Makindo Medical Notes

Related Subjects:Sick Neonate |APGAR Scoring |Approach to Assessing Sick Child |Sick Child with Acute Gastroenteritis |Sick Child with Respiratory Distress |Sick child Diabetes Mellitus Type 1 and DKA

Type 1 diabetes mellitus (T1DM) is a chronic, lifelong disorder of glucose homeostasis characterized by autoimmune destruction of insulin-producing pancreatic β-cells, leading progressively to insulin deficiency and resultant hyperglycaemia.

About

• Type 1 Diabetes Mellitus in children results from the autoimmune destruction of pancreatic β-cells, leading to insulin deficiency and hyperglycaemia.

Aetiology

• Insulin is produced by the islets of Langerhans in the pancreas.
• An autoimmune process targets and destroys insulin-producing β-cells.

Clinical Features

• Common symptoms include weight loss, vomiting, polyuria, excessive thirst, and hyperglycaemia.
• 25% of cases may present with diabetic ketoacidosis (DKA).
• Other symptoms: bedwetting (nocturnal enuresis) and recurrent candida infections.

Investigations

• Basic Blood Work: FBC, Glucose, U&E, TFTs to assess for dehydration and electrolyte imbalances.
• Ketone levels: Assess for high ketones to confirm DKA.
• HbA1c: Elevated levels reflect chronic hyperglycaemia.
• Glucose and Lactate levels: Elevated in hyperglycaemia and metabolic acidosis.
• Autoantibodies: Anti-GAD and anti-islet cell antibodies for confirmation of autoimmune etiology.
• Blood cultures if fever is present to rule out infection.

Management

• Patient and Family Education: Essential to empower patients and their families to manage the condition effectively and independently.
• Insulin Therapy: Multiple regimens available:
  • Basal-Bolus Regimen: A long-acting insulin once daily combined with short-acting insulin at each meal.
  • Insulin Pumps: Continuous subcutaneous infusion for automated insulin delivery, usually for children over 12 with poor HbA1c control. Risks include infection and potential for pump blockage.
• DKA Management: Focus on rehydration, electrolyte correction, and insulin replacement to control blood glucose levels.

Diabetic Ketoacidosis

References

• ALGORITHM FOR THE MANAGEMENT OF DIABETIC KETOACIDOSIS