DIABETES MELLITUS IN CHILDREN: CLINICAL FEATURES, DIAGNOSTICS AND TREATMENT Prof. H.A. Pavlyshyn.
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Transcript of DIABETES MELLITUS IN CHILDREN: CLINICAL FEATURES, DIAGNOSTICS AND TREATMENT Prof. H.A. Pavlyshyn.
DIABETES MELLITUS IN DIABETES MELLITUS IN CHILDREN: CLINICAL CHILDREN: CLINICAL
FEATURESFEATURES, , DIAGNOSTICS DIAGNOSTICS ANDAND TREATMENT TREATMENT
Prof. H.A. PavlyshynProf. H.A. Pavlyshyn
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Risk factorsRisk factors
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Risk factorsRisk factors
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Risk factorsRisk factors
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Clinical classification of DM typeClinical classification of DM type 11. .
SeveritSeverityy
Glycemic Glycemic controlcontrol
ComplicatioComplicationsns
- Mild- Mild
- - ModeratModeratee
- - SevereSevere
- Ideal- Ideal
- Optimal- Optimal
- - SuboptimaSuboptimall
- High risk - High risk for the lifefor the life
- Acute- Acute
- Chronic- Chronic
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DM severity criteriaDM severity criteria
Mild form Mild form - Absence of ketoacidosis in Absence of ketoacidosis in
anamnesisanamnesis- Absence of micro- and Absence of micro- and
macroangiopathiesmacroangiopathies- Treatment consists of diet, Treatment consists of diet,
physical exercises, phytotherapy physical exercises, phytotherapy (it’s enough for ideal glycemic (it’s enough for ideal glycemic control maintaining)control maintaining)
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DM severity criteriaDM severity criteria
Moderate formModerate form- In anamnesis – ketoacidosis (I-II In anamnesis – ketoacidosis (I-II
stages)stages)- Presence of diabetic retinopathy I Presence of diabetic retinopathy I
st., diabetic nephropathy I-III st. or st., diabetic nephropathy I-III st. or diabetic arthropathy I st.diabetic arthropathy I st.
- For achievement of ideal glycemic For achievement of ideal glycemic control is necessary to use insulin, control is necessary to use insulin, or or oral drug therapyoral drug therapy or combination or combination of bothof both
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DM severity criteriaDM severity criteria
Severe formSevere form- Non stable course of the Non stable course of the
disease (frequent ketoacidosis disease (frequent ketoacidosis cases or coma in anamnesis)cases or coma in anamnesis)
- Presence of different chronic Presence of different chronic complicationscomplications
- Patients need permanent Patients need permanent insulin injectionsinsulin injections
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Laboratory criteriaLaboratory criteria of glycemic control of glycemic control
GlucosGlucose, e, (mmol/(mmol/L)L)
IdealIdeal OptimOptimalal
SuboptSuboptimalimal
High risk High risk for the for the lifelife
Fasting Fasting glycemiglycemiaa
3,6-3,6-6,16,1
4,0-7,04,0-7,0 >> 8,0 8,0 >> 9,0 9,0
After After foodfood
glycemiglycemiaa
4,4-4,4-7,07,0
5,0-5,0-11,011,0
11,0-11,0-14,014,0
>> 14,0 14,0
NightNight
glycemiglycemiaa
3,6-3,6-6,06,0
Not Not << 3,63,6
<< 3,6 3,6 or or >> 9,09,0
<< 3,0 or 3,0 or
>> 11,0 11,0
HbHbAlc, Alc, %% << 6,05 6,05 << 7,6 7,6 7,6-9,07,6-9,0 >> 9,0 9,0
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The main evident signs of the DM The main evident signs of the DM type 1:type 1:
hyperglycemiahyperglycemia- - glucose uptake by cells decreasedglucose uptake by cells decreased- - glucose utilisation by cells decreasedglucose utilisation by cells decreased glycosuriaglycosuria polyuriapolyuria - - excessive urine productionexcessive urine production- b- blood glucose levels exceed the ratelood glucose levels exceed the rate of of glomerular filtration glomerular filtration
by the kidneysby the kidneys- glucose appears in the urine and acts as an osmotic glucose appears in the urine and acts as an osmotic
diureticdiuretic polydipsiapolydipsia - - due to dehydrationdue to dehydration polyphagia polyphagia - - excessive eatingexcessive eating- - hypothalamic control of appetite has insulin sensitive hypothalamic control of appetite has insulin sensitive
transport systemstransport systems weight lossweight loss fatigue and weaknessfatigue and weakness
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Diagnostic criteria:Diagnostic criteria: A random blood glucose level greater A random blood glucose level greater
than than 11,1 mmol/l11,1 mmol/l (i.e.>200 mg/dl), (i.e.>200 mg/dl), which is verified on a repeat test, which is verified on a repeat test, is is sufficient to make the diagnosis of sufficient to make the diagnosis of DM DM
or or Fasting blood glucose > Fasting blood glucose > 6,1 mmol/l6,1 mmol/l
(>110 mg/ dl) (fasting is no food for (>110 mg/ dl) (fasting is no food for > 8 hours), which is verified on a > 8 hours), which is verified on a repeat test, repeat test, is sufficient to make the is sufficient to make the diagnosis of DM diagnosis of DM
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ComplicationsComplicationsTrophic changes in the Trophic changes in the
skinskin
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ComplicationsComplications Trophic changes in the Trophic changes in the
skinskin
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ComplicationsComplicationsdiabetic nephropathydiabetic nephropathy
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ComplicationsComplicationsdiabetic retinopathydiabetic retinopathy
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Oral glucose tolerance test Oral glucose tolerance test
(OGTT)(OGTT)
Obtain a fasting blood sugar Obtain a fasting blood sugar level, then administer level, then administer per osper os glucose load (1.75 g/kg for glucose load (1.75 g/kg for children [max children [max 7575 g] g])). Check . Check blood glucose concentration blood glucose concentration again after 2 hours. again after 2 hours.
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Optimal therapy for diabetes Optimal therapy for diabetes mellitus must includemellitus must include
InsulinInsulin A regimen for physical A regimen for physical
fitnessfitness Psychological support Psychological support Nutritional managementNutritional management
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Daily insulin doses for children:Daily insulin doses for children:
AgeAge Insulin dose Insulin dose (Units(Units/kg)/kg)
Infants (< 1 year)Infants (< 1 year) 0,1 - 0,1250,1 - 0,125
Toddlers (1-3 Toddlers (1-3 years)years)
0,15 – 0,170,15 – 0,17
3-9 years3-9 years 0,2 – 0,50,2 – 0,5
9-12 years9-12 years 0,5 – 0,80,5 – 0,8
> 12 years> 12 years 1,0 and more1,0 and more
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Insulin has 3 basic formulations:Insulin has 3 basic formulations: short-actingshort-acting, , regularregular insulin insulin
(aktrapid)(aktrapid) medium- or intermediate-acting medium- or intermediate-acting
((protaphan, protaphan, isophane, lente)isophane, lente) and long-acting (ultralente)and long-acting (ultralente)
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The main rules of insulinotherapy The main rules of insulinotherapy im children:im children:
In ketoacidosis should be used only In ketoacidosis should be used only regularregular insulin insulin
Optimal frequency of injections is 4-5 Optimal frequency of injections is 4-5 times per day (times per day (if 4 timesif 4 times – 9 a.m. – 9 a.m.(regular), 13 p.m.(regular), 18 p.m. (regular), 13 p.m.(regular), 18 p.m. (regular), 22 p.m (medium-acting); (regular), 22 p.m (medium-acting); if 5 if 5 timestimes – 6 a.m.(regular), 9 a.m.(regular), – 6 a.m.(regular), 9 a.m.(regular), 14 p.m. (regular), 19 p.m. (regular), 23 14 p.m. (regular), 19 p.m. (regular), 23 p.m (regular); p.m (regular);
Can be used insulin pompesCan be used insulin pompes
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The catheter at the end of the insulin pump is inserted through a needle into the abdominal fat of a person with diabetes.
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Designer Ellaluna Taylor has come up with her Flex insulin pump system that targets active diabetes sufferers, as this system functions as a “unique prosthetic skin” that can be worn under clothing, functioning as a discreet glucose management solution. It comes with a PDA-like glucose eReader that will talk to the device, where the latter runs on soft battery technology while its MEMS Nano Pump is used for increased dosage accuracy and reliability.
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