W2 - Diabetes in Children Flashcards
what is diabetes
impaired insulin secretion
Impaired insulin action
what cells secrete insulin and from what organ
Beta pancreatic cells
how does glucose enter a cell
GLUT2 receptor
what is an abnormal fasting blood glucose
> 7mmol/L
what is an abnormal random and 2hr post glucose level
> 11.1
what are the 4 main symptoms children present with diabtes
toilet - polyuria
thirsty - polydipsia
tired
thinner
what is T1DM
Autoimmune beta cell destruction → insulin deficiency
what is T2DM
Tissue insulin resistance with progressive insulin secretory defect
what is gestational diabetes
Insulin resistance
what is monogenic diabetes
Caused by a single gene mutation.
AD/AR - characteristics of T1 and T2 diabetes
Most common - MODY
what is the most common cause of monogenic diabetes in children
MODY
how many gene mutations are associated with MODY
13
what are the characteristics of MODY
Absence of β-cell autoimmunity
Absence of signs of insulin resistance (obesity, acanthosis nigricans)
what test results would indicate MODY
direct Fhx
↓/no insulin requirements 5 years after diagnosis
Stimulated C-peptide > 200 pmol/L - normal
No ketones
No obesity
what is the inheritance of MODY
autosomal dominant
what is the most common type of diabetes in children
T1 DM
what else would you screen for in a family with T1DM
hypothyroidism
coeliac
(other autoimmune diseases)
why do most kids present with new diagnosis of diabetes in winter
lots of infections - causes autoimmune trigger
what are some environmental factors triggering diabetes
virus
bacteria
diet
chemicals
stress
intrauterine - pre-eclampsia, C-section, birthweight
what is the management of T1DM
insulin - injections
what is the management of T2DM
diet
exercise
tablets
insulin
how long does insulin types last (short, intermediate and long)
short - 4-6hrs
intermediate - 12hrs
long - 24hrs
mixed (short and long)
how do you manage cardiovascular risk factors for diabetes
Statin
ACEi
Diet
Education
how long does it take for short acting to work
15mins
what is the total daily dose for children
0.75units/kg
what is the total daily dose for children under 5 years
0.5 units/kg
what is the insuiin carb rules
300 <5
400 5-11
500 >11
a 6 yr old kid 20kg
400/15 = 26.6 - 1:27
corrected factor - 100/15 = 6.66 1:7
what are advantages of insulin pumps
Delivers insulin in more physiological way
Lessens the risk of hypoglycaemia - for people who cant tell
Multiple injections a day replaced by insertion of cannula every 2 to 4 days
what are disadvantages of insulin pumps
Intensive therapy, can be hard work
Pump failure
Not everyone wants to visible sign of their diabetes
Concerns about wearing a pump during sport
Risk of skin infection at the cannula site
Expensive
what are the short term complications and risks with diabetes in kids
DKA
Hypoglycaemia
Hyperglycaemia
what are the long term risk and complications of diabetes
macrovascular - cardiovascular
microvascular - retinopathy, neuropathy, stroke, MI, glaucoma, cateracts
what is the triad of DKA
BM >11.1 mmol/L
Ketonaemia >3mmol/L
Acidosis pH <7.3 HCO3<15mmol/L
what are the 3 components of the artificial pancreas pump
sensor
pump
closed loop control algorithm
what can trigger DKA (8Is)
infection
Infarction
Infraction
Infant
Ischaemia
Illegal
Iatrogenic
Idiopathic
severe DKA
below 7.1 - 10% fluid dehydrated
mild DKA
7.1-5 - mild dehydration 5%
what is the first thing you do with an kid with DKA
ABCD
- do this in OSCE
over what time do you correct dehydration
48hrs
what fluids do you give dor DKA
1hr fluid bolus
- 0.9% saline
CHECK K first as it might initially be high due to dehydration
what are the maintenance fluids
100ml/kg - for 1st 10kg in weight
how often should you check obs for a DKA and why
hourly neuro obs
for cerebral oedema
what changes would you see on obs which indicate cerebral oedema
high bp
low heart rate
what is the risk of developing T1 in normal or sibling populatio
normal - 0.3%
sibling - 5-7%
twins - 30%
what are red flag signs of hypoglycaemia
anxiety
weakness
tremor
irritability
convulsions
abdo pain
headache
N&V
blurred vision
when is hypoglycaemia in people and paeds
in T1 lower than 4
paeds - below 2.6
what is cushings triad
- Low RR
- High BP
- Low HR
most common cause of meningitis in children
strep pneumoniae
Haemophilus influenzae
Enterovirus
Neisseria meningitidis
Enterococcus
how does meningitis kill
causes inflammation of the membranes around the brain and spinal cord
what is the most common cause of meningococcal disease
MenB - Neisseria meningitidis
what si the order of most common meningitis serogroups
B
C
W
Y
what are the 3 layers of meninges
dura mater
arachnoid
pia mater
how does bcteria cause sepsis (get in the blood)
colonise nasopharynx and the cross naso pharyngeal epithelium to blood
what causes meningococcal meningitis
Neisseria meningitidis
gram - diplococcus
can people be asymptomatic carriers of meningococcal meningitis
yes
how long is it contageous
normaly 4
2-4
most common symptoms of meningitis
non blanching petichial rash
neck stiffness
sudden vomiting
irritability
fever
photophobia
most sever complications of meningitis and side effects
hearing loss
brain damage
learning disability
loss of limbs
treatment of meningococcal meningitis
ceftriaxone or cefotaxime for 7 days (neonates)
prophylaxis to siblings - rifampicin or ciprofloxacin
when would you not give ceftriaxone to neonates (why)
can be liver toxic
2nd most common cause of meningitis
strep pneumoniae
management for step pneumoniae
ceftriaxone in kids older than 3 months for 14 days
3rd most common cause fo bacterial meningitis
haemophilus influenza B
treatment of haemophilus influenzae B meningitis
ceftriaxone or cefotaxime for 10 days +/- vancomycin
what are the most common causes of viral meningitis
Enterovirus
