W2 - Diabetes in Children

Question 1

what is diabetes

Answer 1

impaired insulin secretion
Impaired insulin action

Question 2

what cells secrete insulin and from what organ

Answer 2

Beta pancreatic cells

Question 3

how does glucose enter a cell

Answer 3

GLUT2 receptor

Question 4

what is an abnormal fasting blood glucose

Answer 4

> 7mmol/L

Question 5

what is an abnormal random and 2hr post glucose level

Answer 5

> 11.1

Question 6

what are the 4 main symptoms children present with diabtes

Answer 6

toilet - polyuria
thirsty - polydipsia
tired
thinner

Question 7

what is T1DM

Answer 7

Autoimmune beta cell destruction → insulin deficiency

Question 8

what is T2DM

Answer 8

Tissue insulin resistance with progressive insulin secretory defect

Question 9

what is gestational diabetes

Answer 9

Insulin resistance

Question 10

what is monogenic diabetes

Answer 10

Caused by a single gene mutation.
AD/AR - characteristics of T1 and T2 diabetes
Most common - MODY

Question 11

what is the most common cause of monogenic diabetes in children

Answer 11

MODY

Question 12

how many gene mutations are associated with MODY

Answer 12

13

Question 13

what are the characteristics of MODY

Answer 13

Absence of β-cell autoimmunity
Absence of signs of insulin resistance (obesity, acanthosis nigricans)

Question 14

what test results would indicate MODY

Answer 14

direct Fhx

↓/no insulin requirements 5 years after diagnosis

Stimulated C-peptide > 200 pmol/L - normal

No ketones

No obesity

Question 15

what is the inheritance of MODY

Answer 15

autosomal dominant

Question 16

what is the most common type of diabetes in children

Answer 16

T1 DM

Question 17

what else would you screen for in a family with T1DM

Answer 17

hypothyroidism
coeliac
(other autoimmune diseases)

Question 18

why do most kids present with new diagnosis of diabetes in winter

Answer 18

lots of infections - causes autoimmune trigger

Question 19

what are some environmental factors triggering diabetes

Answer 19

virus
bacteria
diet
chemicals
stress
intrauterine - pre-eclampsia, C-section, birthweight

Question 20

what is the management of T1DM

Answer 20

insulin - injections

Question 21

what is the management of T2DM

Answer 21

diet
exercise
tablets
insulin

Question 22

how long does insulin types last (short, intermediate and long)

Answer 22

short - 4-6hrs
intermediate - 12hrs
long - 24hrs
mixed (short and long)

Question 23

how do you manage cardiovascular risk factors for diabetes

Answer 23

Statin
ACEi
Diet
Education

Question 24

how long does it take for short acting to work

Answer 24

15mins

Question 25

what is the total daily dose for children

Answer 25

0.75units/kg

Question 26

what is the total daily dose for children under 5 years

Answer 26

0.5 units/kg

Question 27

what is the insuiin carb rules

Answer 27

300 <5 400 5-11 500 >11

Question 28

a 6 yr old kid 20kg

Answer 28

400/15 = 26.6 - 1:27 corrected factor - 100/15 = 6.66 1:7

Question 29

what are advantages of insulin pumps

Answer 29

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

Question 30

what are disadvantages of insulin pumps

Answer 30

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

Question 31

what are the short term complications and risks with diabetes in kids

Answer 31

DKA Hypoglycaemia Hyperglycaemia

Question 32

what are the long term risk and complications of diabetes

Answer 32

macrovascular - cardiovascular microvascular - retinopathy, neuropathy, stroke, MI, glaucoma, cateracts

Question 33

what is the triad of DKA

Answer 33

BM >11.1 mmol/L Ketonaemia >3mmol/L Acidosis pH <7.3 HCO3<15mmol/L

Question 34

what are the 3 components of the artificial pancreas pump

Answer 34

sensor pump closed loop control algorithm

Question 35

what can trigger DKA (8Is)

Answer 35

infection Infarction Infraction Infant Ischaemia Illegal Iatrogenic Idiopathic

Question 36

severe DKA

Answer 36

below 7.1 - 10% fluid dehydrated

Question 37

mild DKA

Answer 37

7.1-5 - mild dehydration 5%

Question 38

what is the first thing you do with an kid with DKA

Answer 38

ABCD - do this in OSCE

Question 39

over what time do you correct dehydration

Answer 39

48hrs

Question 40

what fluids do you give dor DKA

Answer 40

1hr fluid bolus - 0.9% saline CHECK K first as it might initially be high due to dehydration

Question 41

what are the maintenance fluids

Answer 41

100ml/kg - for 1st 10kg in weight

Question 42

how often should you check obs for a DKA and why

Answer 42

hourly neuro obs for cerebral oedema

Question 43

what changes would you see on obs which indicate cerebral oedema

Answer 43

high bp low heart rate

Question 44

what is the risk of developing T1 in normal or sibling populatio

Answer 44

normal - 0.3% sibling - 5-7% twins - 30%

Question 45

what are red flag signs of hypoglycaemia

Answer 45

anxiety weakness tremor irritability convulsions abdo pain headache N&V blurred vision

Question 46

when is hypoglycaemia in people and paeds

Answer 46

in T1 lower than 4 paeds - below 2.6

Question 47

what is cushings triad

Answer 47

* Low RR * High BP * Low HR

Question 48

most common cause of meningitis in children strep pneumoniae Haemophilus influenzae Enterovirus Neisseria meningitidis

Answer 48

Enterococcus

Question 49

how does meningitis kill

Answer 49

causes inflammation of the membranes around the brain and spinal cord

Question 50

what is the most common cause of meningococcal disease

Answer 50

MenB - Neisseria meningitidis

Question 51

what si the order of most common meningitis serogroups

Answer 51

B C W Y

Question 52

what are the 3 layers of meninges

Answer 52

dura mater arachnoid pia mater

Question 53

how does bcteria cause sepsis (get in the blood)

Answer 53

colonise nasopharynx and the cross naso pharyngeal epithelium to blood

Question 54

what causes meningococcal meningitis

Answer 54

Neisseria meningitidis gram - diplococcus

Question 55

can people be asymptomatic carriers of meningococcal meningitis

Answer 55

yes

Question 56

how long is it contageous

Answer 56

normaly 4 2-4

Question 57

most common symptoms of meningitis

Answer 57

non blanching petichial rash neck stiffness sudden vomiting irritability fever photophobia

Question 58

most sever complications of meningitis and side effects

Answer 58

hearing loss brain damage learning disability loss of limbs

Question 59

treatment of meningococcal meningitis

Answer 59

ceftriaxone or cefotaxime for 7 days (neonates) prophylaxis to siblings - rifampicin or ciprofloxacin

Question 60

when would you not give ceftriaxone to neonates (why)

Answer 60

can be liver toxic

Question 61

2nd most common cause of meningitis

Answer 61

strep pneumoniae

Question 62

management for step pneumoniae

Answer 62

ceftriaxone in kids older than 3 months for 14 days

Question 63

3rd most common cause fo bacterial meningitis

Answer 63

haemophilus influenza B

Question 64

treatment of haemophilus influenzae B meningitis

Answer 64

ceftriaxone or cefotaxime for 10 days +/- vancomycin

Question 65

what are the most common causes of viral meningitis

Answer 65

Enterovirus