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DIABETES

DIABETES. Supervised by: Prof. Sulaiman AlFaifi. Our Roadmap…. Diabetes in children. Types :. Other Types. Type I. Type II. Type I DM. Fatima . 7 years old Saudi girl From Abha Came to OPD Found to have High blood glucose on screening campaign Concerns about being Diabetic

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DIABETES

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  1. DIABETES Supervised by: Prof. SulaimanAlFaifi

  2. Our Roadmap….

  3. Diabetes in children

  4. Types : Other Types

  5. Type I Type II

  6. Type I DM

  7. Fatima .. • 7 years old • Saudi girl • From Abha • Came to OPD • Found to have High blood glucose on screening campaign • Concerns about being Diabetic • HOW TO APPROACH ??? is this common presentation ??

  8. History • Risk Factors

  9. History

  10. Examination

  11. Diagnosis Symptoms + one of the following investigations: To confirm Dx, repeat the test another time. Don’t forget to take Drug Hx

  12. Management

  13. Management

  14. Management Goal

  15. Types of insulin

  16. Management

  17. Regemin

  18. Thank you

  19. References • 1- Gillespie, K. M. (2006). Type 1 diabetes: pathogenesis and prevention. CMAJ : Canadian Medical Association journal = journal de l’Associationmedicalecanadienne, 175(2), 165-70. doi:10.1503/cmaj.060244 • 2- Onkamo, P., Väänänen, S., Karvonen, M., & Tuomilehto, J. (1999). Worldwide increase in incidence of Type I diabetes--the analysis of the data on published incidence trends. Diabetologia, 42(12), 1395-403. doi:10.1007/s001250051309 • 3- Ginsberg-Fellner, F., Witt, M. E., Fedun, B., Taub, F., Dobersen, M. J., McEvoy, R. C., Cooper, L. Z., et al. (n.d.). Diabetes mellitus and autoimmunity in patients with the congenital rubella syndrome. Reviews of infectious diseases, 7 Suppl 1, S170-6. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/3890104 • 4- Hober, D., & Sauter, P. (2010). Pathogenesis of type 1 diabetes mellitus: interplay between enterovirus and host. Nature reviews. Endocrinology, 6(5), 279-89. doi:10.1038/nrendo.2010.27 • 5- Hyppönen, E., Läärä, E., Reunanen, A., Järvelin, M. R., & Virtanen, S. M. (2001). Intake of vitamin D and risk of type 1 diabetes: a birth-cohort study. Lancet, 358(9292), 1500-3. doi:10.1016/S0140-6736(01)06580-1

  20. DKA

  21. Meet our patient • Othman, 6yrs old Saudi boy from Abha • Known case of DM type I • Came to ER complaining of : • Fatigue and malaise • Nausea/vomiting • Abdominal pain • On Examination:

  22. Investigations : DKA

  23. New-onset DM1. Known DM1 if : - Insulin injections are omitted. - Stress (infections/surgery). Causes

  24. Management

  25. Dehydration [1] IV fluid bolus of glucose-free isotonic solution (NS/ringer`s lactate). [2] The remaining fluid deficit + maintenance fluid: -replaced SLOWELY over 36-48 hours. • * To avoid rapid shifts in serum osmolality: •  start with 0.9% NaCl • Then replaced by 0.45% NaCl.

  26. Management

  27. Hyperglycemia: [1] Fast-acting IV insulin (0.1U/kg/hour). [2] If serum glucose <300 mg/dl , add glucose to IV fluid. Acidosis: * Insulin  increase glucose uptake.  decrease FFAs production. * Avoid HCO3 unless sever acidosis (pH < 7.0).

  28. Management

  29. Electrolytes imbalance: * potassium should be added to IV fluid , ONLY if adequate urine output is shown. (50% KCl & 50% KPo) at 20-40 mEq/L. Monitoring: [1] Flow-sheet. [2] repeat serum glucose every hour. [3] neurologic & mental status.

  30. Complications

  31. * 1-5%. * 20-80% mortality rate. * pathogenesis: osmolar shift  increase intracellular compartment fluid & cell swelling. * 6-12 hours after therapy. * signs & symptoms: 1- sever headache. 2- bradycardia, HTN, apnea. 3- dilated pupil, papilledema. 4- seizure. Cerebral edema

  32. Treatment of cerebral edema : [1] IV Mannitol. [2] Endotracheal intubation & hyperventilation.

  33. That’s all Thank you

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