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Diabetes (types (other specific types (Mongenic defects of β -cell…
Diabetes
types
- type 1:
β -cell destruction, usually leading to absolute insulin deficiency
Autoimmune / Idiopathic
- type 2:
insulin resistance
other specific types
- Mongenic defects of β -cell function:
HNF-1α MODY (MODY 3), Glucokinase MODY (MODY 2), HNF-4 α MODY (MODY 1), HNF-1β MODY (MODY 4)
- Mitochondrial diabetes
- Genetic defects in insulin action:
Type A insulin resistance, Leprechaunism, Rabson-Mendenhall syndrome
- Diseases of the exocrine pancreas:
Fibrocalculous pancreatopathy, Pancreatitis, Trauma / pancreatectomy, Neoplasia, Cystic fibrosis
- endocrinopathies:
Acromegaly, Cushing syndrome, Phaeochromocytoma, Hyperthyroidism
- Drug- or chemical-induced:
Glucocorticoids, Vacor, Nicotinic acid, Thyroid hormone, β-adrenergic agonists, Thiazides,
- infections:
Congenital rubella, Cytomegalovirus
- Uncommon forms of immune-mediated diabetes:
Insulin autoimmune syndrome (antibodies not insulin), Anti-insulin receptor antibodies, “Stiff-man” syndrome
- other genetic syndromes sometimes associated with diabetes:
Down syndrome, Klinefelter’s syndrome, Turner syndrome, Myotonic dystrophy, Prader-Willi syndrome
-
DKA
- biochemical criteria for the diagnosis of diabetic ketoacidosis (DKA) are:
hyperglycemia [blood glucose (BG) >11mmol/L (≈200 mg/dL)]
venous pH <7.3 or bicarbonate < 15mmol/L
ketonemia and ketonuria
Symptoms
- Frequent vomiting and acute abdominal pain
- Flushed cheeks, Dehydration with continuing polyuria
- Acetone smell on breath
- Decreased level of consciousness
- Kussmaul respiration (deep, rapid, sighing)
- Coma, Shock
Treatment
- IV insulin infusion
- Start with insulin rate of 0.1 unit/kg/hr and titrate to maintain glucose reduction rate of 50-100 mg/dL/hr
- Initial fluidis 0.9% normal saline (NS) due to presence of hyperosmolarity and risk of rapid cellular fluid shifts
- Deficit is replaced gradually over 48-72 hours
- Dextrose is added to IV fluids when serum glucose <300 mg/dL
Symptoms
- Weight loss (body is unable to fully use glucose, and starts to break down fat and muscle)
- Excessive thirst, Polyuria – in younger children bedwetting is common
- Blurred vision, Mood changes, Dehydration with continuing polyuria
- Tiredness - not wanting to work or play, Skin infections
- Oral or vaginal thrush, Abdominal pain
- glucose is excreted in the urine (glycosuria), dragging water with it resulting in polyuria (excessive urination) and polydipsia (excessive drinking)
- breakdown of fat causes ketones to accumulate in the blood (acidosis)
- if the diagnosis is not made, glucose and ketone levels become very high, resulting in severe dehydration and loss of electrolytes from the body
Diagnosis
- Symptoms of diabetes plus casual plasma glucose concentration ≥ 11.1 mmol/l (200 mg/dl). Casual is defined as any time of day without regard to time since last meal.
or
- Fasting plasma glucose ≥ 7.0 mmol/l (≥ 126 mg/dl). Fasting is defined as no caloric intake for at least 8 hours.
or
- 2 hour postload glucose ≥ 11.1 mmol/l (≥ 200 mg/dl) during an OGTT.
The test should be performed as described by WHO (1), using a glucose load containing the equivalent of 75 g anhydrous glucose dissolved in water or 1.75 g/kg of body weight to a maximum of 75 g.
or
- HbA1c ≥ 6.5.
Type 1 Diabetes
- the most common autoimmune disorder in childhood and adolescence
- type 1 diabetes is increasing by 3-5% per year
- onset can be at any age after the neonatal period, but it is most common in childhood and adolescence
Type 2 diabetes
- usually affects people over the age of 40, may run in families and is often associated with being overweight
- it is increasingly being seen in older children, particularly adolescents who are overweight and inactive, have a family history of type 2 diabetes or in those who are of particular ethnic backgrounds where type 2 diabetes in adults is more prevalent
- people with type 2 diabetes produce insulin but the insulin produced does not work effectively (“insulin resistance”). Type 2 diabetes often responds initially to a healthy eating plan, appropriate exercise and weight reduction. However, metformin is frequently needed (+/- an insulin sensitiser), and later insulin may be required
Treatment
Insulins
- Rapid-acting analogs (aspart, glulisine, and lispro)
- Regular/soluble (short acting)
- NPH
- Basal long-acting analogs (Glargine , Detemir, Degludec )
Injection sites
- abdomen, front of thigh/lateral thigh (the preferred site for slower
absorption of longer acting insulins)
- the lateral upper quadrant of the buttocks
- lateral aspect of arm
- rotation of injection sites are important also within the same area of injection
- cleaning or disinfection of skin is not necessary unless hygiene is a real problem. Infection at injection sites is rare.
- group of disorders characterised by a sustained elevation of blood glucose levels (BGL).
- occurs either because the body does not produce enough insulin, or because cells do not respond
to the insulin that is produced (insulin resistance).