Overview

• T1DM → pancreas stops being able to produce insulin, causing hyperglycaemia.
• DKA → hyperglycaemia + ketones + metabolic acidosis with raised anion gap.
  • Classification → Mild (pH<7.3), Moderate (pH<7.2), Severe (pH<7.1).

Making Diagnosis

Clinical Features

• 25-50% of new T1DM children present in diabetic ketoacidosis (DKA) → abdominal pain, N&V, kussmaul respirations (hyperventilation), acetone-smelling breath, dehydration, reduced consciousness.
• Triad → polyuria + polydipsia + weight loss.
• Secondary Enuresis → bedwetting in previously dry child.
• Recurrent Infections.

Investigations

• Blood Glucose → random blood glucose >11.0 mmol/L or fasting glucose >7.0 mmol/L.

Management Plan

• Insulin Therapy (3 Types) ⇒
  • Multiple Daily Injection Basal Bolus → injection of short-acting insulin before meals, with 1 or more seperate daily injections of long-acting insulin. OFFER THIS FROM DIAGNOSIS.
  • Continuous Subcatenous Insulin Infusion (Insulin Pump Therapy) → programmable pump that gives regular or continuous amounts of insulin via subcutaneous cannula.
  • One, Two or Three Insulin Injections Per Day → injections of short-acting insulin or rapid-acting insulin analogue mixed with intermediate-acting insulin.
• Blood Glucose and HbA1c Targets + Monitoring ⇒
  • Perform at least 5 capillary glucose tests per day.
  • HbA1c target <48 mmol/L.
• Monitor Blood Ketones.
• Lifestyle → balanced diet + exercise.