Neobook — clinical reference

ICD-10 Code: E11

DESCRIPTION

Type 2 diabetes develops when insulin secretion cannot meet the increased demand posed by insulin resistance. Type 2 diabetes may be associated with hyperlipidemia, hypertension, acanthosis nigricans, ovarian hyperandrogenism and non-alcoholic fatty liver disease (features of insulin resistance).

DIAGNOSTIC CRITERIA

Clinical

Obesity or overweight.
Children with a strong family history of type 2 diabetes, usually in adolescents with BMI > 95^th centile without auto-antibodies to islet cells and normal serum C-peptide levels.
Keto-acidosis is unusual in type 2 diabetes.
A fasting glucose > 7.0 mmol/L.
Type 2 diabetics may have minimal symptoms or signs for months or even years before the diagnosis.

Investigations

To confirm diagnosis:

Symptoms of diabetes.

PLUS

Fasting plasma glucose > 7.0 mmol/L.

Random plasma glucose 11.0 mmol/L.

No symptoms, but an abnormal 2-hour serum glucose level on the oral glucose tolerance test:
- Ingestion of 1.75 g/kg (maximum 75 g) of glucose dissolved in water.
- Serum glucose > 11.0 mmol/L 2 hours post ingestion of oral glucose.

GENERAL AND SUPPORTIVE MEASURES

Lifestyle modification:
Manage patients who are not ill at diagnosis initially with advice on nutrition and exercise, but most will eventually require medicine therapy.
Education on routine blood glucose monitoring. A logbook with all blood glucose readings should be kept. In most cases fasting, pre-breakfast measurement and 2-hour postprandial dinner measurement are sufficient.
Initial medicine treatment is determined by symptoms, severity of hyperglycaemia and presence of ketosis. This should be decided in consultation with a specialist who is experienced in treating these children.

MEDICINE TREATMENT

Refer for initiation of therapy.

Standard Treatment Guidelines and Essential Medicines List for South Africa, Hospital Level, Paediatrics, 2023 Edition

Chapter 7: Endocrine, 7.5 Diabetes Mellitus, 7.5.4 Diabetes Mellitus, Type 2