DIABETES MELLITUS IN CHILDREN: CLINICAL FEATURES, DIAGNOSTICS AND TREATMENT Prof. H.A. Pavlyshyn.

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DIABETES MELLITUS IN DIABETES MELLITUS IN CHILDREN: CLINICAL CHILDREN: CLINICAL

FEATURESFEATURES, , DIAGNOSTICS DIAGNOSTICS ANDAND TREATMENT TREATMENT

Prof. H.A. PavlyshynProf. H.A. Pavlyshyn

Risk factorsRisk factors

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

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)

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

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

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

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

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

ComplicationsComplicationsTrophic changes in the Trophic changes in the

skinskin

ComplicationsComplications Trophic changes in the Trophic changes in the

skinskin

ComplicationsComplicationsdiabetic nephropathydiabetic nephropathy

ComplicationsComplicationsdiabetic retinopathydiabetic retinopathy

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.

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

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

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)

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

The catheter at the end of the insulin pump is inserted through a needle into the abdominal fat of a person with diabetes.

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.

DIABETES MELLITUS IN CHILDREN: CLINICAL FEATURES, DIAGNOSTICS AND TREATMENT Prof. H.A. Pavlyshyn.

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