diabetes mellitus

Diabetes diabetes. Diabetes in children develops relatively sharply, gaining heavy, progressive course. This is due to the lability of the neuroendocrine regulation of metabolism, the body's intensive growth and high levels of metabolic processes. At the beginning of the disease in young children found significant fluctuations in blood sugar levels throughout the day. The tendency of children to explain the high incidence of ketosis ketonemia and speed the development of diabetic coma. One of the severe manifestations of diabetes in children is Mauriac syndrome, which is characterized by significant growth retardation, gipogenitalizme, enlarged liver, ketosis, hyperlipidemia and obesity. During the insulin therapy in children more often than adults, may develop hypoglycemic coma (exchange instability, anorexia and insufficient food intake after administration of insulin). Diabetic vascular disease, glomerulosclerosis, renal insufficiency (Kim melstila disease - Wilson), retinopathy and cataracts are late consequences of diabetes in children are rare.

The clinical picture. An early sign of diabetes in children is polyuria, which in young children is seen as bedwetting, and polydipsia. Lingerie after drying become stiff, as if podkrahmalennym. Urine excreted in large amounts (3-6 liters per day) and its relative density is high (more than 1020), urine sugar and contains most of the acetone. On the development of coma suggests a number of signs: increasing urine output, rapid decline in body weight, dehydration, vomiting, lethargy, sleepiness, the smell of acetone breath. Signs of ketosis and acidosis are growing increase in the depth of breathing, increased heart rate, decreased blood pressure.

According to the modern classification is accepted to allocate statistical risk classes, when the blood sugar is within normal values, tolerance test galactose also does not reveal abnormalities in the presence of children unfavorable for diabetes heredity (large birth weight, disorders of carbohydrate metabolism in history) and the development of obesity.

In children with a family history physiological restructuring in the period of growth and puberty, in particular neuroendocrine changes themselves may be the factors that contribute to the manifestation of genetically determined metabolic abnormalities and implement them in diabetic disorders such as metabolism. Obesity is genetically closely related to diabetes may be preceded by a long-term diabetes. Some signs of predisposition to diabetic metabolic disorders along with physical development disorders may be a violation of puberty. Symptomatic manifestation of diabetes may be preceded by vascular disturbances (changes in retinal blood circulation, blood pressure).

In the study of glucose tolerance using a standard glucose tolerance test and by a double load Staub - Traugott can identify the different types of glycemic curve (hyperinsulinemic, doubtful, hypoinsulinemic, pre-diabetic or even diabetic), reflecting the consistency and depth of carbohydrate tolerance impairment among children with family on diabetes heredity.

High probability of manifest forms of diabetes among children, family history (diabetes, obesity), require special dispensary observation of this group of children.

Diagnosis. In the initial stage of diabetes fasting blood sugar level in daily urine and children usually increased, so holding diagnostic test for glucose tolerance (glucose load of 1.75 g / kg) only after verification of the original data.

The differential diagnosis is carried out with alimentary hyperglycemia when receiving large amounts of sweets, renal glucosuria (renal diabetes, usually not combined with hyperglycemia), diabetes insipidus, helminthic infestation, the initial stage of hyperthyroidism.

Treatment of diabetes in children - complete with mandatory application insuline- and diet therapy, aimed not only at the treatment of the underlying disease, but also to ensure proper physical development. Meals must meet certain age physiological norms. Extractive meals excluded. The need for sugar in the period covered by carbohydrate contained in milk, fruits and vegetables. Easily absorbed crystal sugar, sweets and fats should be periodically limit and in the period of compensation; in the presence of ketosis and expressed acetonuria should sharply limit the introduction of fat, maintaining a normal or even increased intake of carbohydrates. Assign low-fat cottage cheese, cereals, meat dishes, steamed. In childhood, not used oral antidiabetic drugs (sulfonylureas and biguanides). It is necessary to take into account children's higher sensitivity to insulin. The injection is carried out at intervals of 8 hours, taking into account glyukozuricheskogo Profile: increase the dose, after which marked the highest excretion of sugar in the urine, and, accordingly, reduce the dose causing the maximum reduction in glucosuria. Long-acting insulin preparations should not be used in cases of suspected diabetic coma. In order to prevent lipodystrophy should change the place of insulin injections. If the compensation of diabetes is a therapeutic exercises, allowed skating, skiing under the supervision of a physician and parent. It is forbidden to participate in sports. Treatment of diabetic and hypoglycemic coma (see. Com).

Prevention. Install dispensary observation of children from families where there are people with diabetes. Periodically examine the blood sugar and urine, limit the use of sweets. By monitoring and taking of children born with high birth weight (over 4 kg). In children with signs of prediabetes at risk investigate glycemic curves with two loads.

The prognosis of early detection, a diet, proper treatment of children-friendly, but it is getting worse with the development of serious complications and infections accession.