Description
Type 1 diabetes in children is an autoimmune disorder where the immune system attacks the insulin-producing cells in the pancreas. It is usually diagnosed in childhood or adolescence, though it can occur at any age. Children with type 1 diabetes require insulin injections or an insulin pump to manage their blood sugar levels. The exact cause of type 1 diabetes in children is not fully understood, but genetic and environmental factors may play a role. Symptoms of type 1 diabetes in children include frequent urination, excessive thirst, unexplained weight loss, and fatigue. Diabetic ketoacidosis (DKA) is a severe complication that can arise if type 1 diabetes is left untreated or poorly managed. Continuous glucose monitoring (CGM) and insulin pumps have significantly improved diabetes management in children. Children with type 1 diabetes need to follow a carefully balanced diet and monitor their carbohydrate intake. Regular physical activity is essential for children with type 1 diabetes, as it helps control blood sugar levels and promotes overall health. Careful monitoring of blood sugar levels is crucial to prevent hypoglycemia (low blood sugar) or hyperglycemia (high blood sugar) in children.
Summary Listen
- Dr. Sunil discussed type 1 diabetes in children, highlighting its increasing incidence worldwide. He differentiated it from type 2 diabetes, explaining that type 1 involves insulin deficiency due to autoimmune destruction of pancreatic beta cells, while type 2 is characterized by insulin resistance.
- The presentation included a case report of a six-year-old boy presenting with abdominal pain, vomiting, polyuria, polydipsia, weight loss, and dehydration, ultimately diagnosed with diabetic ketoacidosis (DKA). The initial treatment focused on IV fluids, insulin infusion, and antibiotics to address potential infection.
- Dr. Sunil then elaborated on the etiology of type 1 diabetes, pointing out the interplay of environmental factors and genetic predisposition. He touched on the potential roles of viral infections, microbial deprivation, diet, stress, and ionizing radiation in triggering the disease.
- The natural history of type 1 diabetes was outlined, consisting of preclinical autoimmunity, defects in insulin secretion, clinical diabetes, and potential remission (honeymoon period). The common manifestations include polyuria, polydipsia, polyphagia, weight loss, nocturnal enuresis, fatigue, and increased susceptibility to infections.
- Diagnosis is confirmed through elevated random blood glucose, fasting blood glucose, or glycosylated hemoglobin (HbA1c) levels. Oral glucose tolerance tests are typically not required.
- Management strategies emphasize insulin therapy as a lifelong necessity, alongside frequent blood glucose monitoring, diet control, exercise, and comprehensive education for both the child and parents. Newer insulin analogs, such as lispro, aspart, glargine, and detemir, were highlighted for their effectiveness and reduced side effects.
- Different methods of insulin delivery, including injections, pen devices, jet injectors, and insulin pumps, were discussed, with emphasis on the importance of site rotation. Continuous glucose monitoring (CGM) and closed-loop insulin delivery systems (artificial pancreas) are promising advancements.
- The potential complications of diabetes, including microvascular (nephropathy, retinopathy) and macrovascular (coronary artery disease, cerebrovascular accidents, peripheral vascular disease) issues, were acknowledged, stressing the importance of good glycemic control for prevention. The presentation also highlighted the need for long-term management, including regular follow-up and monitoring.
- Diabetic ketoacidosis (DKA) pathophysiology was discussed, linking insulinopenia to excessive glucose production, decreased utilization, and increased fatty acid release. Clinical features like vomiting, abdominal pain, drowsiness, hyperventilation, and dehydration were noted. The treatment approach includes fluid replacement, insulin administration, electrolyte management (particularly potassium), and cautious correction of acidosis.
Sample Certificate
About the Speakers
Dr Tejasvi Sheshadri
Consultant Paediatric Endocrinologist,
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