1. Presentation title Diagnosing diabetes in Childhood

2. 1 Suspecting diabetes Confirming the diagnosis Programme 2

3. Presentation title Suspecting diabetes

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 4

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 5

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) Slide no 6

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

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

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

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

11. 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 loss Ketones

12. 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

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 Slide no 13 *) Great question to distinguish from most other dehydration illnesses in your emergency room

14. World Diabetes Day poster Slide no 14

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 15

16. Other types of diabetes Malnutrition associated diabetes Neonatal diabetes Maturity onset diabetes of the young Gestational diabetes Slide no 16

17. Questions

18. Presentation title Confirming the diagnosis

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 19

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 20

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 21

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 22

23. Intermission Using blood glucose meters Using urine dipstix Slide no 23

24. Questions

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