PE30.3-4 | Diabetes Mellitus — Summary & Reflection

KEY TAKEAWAYS

Diabetes Mellitus in Children — key take-aways:

• T1DM is the commonest paediatric form; presents with polyuria, polydipsia, weight loss; 30% present acutely in DKA at diagnosis.
• T2DM in obese Indian adolescents — acanthosis nigricans, family history, insidious onset.
• DM diagnostic criteria: fasting ≥126, random ≥200 + symptoms, HbA1c ≥6.5%, 2h OGTT ≥200 mg/dL.
• DKA: glucose >200 + pH <7.3 + ketonaemia/ketonuria. Urine dipstick (2+ glucose + 2+ ketones) = urgent evaluation.
• DKA management: isotonic saline (10 mL/kg for shock only), fluid deficit + maintenance over 48h, insulin 0.05–0.1 U/kg/hr IV, potassium add when K <5.5, no routine bicarbonate.
• Cerebral oedema = most feared complication → mannitol 0.5–1 g/kg IV immediately.
• HbA1c target in children: <7.0–7.5% (ISPAD); screen annually for nephropathy, retinopathy after 5 years.
• Refer all children with new DM or DKA — management is at tertiary paediatric centre.

REFLECT

A family whose 7-year-old daughter has just been diagnosed with Type 1 DM after recovering from DKA is devastated. The parents ask: 'Why did this happen? Did we do something wrong? Will she need injections forever? Can she go to school normally?' Reflect on how you would counsel this family — addressing the autoimmune aetiology (no parental fault), the need for lifelong insulin, a normal school and social life with good control, and what training the family needs before discharge. How does the psychological impact of a chronic childhood disease shape your approach to education and follow-up?