Primary care providers and pediatricians play an invaluable role in the diagnosis of pediatric diabetes and timely intervention in cases of hypoglycemia, hyperglycemia and diabetic ketoacidosis.
Primary care providers and pediatricians play an invaluable role in the diagnosis of diabetes mellitus and timely interventions.
“Diagnosing diabetes mellitus often starts with pediatricians or other primary care providers when parents bring in their child for unexplained weight loss, frequent urination and excessive fluid consumption,” said Brad Thrasher, D.O., MBA, pediatric endocrinologist with Wendy Novak Diabetes Institute, part of Norton Children’s Endocrinology, affiliated with the UofL School of Medicine.
Diabetes mellitus is a condition in which the body doesn’t make enough insulin (Type 1), or can’t use insulin appropriately (Type 2). The diagnostic criteria for diabetes include:
- An A1C greater than 6.5%
- Fasting blood sugar greater than 126 milligrams per deciliter (mg/dL), with fasting defined as no caloric intake for at least eight hours
- Random blood sugar greater than 200 mg/dL in a patient with classic symptoms of hyperglycemia, such as increased thirst and urination and/or weight loss
- Or blood sugar greater than 200 mg/dL measured two hours after oral glucose tolerance test (This final criterion is not routinely done on children.)
In the absence of unequivocal hyperglycemia, diagnosis requires two abnormal test results from the same sample or in two separate samples.
If a primary care provider is concerned one of their pediatric patients has developed diabetes mellitus, Wendy Novak Diabetes Institute is here to help.
Suspected or confirmed new onset diabetes mellitus, Type 1: Contact Norton Children’s Endocrinology at (502) 588-3400 to discuss with an endocrinology provider by phone to arrange for urgent care. For any symptomatic, ill-appearing child, the patient also should be sent to the Norton Children’s Hospital emergency department.
Suspected new onset diabetes mellitus, Type 2: Contact Norton Children’s Endocrinology at (502) 588-3400 to discuss with an endocrinology provider by phone to arrange for care. If the patient appears ill, has blood glucose greater than 250 mg/dL, has ketonuria and/or A1C equal to or greater than 8.5%, the patient also should also be sent to the Norton Children’s Hospital emergency department.
Diabetes is a complex, challenging disease, as blood sugar sometimes can change unpredictably. At diagnosis, patients and families require extensive diabetes education. Certified diabetes care and education specialists work with patients and families to provide knowledge to assist with daily self-management decisions for this complex disease. However, despite best efforts, issues will still arise.
Refer a patient
To refer a patient to Norton Children’s Endocrinology, visit Norton EpicLink and open an order for Pediatric Endocrinology/Diabetes Mellitus.
Hypoglycemia
Hypoglycemia is the medical term for a low blood sugar level. Low blood sugar is not uncommon in people living with T1D and can occur due to increased physical activity, skipping a meal or injecting too much insulin.
Symptoms of hypoglycemia include pallor, headache, sweating, shaking, hunger or nausea, fatigue, an irregular or fast heartbeat, difficulty concentrating, dizziness or lightheadedness, and tingling or numbness on the lips, tongue or cheeks. If not treated quickly, symptoms will get worse.
Severe hypoglycemia, below 54 mg/dL, can result in more serious symptoms such as difficulty walking or seeing clearly, becoming confused, and seizure.
When hypoglycemia occurs, patients need fast-acting carbohydrate to quickly raise blood sugar levels. Blood sugars need to be monitored after treatment to ensure sugar levels get back in range. Once blood sugar are back in range, a healthy snack should be consumed to help prevent another hypoglycemic event.
Hyperglycemia
Hyperglycemia is the medical term for a high blood sugar level. Hyperglycemia can occur for many reasons such as eating certain types of foods, not taking enough insulin, using certain medications such as steroids, and illnesses.
Symptoms of hyperglycemia include increased thirst and a dry mouth, frequent urination, fatigue, blurred vision, nausea, and unintentional weight loss.
With hyperglycemia, a patient needs insulin administration, if prescribed, and fluid replacement. If blood sugar readings are above 250 mg/dl, urine needs to be tested for ketones.
Having high glucose over a long period of time can result in permanent damage to eyes, nerves, kidneys and blood vessels. Very high blood glucose also can lead to life-threatening complications such as diabetic ketoacidosis.
Diabetic ketoacidosis
Major risk factors for diabetic ketoacidosis include undiagnosed Type 1 or Type 2 diabetes, with as many as a third of undiagnosed cases presenting with DKA in the first instance. Other major risk factors include not taking insulin as prescribed, infections and stomach illness.
Symptoms of DKA include abdominal pain, nausea, vomiting, and Kussmaul respirations. Untreated, DKA can lead to loss of consciousness and death.
Patients presenting with diabetic ketoacidosis need intravenous administration of insulin, fluid resuscitation and electrolyte replacement, and they need to be sent to an emergency department.
