|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 the insulin-producing pancreatic b-cell, leading progressively to insulin deficiency and resultant hyperglycemia
- Loss of pancreatic insulin
- Insulin from islets of Langerhans
- Autoimmune attack of beta cells
- Weight loss, Vomiting, polyuria, thirst, hyperglycaemia
- Diabetic ketoacidosis in 25%, glycosuria
- Bed wetting, candidal infection
- FBC, Glucose, U&E, TFTs: may show dehydration
- Ketones are high. Assess Hba1C which is high
- Glucose: high, Lactate: high
- Blood cultures if fever
- Anti GAD and anti Islet cell abs
- Patient and family education.
- Commence Insulin S/C to replace insulin or Insulin pump. There are various regimens
- Basal (Long acting OD) + short acting with each meal
- Insulin pumps. Alternative. Automated. Usually age over 12 and poor Hba1C. Can be blocked, risk of infection
- Treatment focuses on rehydration and insulin replacement.
- Involve patients and their families attain ownership of their condition as part of a continuing, empowering relationship with their diabetes care team.
- Optimal health and wellness is achieved when blood glucose is controlled tightly. Intensive control significantly decreases the likelihood of developing the microvascular and macrovascular complications of T1DM