विवरण
The prevalence of both type 1 and type 2 diabetes (T1DM and T2DM) is increasing among children. T1DM, however, continues to be the most common type found in pediatricians. To ensure optimal treatment, health care workers must be aware of the different forms of diabetes identified in children, particularly the characteristics that set T1DM and T2DM apart. Lifelong exogenous insulin delivery is essential for survival in people with T1DM in general. However, compared to adults with diabetes, children have quite different demands and difficulties. Treatment, objectives, and age-appropriate needs must all be addressed on an individual basis. Maintaining glucose levels as close to normal as feasible, avoiding acute problems, and preventing long-term issues are the key goals for treating pediatric T1DM.
सारांश
- Dr. Sunil discusses type 1 diabetes in children, highlighting its increasing incidence worldwide, affecting approximately 2 per 1,000 children. He differentiates it from type 2 diabetes, emphasizing the autoimmune destruction of pancreatic beta cells leading to insulin deficiency in type 1, versus insulin resistance in type 2.
- A case report of a six-year-old boy presenting with abdominal pain, vomiting, polyuria, polydipsia, polyphagia, and weight loss is examined. The child displayed moderate dehydration, tachycardia, and tachypnea, eventually diagnosed with diabetic ketoacidosis (DKA) based on elevated blood glucose, ketonuria, and metabolic acidosis. DKA is identified as a medical emergency.
- The etiology of type 1 diabetes is primarily environmental factors acting on genetically predisposed individuals. Genetic links include HLA class II genes (DR3 and DR4), family history, and twin studies. Environmental factors are viral infections, microbial deprivation, and diet. Stress and ionizing radiation are identified as less common causes.
- The natural history of type 1 diabetes involves preclinical autoimmunity, defects in insulin secretion, clinical diabetes, and a possible remission period (honeymoon phase). Symptoms include polyuria, polydipsia, polyphagia, weight loss, nocturnal enuresis, fatigue, and increased susceptibility to infections.
- Management focuses on insulin therapy, frequent blood glucose monitoring, dietary adjustments, and exercise. Newer insulin analogues (lispro, aspart, glargine, detemir) are preferred for better glycemic control and reduced hypoglycemia risk. Insulin dosages range from 0.5 to 1.2 units per kg, with 50% as long-acting insulin.
- Multiple injection methods are mentioned: syringes, insulin pens, jet injectors, and continuous infusion pumps. Injection sites should be rotated to avoid skin complications. Target blood glucose levels are 90-130 mg/dL before meals and 90-150 mg/dL before bedtime, with HbA1c below 7.5% in children and 7% in adolescents.
- Dietary guidelines recommend a balanced diet with complex carbohydrates (50-55%), fats (30-35%), and proteins (10-15%). Sucrose and refined sugars should be limited. Regular follow-up is crucial, including annual growth assessments, examination of injection sites, hand/foot examination, blood pressure monitoring, and retinal exams.
- New technologies such as continuous glucose monitoring (CGM) and closed-loop insulin delivery systems (artificial pancreas) are highlighted. These systems improve glycemic control, reduce parental burden, and improve the quality of life for children with type 1 diabetes.
- Diabetic ketoacidosis (DKA) is characterized by insulinopenia leading to excessive glucose production, decreased glucose utilization, osmotic diuresis, dehydration, and ketoacid production. Management includes fluid replacement with normal saline and insulin drip, along with potassium and electrolyte management.
- The importance of educating both the child and parents about diabetes management, including insulin injection techniques, blood glucose monitoring, diet, and recognizing hypoglycemia is emphasized. The ultimate goal is to prevent long-term complications, promote normal growth and development, and ensure a normal school and home life.
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