The Newly Diagnosed Diabetic Child

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The Newly Diagnosed Diabetic Child

• Dr Amalia Mayo
• Consultant Paediatrician
• RACH

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Childhood diabetes in Scotland (1968-2000)
35
30
Male
25
20
Female
Rate per 100,000
15
10
5
0
1968 1972 1976 1980
1984 1988 1992 1996
2000
Year
Diabetologia 1983 24 238-43 Diabet Med 1988 5
160-5 Arch Dis Child 1997 77 210-3
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Age-standardised incidence rate per 100,000 by
Health Board 1984-2000
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The assessment of a child with possible diabetes
is an emergency
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When to suspect diabetes

• Thirst
• Polydipsia
• Polyuria (bed wetting, wetting accidents)
• Weight loss
• Lethargy and tiredness
• Abdominal pain

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Diagnostic tests

• Urinalysis
• Glycosuria
• Ketonuria
• Blood test (finger prick)
• Hyperglycaemia

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Initial Management Models

• Home Starts
• Hospital Admission
• Day Care Model

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New diabetics (2004)

• 29 children
• 15F14M
• Length of Stay 3.2 (1-7)
• Age 10 (2-14) 50 gt10

• Length of stay gt4 days
• 2- Shetland
• 4- DKA
• 3- Admitted on Friday?
• 1- ??

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New diabetics- length of stay
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New diabetics (2004)- presentation

• Well-No treatment 19 (73)
• Dry- IV fluids/insulin 4 (15)
• DKA 3 (11.5)

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When to suspect DKA

• Acidotic respiration (Kussmaul)
• Dehydration
• Drowsiness
• Abdominal pain/ vomiting

• Definition of DKA
• Hyperglycaemia (BG gt11 mmol/l) and
• pH lt7.3 or
• Bicarbonate lt 15 mmol/l

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News screening tests
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Basal-bolus regime
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Education

• Use of glucose monitor
• Injection technique
• Checking for ketones
• Hypoglycaemia
• Diet

Information pack
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Discharge supplies
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Routine follow up

• Height and weight- plot in chart
• HbA1c
• Current insulin therapy
• Review of blood sugar home monitoring
• Review of hypoglycaemia
• Injection sites
• School issues
• Family issues (holidays, special dates, new
  situation)
• Has the child had an annual review in the last
  year?

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Annual review

• BP
• Urine for microalbumin (over 10 years old)
• Blood test for thyroid function and coeliac
  antibodies
• Check retinal screening in place (over 12 years
  old)
• Check Podiatrist screening done
• DSN review
• Dietetic review

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Other issues

• CGMS
• Insulin pumps
• Type 2 DM
• Adolescents
• Psychology
• Nurse clinics

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