T1DM and Hypoglycaemia Flashcards
What are the diagnostic criteria for hypoglycaemia?
Plasma glucose less than 2.6mmol
What are the causes of hypoglycaemia?
Neonatal: Delayed feeding of a child from a diabetic mother Pre term infant IUGR infant Infection
Children:
Fasting
Insulin excess (diabetic treatment or insulin secreting tumour)
Liver disease
What are the symptoms of hypoglycaemia in neonates?
Drowsiness Floppiness Irritability Seizures Coma Apnoeas
What are the symptoms of hypoglycaemia in children?
Pallor CNS signs (irritability, headache, seizures and coma)
How should you investigate hypoglycaemia?
Bloods looking at the different metabolic markers: GH, cortisol, insulin, c-peptide, fatty acids, ketones, glycerol, lactate and Pyruvate
How should you manage hypoglycaemia?
If awake encourage sugary drink followed by complex carbs
If unconscious buccal glucose gel
OR
IV dextrose
If previous attempts have not helped give IM glucagon
How common is type 1 diabetes?
2 per 1000 children
How does T1DM commonly present?
Losing weight.
Polyuria and polydispisa
What are the diagnostic criteria for diabetes?
A random venous plasma glucose concentration greater than or equal to 11.1 mmol/l
A fasting plasma glucose concentration greater than or equal to 7.0 mmol/l
OGTT of greater than or equal to 11.1 mmol/l
One +ve test and symptoms Or 2 positive tests on separate occasions
How does DKA present?
Presentation is often late with:
- acetone on the breath
- vomiting & dehydration
- abdominal pain
- hyperventilation due to acidosis
How should you treat DKA?
IV fluids to correct dehydration
Dehydration needs correcting gradually over 48-72 hours as rapid rehydration can lead to cerebral oedema.
Insulin sliding scale
Electrolyte balance should resolve with treatment
