Diagnosing diabetes in Childhood

1. Diagnosing diabetes in Childhood Presentation title

2. Programme Suspecting diabetes 1 2 Confirming the diagnosis

3. Suspecting diabetes Presentation title

4. Diabetes in childhood How does diabetes in children develop? Why should children with diabetes be treated differently from most adults with diabetes? Why can children with diabetes become so ill, and sometimes die?

5. Diabetes • Group of disorders characterised by chronically high blood glucose levels. • Glucose in blood comes from • Food (food converted to glucose in the liver) • Stores (energy stored in liver, muscle and fat) • Glucose provides energy to cells and organs • Requires insulin to move from blood to cells

6. Insulin • Hormone secreted by the pancreas • Produced by β-cells of the pancreas • Diabetes occurs if: • Pancreas does not produce enough insulin (type 1 diabetes) • Effect of insulin decreased (type 2 diabetes)

7. Glucose Food converted to glucose Glucose is the main source of energy for cells Glucose unable to enter cells without insulin Glucose Blood vessel Cell

8. Insulin Pancreas secretes insulin Insulin moves glucose into cells and provides energy for the cell Insulin Pancreas

9. Type 1 diabetes Too little insulin from pancreas Glucose accumulates in blood Not enough energy in cells Lethargic

10. Type 1 Diabetes (cont.) Blood circulates through kidneys Glucose excreted in urine (attracts ants) Increased urine Enuresis Dehydration and weight Loss Increased drinking

11. Type 1 Diabetes (cont.) Body breaks down stores in liver, muscle and fat to produce more energy Weight loss Ketones Liver Muscle Fat Ketones Weight loss Cell

12. Ketones • Common feature of type 1 diabetes • Rare in type 2 diabetes • Occurs because of a breakdown of fat • Is life-threatening • Signs and symptoms: • Sweet smell on breath • Vomiting • Stomach pain • Rapid/acidotic breathing • Altered level of consciousness

13. Symptoms and signs of type 1 diabetes • Symptoms: • Lethargy • Increased urination* • Increased thirst • Bed wetting* • Vomiting • Signs: • Weight loss • Dehydrated • Altered level of consciousness • Acidotic/rapid breathing • Fruity odour *) Great question to distinguish from most other dehydration illnesses in your emergency room

14. World Diabetes Day poster

15. Type 2 diabetes Usually seen in older people Due to resistance to effects of insulin Often associated with obesity Often asymptomatic Treated with life style change and oral medications Increasingly seen in youth as they get more obese at younger and younger ages around the world

16. Other types of diabetes Malnutrition associated diabetes Neonatal diabetes Maturity onset diabetes of the young Gestational diabetes

17. Questions

18. Confirming the diagnosis Presentation title

19. Criteria for diagnosis • Symptoms of diabetes plus casual/random plasma glucose concentration above or equal 11.1 mmol/l (200 mg/dl) OR • Fasting plasma glucose above or equal 7.0 mmol/l (126 mg/dl) • Laboratory blood glucose • Glucometer

20. Making a diagnosis • If blood glucose testing not available • Urine dipstix: • Glucose • Ketones • If ketones are present in urine or blood, treatment is urgent and the child should be treated the same day to avoid the development of ketoacidosis (DKA)

21. Glucose meters Portable device that measures blood glucose Drop of blood placed on plastic strip Result in 5-10 seconds Accurate Meters require coding and strips may expire Be aware of difference between glucose meters and laboratory glucose values

22. Precautions Strips – brand, code and expiry date Confirm units of measure (mmol/l, mg/dl) Wash hands (yours and the patients) Technique Dispose of strips after use Do not share or reuse lancets Dispose lancets safely

23. Intermission • Using blood glucose meters • Using urine dipstix

24. Questions

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