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At GP surgery: BGL 25mmol/L – referred to ED In ED: Capillary blood gas: pH 7.18, bicarbonate (HCO3) 12 mmol/L, BGL 25 mmol/L, Na 136 mmol/L (corrected.

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Presentation on theme: "At GP surgery: BGL 25mmol/L – referred to ED In ED: Capillary blood gas: pH 7.18, bicarbonate (HCO3) 12 mmol/L, BGL 25 mmol/L, Na 136 mmol/L (corrected."— Presentation transcript:

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5 At GP surgery: BGL 25mmol/L – referred to ED In ED: Capillary blood gas: pH 7.18, bicarbonate (HCO3) 12 mmol/L, BGL 25 mmol/L, Na 136 mmol/L (corrected = 142), K 4.9 mmol/L Corrected Na = measured Na (glucose – 5.5)

6 Management: 10ml/kg bolus Normal saline Re-assessed: PR 118, RR 36, BP 96/58 IV insulin infusion: 0.1U/kg/hr Fluids: N/S + 40mmol/L KCL at maintenance + 5% replacement over 48 hrs Transferred to HDU – further management as per DKA protocol

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8 Diabetes Care 2013;36(suppl 1):S11.

9 A1C ≥6.5% OR Fasting plasma glucose ≥7.0 mmol/L OR 2-h plasma glucose ≥11.1 mmol/L during an OGTT OR A random plasma glucose ≥11.1 mmol/L Diabetes Care 2013;36(suppl 1):S13; Table 2.

10 Categories of increased risk for diabetes (prediabetes) IFG: 5.6–6.9 mmol/L OR IGT: 2-h plasma glucose in the 75-g OGTT 7.8–11.0 mmol/L OR A1C 5.7–6.4% *For all three tests, risk is continuous, extending below the lower limit of a range and becoming disproportionately greater at higher ends of the range. Diabetes Care 2013;36(suppl 1):S13; Table 3.

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12 Diabetic Medicine 2009; 26(6): Australian incidence (NDR) in children 0-14 years between

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16 Cow’s milk protein exposure (bovine serum albumin and β-lactoglobulin) Vitamin D deficiency Viruses: coxsackie A or B, enterovirus, rubella, cytomegalovirus, ECHO virus, EBV, mumps, retrovirus Drugs & toxins: eg alloxan-like or streptozotocin- like agents that induce oxidant beta-cell damage Stress The Environmental Determinants of Diabetes in the Young (TEDDY) study

17 Diabetes Care 2009;32:

18 Cell Mol Life Sci 2007;64: Ann Intern Med 2004;140:882-6 J Clin Endocrinol Metab 2004;89: Diabetes 1999;48:460-8

19 Atkinson MA & Eisenbarth GS. Lancet 2001; 358;

20 Meal

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22 Fasting blood glucose is not an appropriate screen test for T1DM

23 The EURODIAB study Diabetologia 2001;44(Suppl 3):B75-80.

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25 DCCT/EDIC Research Group. JAMA. 2002;15;287: Intensive treatment should be started as soon as is safely possible after the onset of T1DM and maintained thereafter

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27 ISPAD Clinical Practice Consensus Guidelines 2006–2007

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29 Rapid (Humalog, Novorapid, Apidra) Hours Long (glargine) Short (Humalin R, Actrapid) Intermediate (NPH, Protaphane) Long (detemir) Insulin Level N Engl J Med. 2005;352:

30 Pre-mix Twice- daily MDI Increased Complexity Better control Less Hypoglycaemia Increased Complexity Better control Less Hypoglycaemia CSII

31 INSULIN DOSING CARD Ezy-BICC SMART-METER Accu-Chek Aviva Expert INSULIN DOSING APP Insulin Pro

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33 Diabet Med doi: /dme Pediatr Clin N Am 2011; 58 : 1301–1315

34 ISPAD Clinical Practice Consensus Guidelines 2006–2007

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43 ISPAD Guidelines Pediatric Diabetes 2009: 10(Suppl. 12): 134–145

44 ISPAD Guidelines Pediatric Diabetes 2009: 10(Suppl. 12): 134–145

45 Diabetes Care. 2005;28:

46 Garg S, et al. Presented at 5th International Conference on Advanced Technologies & Treatment for Diabetes, Barcelona, 2012.

47 J Pediatr. 2002;141:

48 Health Psychol. 1992;11: Diabetes Care. 1996;19: ; Diabetes Technol Ther. 2008;10: Glucose variability Reluctance to intensify therapy High A1C Complications Morbidity Mortality Complications Morbidity Mortality Quality of life Fear of hypoglycemia Severe hypoglycemia Controversial

49 DEXCOM MEDTRONIC HYPOMON

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51 STRESS COUNTER- REGULATORY HORMONE COUNTER- REGULATORY HORMONE INSULIN RESISTANCE INSULIN RESISTANCE KETOSIS HYPERGLYCAEMIA Also hypoglycaemia with ketosis eg gastroenteritis

52 Paediatric Diabetes 2009; 10 (Suppl. 12):

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