Week 5 - Endocrine Flashcards
Type 1 Diabetes
caused by autoimmune destruction of pancreatic beta cells in the islets of Langerhans thought to be triggered by a preceding environmental event in genetically susceptible individuals. This destruction of beta cells results in an absolute deficiency in insulin secretion, reduced biologic effectiveness, or both
Diabetes Type 1 S/S
‣ Usually sudden onset of illness
‣ Polydipsia, polyphagia, polyuria
‣ Dehydration
‣ Nocturia, blurred vision
‣ Weight loss or poor weight gain
‣ Muscle wasting
‣ Tachycardia
‣ Fatigue and lethargy
‣ Vaginal yeast, thrush or other infection
Diabetes Type 1 S/S ketoacidosis
‣ Abdominal pain, nausea and/or vomiting
‣ Fruity-smelling breath
‣ Weakness (caused by dehydration)
‣ Mental confusion
‣ Slow labored breathing (Kussmaul breathing)
‣ Flushed face and cheeks
‣ Coma
Diabetes Type 1 Diagnostics
‣ Urine for glucose and ketones
‣ Metabolic screen for acid-base status to exclude DKA
‣ Hemoglobin A1c (HbA1c)
‣ Blood glucose
‣ Screen for the presence of pancreatic autoantibodies: This should be considered to confirm the diagnosis of type 1 diabetes, particularly in those cases where there may be uncertainty regarding type
Diagnostic criteria for diabetes
‣ HbA1c ≥ 6.5%
‣ Fasting plasma glucose 126 mg/dL (7 mmol/L) or greater
‣ Random plasma glucose 200 mg/dL or greater plus presence of classic symptoms (polyuria, polydipsia, polyphagia)
‣ Postprandial (2 hours after eating) plasma glucose 200 mg/dL (11.1 mmol/L) or greater
Diabetes Type 1 Treatments
‣ determining the insulin regimen and dose best suited to the individual child
‣ target range for blood glucose levels
‣ best methods to manage the child’s diet
‣ Start on insulin
‣ Screen for hypothyroidism (thyroid peroxidase/thyroglobulin testing) – annual screening
‣ Screen for celiac disease
‣ Exercise
‣ Nutrition
‣ f/u ever 3-4 months
Insulin dosages
‣ Partial remission (any age) <0.5units/kg/day
‣ Prepubertal 0.7-1.0 units/kg/day
‣ Pubertal 1.0-2.0 units/kg/day
Goal for insulin treatment
‣ HbA1c less than 7.5% and/or a fasting blood glucose level between 90 and 130mg/dL
Recommended screenings for youth with diabetes
‣ HbA1c
‣ Thyroid disease
‣ Celiac disease
‣ Dyslipidemia
‣ Hypertention
‣ Retinopathy
‣ Neuropathy
‣ Nephropathy
‣ Psychosocial
Type 2 Diabetes
increased tissue resistance to insulin, resulting in hyperinsulinemia and hyperglycemia. Although pancreatic beta cells initially produce insulin, hyperglycemia creates an increased insulin demand; with increasing demand for insulin over time, the pancreas loses its ability to effectively secrete insulin
Diabetes Type 2 Screening guidelines
‣ Screen if BMI over 85th percentile + two of the following
‣ Family history of DM2 in 1st or second degree relative
‣ Native American, African American, latino, Asian, pacific islander)
‣ Signs of insulin resistance (PCOS, HTN, Hyperlipidemia, acanthosis nigricans)
‣ Maternal history of diabetes or gestational diabetes
History findings for someone with suspected type 2 diabetes
‣ Polydipsia, polyphagia, polyuria
‣ Nocturia or bedwetting
‣ Blurred vision
‣ Obesity, especially central
‣ Report of a hyperpigmented, velvetlike rash in skin folds
‣ Frequent or slow-healing infections
‣ Fatigue, symptoms of sleep apnea
‣ History of premature adrenarche
‣ Family history of type 2 diabetes
Diabetes Type 2 Physical Exam
‣ Dehydration
‣ Overweight (BMI greater than 85th percentile for age and gender) or obesity
‣ Weight loss (less common)
‣ Acanthosis nigricans noted in the axilla, base of the neck, groin, knuckles, and other skin folds
‣ Vaginal yeast, thrush, other infection
‣ Polycystic ovary syndrome symptoms (e.g., acne, hirsutism)
‣ Hypertension
Diabetes Type 2 Diagnostics
‣ Urine for glucose and albumin (can be performed in the office)
‣ Children can have ketoacidosis if they have gone undiagnosed for a long time
‣ Fasting blood sample for blood glucose, HbA1c, lipid panel, TSH and free T4, and insulin level
Diabetes Type 2 Treatments
‣ Daily self-monitoring
‣ HBA1C Q3 months (6 months with glycemic control)
‣ Follow up q3 months lifestyle, nutrition,
‣ Screening for HTN, HLD,
‣ Diet changes – healthy plate
‣ Exercise changes – 60 minutes per day
Obesity
BMI greater than or equal to the 95th percentile for age and gender
Assessment for obese children – screen for…
‣ DM and pre-DM
‣ Dyslipidemia with fasting lipid panel
‣ Nonalcoholic steatohepatitis w/ ALT
‣ OSA
‣ PCOS
‣ Free total testosterone level
‣ Pre HTN or HTN
‣ Psych issues – low-self esteem, behavior problems, depression
Management of obesity in children
‣ Refer to endocrinology for DM2, PCOS
‣ Aim to maintain weight not lose (children grow into weight)
‣ For complications – weight loss of 1 pound per month is appropriate
Congenital hypothyroidism
Results from an abnormality in development of the thyroid gland during fetal life (dysgenesis or agenesis) or a problem with the ability of the thyroid to make thyroid hormone
OR
may result from an abnormality at the level of the pituitary or hypothalamus
Untreated congenital hypothyroidism can lead to…
‣ Irreversible brain damage ‣ ‣ variable degrees of growth failure
‣ deafness
‣ neurologic abnormalities.
Earlier detection of CH through improvements in newborn screening combined with more aggressive thyroid hormone replacement regimens (10 to 15 μg/kg/day) at diagnosis have led to improved developmental outcomes for newborns with CH.
