Algorithm: Child with Diabetes (P-Glu>11.1mM/L random, >7mM/L fasted)

•  Unwell a/o ketonuria
• T1DM most likely: start insulin, Ab studies (GAD/IA-2)
• Review diag at 3+ mth if Ab neg or Insulin dose<0.5u/kg
• Well ±polyuria/polydipsia ±weight loss; no ketonuria; no systemic features
• consider DD, if unsure treat with insulin
• T1DM and latent autoimmune: Ab pos (GAD/IA-2), lean, development of ketonuria: trial of insulin
• T2DM: overweight, FHx of T2DM, Ab neg, metabol syndr (lipid abnmlties a/o acanthosis nigricans a/o Htn): trial of metformin
• MODY: usu white, FHx of DM, usu lean, Ab neg: trial of diet (GK) or low dose SU (HNF)
• Diabetes and disorder
• iatrogenic DM
• post-BMT
• post organ transplant: 43% DM/IGT at 3yrs post transplant: RF: TBI, overweight, insulin-resistant, hypogonadism, tacrolimus, pulsed corticosteroids
• thalassaemia: insulin-resistance ±beta cell damage/exhaustion
• steroids: 20% of high-dose steroid recipients
• other secific disorders
• CF: CFRD: commonest form of secondary diabetes, in up to 34% in children with CF, usu no ketosis; DM manifesting as deterioration in lung fx and wt loss
• HNF-1β MODY
• Wolfram (DIDMOAD): AR: DM (non-autoimmune, <10y), progressive optic atrophy<16y, senorineural deafness, DI, dilated renal tracts, truncal ataxia; median survival; 30y; 90% mutations in Wolfram gene WFS-1
• Wolcott-Rallison
• Alström
• Roger's
• Bardet-Biedl: retinal dystrophy, obesity, hand abnmlties, renal abnmlties, male hypogonadism, ±mental retardation; 30% DM (insulin-resistant)
• Mitochondrial
• Prader-Willi
• Down's: autoimmune, similar to T1DM; also autoimmune thyr and coel dis
• Turner's
• Klinefelter's
• Insulin resistance syndromes
• PCOS: menstrual disturb, acne, hirsutism, icrd testosterone, icrd LH
• Lipodystrophy
• Type A syndr
• Donohue syndr (Leprechaunism): severe IUGR, lipodystrophy, fasting hypoglycaemia with postprandial hyperglycaemia: most die <1yr
• Rabson-Mendenhall