetes
  • Genetic influences
  • Sex
  • Glycaemic control –HbA1C vs glucose variability
  • Hypertension
  • Smoking
  • Hyperlipidaemia
  • Growth hormone axis
31
Q

What are the aims of annual screenings in a patient with DM?

A
  • Detect complications early
  • Potential to reverse some complications with improved glycaemic control
  • Treatment can arrest or slow progression
32
Q

What patients with DM are screened for?

A
  • Height and Weight
  • Blood pressure
  • Bloods- thyroid, coeliac, lipids
  • Urine- microalbuminuria
  • Psychology
  • Retinopathy >12 years
  • Feet
33
Q

What level of glucose is considered as hypoglycaemia in children?

A

For children with diabetes sugar< 4mmol/l is to be treated as hypoglycaemia

34
Q

Signs and symptoms of hypoglycaemia

A
35
Q

Management of hypoglycaemia in kids

A
  • Treat with 10-15g fast acting glucose
  • Check sugar after 15 mins
  • Followed by carbohydrate snack if meal time is >1 hour away
  • If sugar has come up to >5.5mmol/l, and eating soon, no need for snack
36
Q

Initial management of hyperglycaemia

A
  • Give extra correction doses of rapid acting insulin
  • •If a consistent pattern, adjust regular insulin doses
  • If BG >14 mmol/l, check blood ketones
  • Ensure well hydrated
37
Q

When to check for ketones?

A
  • If BG >14 mmol/l → check blood ketones
  • Increasing ketones (>3mmol/l) is a sign of impending DKA
38
Q

Causes of hyperglycaemia

A
  • Insufficient Insulin
  • High intake of glucose foods/drinks
  • Intercurrent infection
  • Post Hypo
  • Stress
  • Medications
  • Steroids
  • Risperidone
  • Eating disorders
39
Q

Sick Day Rules

A
  • Always give basal
  • Basal requirements will increase
  • Measure BG every 2-4 hours, if >14 check ketones
  • Lots of sugar free fluids
  • Adjust rapid acting to food eaten
  • If not eating, regular sugar containing fluids 10g/hr
  • Correction doses of rapid acting if high
  • High BG or ketones not improving- hospital
40
Q

What’s continuous glucose monitoring?

A
  • Measures the interstitial glucose every few minutes
  • Offer ongoing real-time continuous glucose monitoring with alarms to children and young people with type 1 diabetes who have:
  • frequent severe hypoglycaemia or impaired awareness of hypoglycaemia associated with adverse consequences (e.g.seizures or anxiety)
  • Or inability to recognise, or communicate about, symptoms of hypoglycaemia (e.g. because of cognitive or neurological disabilities).
41
Q

Who can be considered for ongoing real-time Continuous Glucose Monitoring?

A

Consider ongoing real-time continuous glucose monitoring for:

  • neonates, infants and pre-school children
  • children and young people who undertake high levels of physical activity
  • children and young people who have comorbidities (for example anorexia nervosa) or who are receiving treatments (e.g. corticosteroids) that can make blood glucose control difficult.
42
Q

Who can be considered for intermittent continuous glucose monitoring?

A

Consider intermittent continuous glucose monitoring to help improve blood glucose control in:

  • children and young people who continue to have hyperglycaemia despite insulin adjustment and additional support
43
Q

Pathophysiology of DKA

A
  • The lack of insulin over time → abnormal metabolic pathways to generate energy for the body’s cells
  • These pathways → production of ketones and a metabolic acidosis

* The situation is exacerbated by relative dehydration through glycosuria causing a diuresis and respiratory compensation for the acidosis with hyperventilation to “blow off” carbon dioxide, further disrupting the acid-base balance.

44
Q

Symptoms of DKA

A
  • Polyuria (nocturia)
  • Extreme thirst
  • Inability to concentrate
  • headaches
  • diminished conscious levels
  • abdominal pain
  • other non-specific symptoms
45
Q

Principles of management for DKA

A
  • rehydration and electrolyte management (especially a rapid reduction in serum potassium after introduction of insulin (as forces K+ into cells)
  • gradual introduction of a fast-acting insulin, either by pump or injection depending on the status of the patient.

The aim of therapy is a gradual correction of all elements to avoid dramatic fluid and electrolyte shifts

**Y4 CBLs edited (32 decks)

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