BNF for Children 2011-2012

348 BNFC 2011–20126 Endocrine system6 Endocrine system6.1 Drugs used in diabetes 3486.1.1 Insulins 3496.1.1.1 Short-acting insulins 3526.1.1.2 Intermediate- and long-actinginsulins 3536.1.1.3 Hypodermic equipment 3566.1.2 Antidiabetic drugs 3576.1.2.1 Sulfonylureas 3586.1.2.2 Biguanides 3596.1.2.3 Other antidiabetic drugs 3606.1.3 Diabetic ketoacidosis 3606.1.4 Treatment of hypoglycaemia 3616.1.5 Treatment of diabetic nephropathyand neuropathy 3626.1.6 Diagnostic and monitoringdevices for diabetes mellitus 3636.2 Thyroid and antithyroid drugs 3656.2.1 Thyroid hormones 3656.2.2 Antithyroid drugs 3676.3 Corticosteroids 3696.3.1 Replacement therapy 3696.3.2 Glucocorticoid therapy 3706.4 Sex hormones 3776.4.1 Female sex hormones 3776.4.1.1 Oestrogens 3776.4.1.2 Progestogens 3786.4.2 Male sex hormones and antagonists3796.4.3 Anabolic steroids 3816.5 Hypothalamic and pituitary hormones3826.5.1 Hypothalamic and anterior pituitaryhormones including growthhormone 3826.5.2 Posterior pituitary hormones andantagonists 3856.6 Drugs affecting bone metabolism3886.6.1 Calcitonin 3886.6.2 Bisphosphonates 3886.7 Other endocrine drugs 3916.7.1 Bromocriptine and otherdopaminergic drugs 3916.7.2 Drugs affecting gonadotrophins 3916.7.3 Metyrapone 3916.7.4 Somatomedins 391This chapter includes advice on the drug managementof the following:Adrenal suppression during illness, trauma orsurgery, p. 371Serious infections in patients taking corticosteroids,p. 371Nephrotic syndrome, p. 371Delayed puberty, p. 377Precocious puberty, p. 380Diabetes insipidus, p. 385For hormonal contraception, see section 7.3.6.1 Drugs used in diabetes6.1.1 Insulins6.1.2 Antidiabetic drugs6.1.3 Diabetic ketoacidosis6.1.4 Treatment of hypoglycaemia6.1.5 Treatment of diabetic nephropathyand neuropathy6.1.6 Diagnostic and monitoring devices fordiabetes mellitusDiabetes mellitus occurs because of a lack of insulin orresistance to its action. It is diagnosed by measuringfasting or random blood-glucose concentration (andoccasionally by oral glucose tolerance test). Althoughthere are many subtypes, the two principle classes ofdiabetes are type 1 diabetes and type 2 diabetes.Type 1 diabetes, (formerly referred to as insulin-dependentdiabetes mellitus (IDDM)), is due to a deficiency ofinsulin following autoimmune destruction of pancreaticbeta cells and is the most common form of diabetes inchildren. Children with type 1 diabetes require administrationof insulin.Type 2 diabetes, (formerly referred to as non-insulindependentdiabetes mellitus (NIDDM)), is rare in childrenbut the incidence is increasing, particularly inadolescents, as obesity increases. It results fromreduced secretion of insulin or from peripheral resistanceto the action of insulin, or from a combination ofboth. Although children may be controlled on diet alone,many require oral antidiabetic drugs or insulin to maintainsatisfactory control. There is limited informationavailable on the use of oral anti-diabetic drugs in children(see section 6.1.2). In overweight individuals, type2 diabetes may be prevented by losing weight andincreasing physical activity.Genetic defects of beta-cell function (formerly referredto as maturity-onset diabetes of the young (MODY)),describes a number of rare disease states, characterisedby onset of mild hyperglycaemia, generally before 25years of age. A sulfonylurea, such as gliclazide (p. 359),may be effective in these patients.