T1DM in kids (paeds)

Question 1

Which DM is more common in children?

Answer 1

T1DM - insulin dependent (2 in 1,000)

but incidence of non-insulin-dependent is rising due to childhood obesity

Question 2

What causes T1DM?

Answer 2

autoimmune destruction of b-cells in pancreatic islets of langerhans

• • genetic predisposition
• • ?environmental triggers involvement e.g. viruses or diet

Question 3

What age does T1DM present after & how present?

Answer 3

normally after 1 y/o
w/ few weeks history of 
- polyuria - nocturnal enuresis in young children
- polydipsia - inc thirst
- Weight loss

Question 4

T1DM can present with advanced DKA. What are the S&Sx of DKA?

Answer 4

vomiting and dehydration
abdo pain
hyperventilation (kussmauls)
acetone smelling breath
hypovolaemia shock
drowsiness & coma

Question 5

What Ix for T1DM can you do?

Answer 5

random or fasting blood glucose

not HbA1C in children

Question 6

what random blood glucose levels indicates DM?

Answer 6

> 11 mmol/L

Question 7

What fasting blood glucose levels indicate DM?

Answer 7

> 7 mmol/L [over 5.6 = GDM if they are pregnant]

Question 8

What Ix do you need to look at for paeds diabetes yearly reviews?

Answer 8

TFT
anti-TTG (coeliac)
lipid profile
urine albumin:creatinine (kidney function)

Question 9

Part of the Rx for children’s diabetes is education, what does this involve?

Answer 9

LT complications
diet
exercise
meds
blood glucose monitoring
seek urgent advice in emergencies
self-help groups

Question 10

Part of the Rx for children’s diabetes is insulin, what does this involve?

Answer 10

can be short, intermediate or long acting
young children:
- usually given a mixed dose BD
- once before breakfast and once again before evening meal
older children:
- long acting analogue pre-breakfast OR in evening to provide background
+ short acting analogue 3-4x daily before each meal

Question 11

Part of the Rx for children’s diabetes is diet, what does this involve?

Answer 11

make sure 3 x regular meals with snacks inbetween
+ 1 x after dinner to avoid hypoglycaemia
- healthy diet high in fibre should provide a sustained release of glucose

Question 12

Part of the Rx for children’s diabetes is exercise, what does this involve?

Answer 12

if doing vigorous or prolonged exercise then need to reduce insulin dose (as glucose is being used up)
+ increase in dietary intake
– short episode of exercise e.g. sports lesson = need a snack eaten before

Question 13

Part of the Rx for children’s diabetes is blood glucose monitoring, what does this involve?

Answer 13

regular finger prick tests & record in diary
aim:
4 - 10 mmol / L in children
4 - 8 mmol/ L in adolescents
e.g. so tighter control for adolescents
NB: (random blood glucose for diabetes is >11)

Question 14

Part of the Rx for children’s diabetes is regarding if they are ill, what does this involve?

Answer 14

in illness = Need higher dose of insulin (as illness = hyperglycaemia)

• • BUT child may be eating less so should monitor
• -> ! –> Urine or blood should be tested for ketones

Question 15

Part of the Rx for children’s diabetes is regarding if they have a hypo, what does this involve?

Answer 15

hypoglycaemia = < 2.6 mmol/L
however, symptoms appear at < 4mmol/L
the symptoms are:
sweating, pallor and CNS signs
e.g. irritability, headache, seizures, coma
if this happens –> take glucose tablet, sugary drink or oral glucose gel

Question 16

How do you do a SC injection with a pen?

Answer 16

pinch the skin and insert at 45o into the site
- upper arm,
- anterior or lateral thigh
- buttock
- abdomen
rotate sites to avoid lipohypertrophy or lipoatrophy

Question 17

What are the psychological problems paediatric populations may have with diabetic control?

Answer 17

1) fear of injecting
2) making up measurements to please diabetic team
3) psychological upset that they’re different from peers
4) family disturbance e.g. divorce

Question 18

What are the physical problems paediatric populations may have with their diabetic control?

Answer 18

1) frequent viral illness
2) sugary foods e.g. sweets at parties
3) alcohol (inhibits bodys response to raised blood sugar levels, often contains lots of sugar
4) need for regular mealtimes may disrupt activities
5) puberty increases insulin need (sex hormones and GH antagonise insulin)
6) use of glycosuria for crash diets in teen years

Question 19

What are the long term complications of paeds T1DM?

Answer 19

they are uncommon in childhood but must be regularly reviewed

• growth & pubertal development can be delayed
• BP must be checked annually
• Renal disease - checked microalbuminaemia
• Eyes checked 5 years post dx or from puberty onset –> retinopathy
• Feet – children advised not to wear tight shoes & treat infections early
• Screening for other autoimmune conditions e.g. coeliac & thyroid disease – should be done annually