Clinical Cases
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Clinical Case no: 1 (8 year old boy with T1D) 4 G. Hoorweg-Nijman This is a very challenging situation. The label Multi Complex Development Disorder is not one in wide usage, and a literature search suggests it may no longer be appropriate. I have seen children with severe autism including difficult behaviours, who have developed obesity and T2DM on Risperidone. In one case the reduction of Risperidone and introduction of metformin helped to control the T2DM but most have needed to withdraw from Risperidone completely. Aripiprazole has recently been approved for children with autism in New Zealand, if Risperidone causes excessive weight gain, but so far my experience with this option is limited. It is also likely that this boy has a form of autism, and these children may have very high levels of anxiety so he may benefit fro the cautious introduction of a SSRI.I would agree with the previous responses, that this boy needs a full assessment by a Developmental Paediatrician and/or Neurologist, including genetic studies such as microarray, and EEG.In the interim you may wish to try a small dose of Clonidine (50-100 micrograms at night increasing to two or three times a day) which can help with these behaviours and although it is an 'older' medication it has been increasingly 'rediscovered' for such situations and discussed at meetings of the NBPSA (Neurodevelopmental and Behavioural Paediatric Society of Australasia). Clonidine may also cause some reduction in blood glucose levels as a useful side-effect in this boy. Hypotension can also occur.Best wishesJohn GoldsmithGeneral Paediatrician, Hamilton NZ
by J. Goldsmith
Saturday, June 16, 2018
insulin dose administration 0 M. Nasaif I would like to discuss the possibility of splitting regular insulin dose in children with erratic appetite , half the dose 30 minutes before the meal & 2nd half after the meal if the child took the whole meal so by that we will avoid hypos which can follow the regular insulin . as we see in many children that regular working well with children eating small frequent meals combined with long acting insulin analogue .
by M. Nasaif
Thursday, February 25, 2016

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