Presentation title

Diagnosing diabetes in Childhood

1 Suspecting diabetes

Confirming the diagnosis

Programme

2

Presentation title

Suspecting diabetes

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?

Slide no 4

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

Slide no 5

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)

Slide no 6

Glucose

Glucose

• Food converted to glucose

• Glucose is the main source of energy for cells

• Glucose unable to enter cells without insulin

7

Blood vessel Cell

Insulin

• Pancreas secretes insulin

• Insulin moves glucose into cells and provides energy for the cell

8

Insulin

Pancreas

Type 1 diabetes

• Too little insulin from pancreas

• Glucose accumulates in blood

• Not enough energy in cells

• Lethargic

9

Type 1 Diabetes (cont.)

• Blood circulates through kidneys

• Glucose excreted in urine (attracts ants)

• Increased urine• Enuresis• Dehydration and

weight Loss• Increased drinking

10

Cell

Type 1 Diabetes (cont.)

• Body breaks down stores in liver, muscle and fat to produce more energy

• Weight loss

• Ketones

11

Liver

Muscle

Fat

Weight lossKetones

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

Slide no 12

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

Slide no 13

*) Great question to distinguish

from most other dehydration

illnesses in your emergency room

World Diabetes Day poster

Slide no 14

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

Slide no 15

Other types of diabetes

• Malnutrition associated diabetes

• Neonatal diabetes

• Maturity onset diabetes of the young

• Gestational diabetes

Slide no 16

Questions

Presentation title

Confirming the diagnosis

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

Slide no 19

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)

Slide no 20

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

Slide no 21

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

Slide no 22

Intermission

• Using blood glucose meters

• Using urine dipstix

Slide no 23

Questions

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