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					Presentation title




     Diagnosing
     diabetes in
      Childhood
                      Programme


1   Suspecting diabetes

2   Confirming the diagnosis
                      Presentation title




Suspecting diabetes
                                                      Slide no 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?
                                                         Slide no 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
                                                        Slide no 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
Glucose
                           cells
                         • Glucose unable to
                           enter cells without
                           insulin

   Blood vessel   Cell
                                                 8




 Insulin

           Insulin
                     • Pancreas secretes
                       insulin
                     • Insulin moves glucose
Pancreas
                       into cells and provides
                       energy for the cell
                                              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.)
 Liver

                             • Body breaks down
Muscle                         stores in liver,
                               muscle and fat to
                               produce more
Fat                            energy
                             • Weight loss
                             • Ketones


              Ketones
Weight loss



                          Cell
                                           Slide no 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
                                                              Slide no 13




Symptoms and signs of
type 1 diabetes
• Symptoms:                          • Signs:
  •   Lethargy                         • Weight loss
  •   Increased urination*             • Dehydrated
  •   Increased thirst                 • Altered level of
  •   Bed wetting*                       consciousness
  •   Vomiting                         • Acidotic/rapid breathing
                                       • Fruity odour


  *) Great question to distinguish
   from most other dehydration
  illnesses in your emergency room
                            Slide no 14




World Diabetes Day poster
                                                        Slide no 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
                                         Slide no 16




Other types of diabetes

• Malnutrition associated diabetes
• Neonatal diabetes
• Maturity onset diabetes of the young
• Gestational diabetes
Questions
                           Presentation title




Confirming the diagnosis
                                                   Slide no 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
                                                      Slide no 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)
                                                      Slide no 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
                                             Slide no 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
                               Slide no 23




Intermission


• Using blood glucose meters
• Using urine dipstix
Questions
Changing Diabetes® and the Apis bull logo are registered trademarks of Novo Nordisk A/S

				
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posted:8/16/2011
language:English
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