What percentage of children with Type 1 diabetes present in Diabetic Ketoacidosis (DKA)?
What symptoms do parents notice their children developing prior to a diagnosis of T1D?
Bedwetting (when this is atypical for the child)
How would you ask a parent if they had noticed their child losing weight?
Have their clothes/school uniform been hanging off them or felt looser lately?
often parents don’t notice chlidren getting slimmer
What symptoms are experienced by kids who present in DKA?
“Pear drops” smell on breath
Above what values in a fasting or random blood glucose may indicate Type 1 diabetes?
fasting blood glucose >7.0 mmol/l
random blood glucose >11.0 mmol/l
If a child presents clinically well with polyuria, polydipsia, nocturnal enuresis and weight loss. Their blood sugar is markedly raised (>17mmol/L). How should they be referred?
- Urgent phone contact with duty Paediatric team
- Clinical review arranged within 24 hours
A child presents clinically well with polyuria, polydipsia, nocturnal enuresis and weight loss, and when tested has a raised blood glucose and ketones in their urine. How should they be referred?
- Urgent phone referral to duty Paediatric Team
- same day review
A child presents clinically unwell with symptoms of DKA. How should they be referred?
Emergency referral to Paediatrics
How should fluids be given in DKA?
CAREFULLY (don’t fluid overload)
based on child’s weight
What are children at risk of if they are fluid overloaded in DKA?
Risk of cerebral oedema
When should insulin be started in DKA?
1 hour after iv fluids started
What are the 4T’s of Type 1 Diabetes to make the public aware of the presenting symptoms?
What is the name of the national diabetes database used to store patient’s information to be used at each follow up appointment?
SCI diabetes Database
What are the main aims of the Children’s Diabetic team?
- Normal growth and development
- Minimal effects on school attendance.
- Local protocols for emergency events
- Best HbA1c for each individual child
- Microvascular screening from age 12
- Avoid hospital readmission <1year after diagnosis
- Avoid Hypoglycaemic fit/ Episode of DKA
- Transitional care through teenage years
What are the targets for children’s blood sugars during the day (pre-meal, post-meal and bedtime)?
Pre-meal (inc. breakfast) = 4-7 mmol/L
2 hrs post-meal = 5-9 mmol/L
Bedtime = 4-7 mmol/L
If diabetes is poorly controlled in childhood, what can this result in?
- Social and emotional disruption
- Sub-optimal physical growth
- micro-vascular disease
What early changes of vascular disease can be seen in Type 1 diabetes patients?
- Cardiovascular autonomic neuropathy
- Sensory nerve damage
- Cheiroarthropathy (thick skin/joint contractures)
- Skin vascular changes
- Vascular endothelial pathology
Why may strict glycaemic control worry parents?
Children are at more of a risk of Hypo with strict control
=> need to convince parents that strict control is better in the long run to minimise complications
Why are the teenage years particularly a problem when implementing strict glycaemic control?
- health not priority
- may miss their insulin
- May be embarassed to administer insulin in front of others
What do children and their families need to think about before administering their insulin?
What was their last blood glucose? Have they/Are they planning to exercise? What have they/ what are the planning to eat? What type of insulin is it? How sensitive are they to insulin?
Give an example of a device used to interpret all required information before administration of an insulin dose?
Accu-check Aviva Expert
Aside from an insulin pump, what other device is now being implanted in patients to improve their glycaemic control?
Continous glucose monitor
has the potential to interact with an insulin pump to automatically decide insulin requirements
What is the largest drawback of the insulin pump?
If it breaks and this isnt noticed (i.e. during sleep)
Insulin stops being infused and patient can go into DKA
What are the main symptoms of congenital thyroid disease?
Delayed jaundice Poor feeding but “normal” weight gain Hypotonia umbilical hernia; constipation Skin and hair changes
What test is used to check for congenital thyroid disease and when is it performed?
Guthrie Heel Prick Test
Day 5 post birth
Measure TSH and T4 levels
How early should thyroxine therapy be given in congenital thyroid disease?
After 3 months, what complication of congenital thyroid disease can present?
leads to permanent developmental delay “Cretinism”
What can cause acquired thyroid disease in the young?
- Delayed congenital
- Post infectious
- Autoimmune (T1D)
- Iodine deficiency and nutrition
Hyperthyroidism can cause early onset puberty. TRUE/FALSE?
What therapy can be used in hyperthyroidism to suppress symptoms?
What treatments are considered more permanent in treating hyperthyroidism rather than just anti-thyroid drugs?
What conditions are considered PRIMARY adrenal disease in the young?
- Adrenal hypoplasia (absent/dysplastic/destroyed)
- Inborn error of metabolism
- Congenital adrenal hyperplasia
What can cause SECONDARY adrenal disease in the young?
- Pituitary disease (Congital/Acquired)
- steroid therapy (high dose/ prolonged can cause suppression)
Why does virilisation occur in congenital adrenal hyperplasia?
Enzyme defect means that cholesterol cant make aldosterone or cortisol
=> all is shunted to make androgens e.g. testosterone
This means females are born with ambiguous genitalia
Males often go through puberty very early (preocious puberty)