What type of diabetes is common in children?
Type 1 diabetes
In what emergency situation can children be newly diagnosed with Type 1 diabetes?
DKA
Type 1 diabetes in children has a strong ___ component.
genetic
What sort of precipitating event can trigger Type 1 diabetes in children?
Viral illness
In the pre-diabetes change, what biochemical abnormality can be detected in children?
Production of islet cell autoantibodies
What are the signs of hyperglycaemia in children?
Four Ts
tired
thirsty
toilet (bedwetting)
thin (weight loss)
What are major signs of DKA in children?
Vomiting
Abdominal pain
Kussmaul breathing +/- pear drop breath
A fasting blood glucose of over ___ mmol/L is diagnostic of Type 1 diabetes.
7 mmol/L
A random blood glucose of over __ mmol/L is diagnostic of diabetes.
11.0 mmol/L
Apart from symptoms, what do you need to diagnose a child with DKA?
pH < 7.3
Ketonuria
What is a fatal complication of DKA in children?
Cerebral oedema
What is the most common symptom of new onset diabetes in children?
Bedwetting
(noctural enuresis)
What tests would you perform on a child who you suspect has diabetes?
Random blood glucose
Urinalysis
As cerebral oedema is a fatal complication of DKA in children, what must be administered carefully?
Fluids
In DKA, fluids and insulin are administered based on the ___ of the child.
weight
In DKA of patients under 18 years, when is insulin given?
1 hour after fluids
A goal of diabetes treatment in children is ensuring they have normal ___ and development and their education isn’t disrupted.
normal growth and development
normal education
What are the HbA1c targets in children?
< 48 mmol/mol in first year after diagnosis
< 58 mmol/mol thereafter
Obviously the lower the better
What microvascular screens are done for children in diabetes clinics?
BP
Retinal screening
Urinalysis
What are the blood glucose targets
a) before meals
b) 2hrs after meals
c) at bedtime?
a) Before meals: 4-7 mmol/L
b) After meals: 5-9 mmol/L
c) Bedtime: 4-7 mmol/L
What type of insulin therapy are children with Type 1 diabetes offered?
CSII
(insulin pump)
What new technology avoids the use of skin prick tests to measure blood glucose?
Glucose sensor
What thyroid abnormalities may babies be born with?
Dysplastic, absent or abnormal-site thyroids
Congenital thyroid diseases may also be caused by problems with the ___ gland.
pituitary gland
What are some signs of congenital thyroid disease?
Delayed jaundice
Poor feeding, normal weight gain
Hypotonia (reduced muscle strength)
Skin and hair changes
Which general test is carried out on Day 5 after birth to diagnose a variety of diseases in babies?
Guthrie test
Where can ectopic thyroid be found?
Sublingual
What is the result of untreated hypothyroidism in babies?
Cretinism
What are some signs of hypothyroidism in children?
Slow growth, delayed puberty
Poor general health
Learning difficulties
What will a thyroid function test look like in a hypothyroid child?
High TSH
Low T3/T4
How is paediatric hypothyroidism treated?
Levothyroxine
What are some signs of hyperthyroidism in children?
Behavioural problems, sleep disturbance
Goitre
Face, eye signs
Tachycardia, palpitations
Early puberty
What will a thyroid function test look like in a hyperthyroid child?
Low TSH
High T3/T4
How is paediatric hyperthyroidism treated?
Beta blocker for autonomic symptoms
Anti-thyroid drugs - e.g carbimazole
+/- Radio-iodine, surgery
What is the most common primary cause of underactive adrenal glands in children?
Congenital adrenal hyperplasia
What is the most common secondary cause of underactive adrenal glands in children?
Pituitary disease
High dose steroid therapy
What is overproduction of steroids by the adrenal glands caused by?
Cushing’s disease / syndrome
Children with adrenal problems will present with overly ___ features.
masculinised
Problems with the hypothalamic-pituitary-gonadal axis e.g in congenital adrenal hyperplasia can produce ___ genitalia in children.
ambiguous
What are some causes of ambiguous genitalia in children?
Congenital adrenal hyperplasia
Genetic disease
Congenital defects
How is the sex confirmed when a baby has ambiguous genitalia?
Karyotyping
