Diabetes Lecture Flashcards
(25 cards)
Diagnosis of diabetes in children
- Symptoms of diabetes with random plasma glucose of more than 11mmol/L - if ketones = urgent
- WHO - fasting glucose over 7mmol/L, 2hr post OGTT over 11.1
FINISH
HbA1C cut off for diabetes
48 mmol/L
Bloods for ?diabetes if can’t diagnose in children
- HbA1C
- OGTT or fasting glucose
- Fasting insulin
- Fasting C peptide
How to tell difference between T1 and T2 in children?
Antibodies:
* Islet cell
* Anti GAD
* IA2
Most common diabetes in children
Type 1 - no matter weight
NICE guidelines if suspect T1DM in child
Children and young people with suspected Type 1 diabetes should be offered immediate (same day) referral to multi- disciplinary paediatric diabetes team - often need same day hospital appt
Trigger for diabetes to manifest in children
- Background genetic cause and then virus are common trigger
- Also Vit D deficiency
Stages of T1 diabetes development
DKA diagnosis
Biochemical diagnosis
* Hyperglycaemia - above 11 mmol/l
* Acidosis - below 7.3
* Ketonuria/ketonaemia - above 3mmol/l
Features of DKA
- Polyuria
- Polydipsia
- N+V
- Acetone smell to breath
- Dehydration
- Weight loss
- Hypotension
- Altered conciousness
If can’t get IV access in child, how to give fluid?
Interosseus line
Management of DKA
- IV fluids
- IV insulin - fixed rate
Life threatening complication of DKA
Cerebral oedema
Warning symptoms/signs of cerebral oedema
- Headache
- Changing neuro status/consciousness
- CN palsies
- Bradycardia
- Increased BP
- Falling sodium level
Why does cerebral oedema occur?
- Dehydration + high blood glucose
- = water moves from intracellular to extracellular in brain
- = brain cells shrink and dehydrate
- Correction of dehydration = shift from extracellular to intracelllar in brain
- = oedematous brain
Management of cerebral oedema
- Slow IV fluids
- IV mannitol
- IV hypertonic saline
Guided by experienced consultant
Results for T2 diabetes vs T1
- High C peptide and high insulin levels - shows resistance
- Raised HbA1C
3 parts of T1DM management
- Glucose monitor - continious glucose monitoring system
- Insulin
- Diet/exercise
Glucose monitor vs CGMS
Glucose monitor
* Finger prick - capillary blood
* No lag with reading
CGMS:
* Measures interstitial fluid, lag of readings (will be different if do them both at same time)
* Allows to see past readings, predicts future readings. See trends
Insulin methods of administration
- Insulin pens
- Insulin pumps - wired/tubed pump (replace every 3 days), also wireless ones (change every 3 days, controlled with remote)
Long acting and short acting insulin used in insulin pens
- Lantus/tresiba - long acting
- Novorapid
Pump insulin use
- One type of insulin only - fast acting only
What is hybrid closed loop?
3 components:
* Continious glucose monitors
* Insulin pump
* Algorithm - program that reads levels and works out how much insulin needed - part of pump or part of app
HbA1C and risk of microvascular
- Retinopathy - highest risk as HbA1C increases (most sensitive to higher HbA1C)
- Then nephropathy
- Then neuropathy
- If keep low, relative risk is low
