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

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4 Risk factors

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7 Clinical classification of DM type 1. Severity Glycemic control Complication s - Mild - Moderate - Severe - Severe - Ideal - Optimal - Suboptimal - High risk for the life - Acute - Chronic

8 DM severity criteria Mild form Mild form - Absence of ketoacidosis in anamnesis - Absence of micro- and macroangiopathies - Treatment consists of diet, physical exercises, phytotherapy (it’s enough for ideal glycemic control maintaining)

9 DM severity criteria Moderate form Moderate form - In anamnesis – ketoacidosis (I-II stages) - Presence of diabetic retinopathy I st., diabetic nephropathy I-III st. or diabetic arthropathy I st. - For achievement of ideal glycemic control is necessary to use insulin, or oral drug therapy or combination of both

10 DM severity criteria Severe form Severe form - Non stable course of the disease (frequent ketoacidosis cases or coma in anamnesis) - Presence of different chronic complications - Patients need permanent insulin injections

11 Laboratory criteria of glycemic control Glucose, (mmol/ L) IdealOptimal Subopti mal High risk for the life Fasting glycemia 3,6-6,14,0-7,0 > 8,0 > 9,0 After food glycemia4,4-7,0 5,0- 11,0 11,0- 14,0 > 14,0 Nightglycemia3,6-6,0 Not < 3,6 9,0 9,0 < 3,0 or > 11,0 Hb Alc, % < 6,05 < 7,6 7,6-9,0 > 9,0

12 The main evident signs of the DM type 1: hyperglycemia hyperglycemia - glucose uptake by cells decreased - glucose utilisation by cells decreased glycosuria glycosuria polyuria polyuria - excessive urine production - blood glucose levels exceed the rate of glomerular filtration by the kidneys - glucose appears in the urine and acts as an osmotic diuretic polydipsia polydipsia - due to dehydration polyphagia polyphagia - excessive eating - hypothalamic control of appetite has insulin sensitive transport systems weight loss weight loss fatigue and weakness fatigue and weakness

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14 Diagnostic criteria: A random blood glucose level greater than 11,1 mmol/l (i.e.>200 mg/dl), which is verified on a repeat test, is sufficient to make the diagnosis of DM A random blood glucose level greater than 11,1 mmol/l (i.e.>200 mg/dl), which is verified on a repeat test, is sufficient to make the diagnosis of DMor Fasting blood glucose > 6,1 mmol/l (>110 mg/ dl) (fasting is no food for > 8 hours), which is verified on a repeat test, is sufficient to make the diagnosis of DM Fasting blood glucose > 6,1 mmol/l (>110 mg/ dl) (fasting is no food for > 8 hours), which is verified on a repeat test, is sufficient to make the diagnosis of DM

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16 Complications Trophic changes in the skin

17 Complications Trophic changes in the skin

18 Complications diabetic nephropathy

19 Complications diabetic retinopathy

20 Oral glucose tolerance test (OGTT) Obtain a fasting blood sugar level, then administer per os glucose load (1.75 g/kg for children [max 75 g]). Check blood glucose concentration again after 2 hours. Obtain a fasting blood sugar level, then administer per os glucose load (1.75 g/kg for children [max 75 g]). Check blood glucose concentration again after 2 hours.

21 Optimal therapy for diabetes mellitus must include  Insulin  A regimen for physical fitness  Psychological support  Nutritional management

22 Daily insulin doses for children: Age Insulin dose (Units/kg) Infants (< 1 year) 0,1 - 0,125 Toddlers (1-3 years) 0,15 – 0, years 0,2 – 0, years 0,5 – 0,8 > 12 years 1,0 and more

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25 Insulin has 3 basic formulations: short-acting, regular insulin (aktrapid) short-acting, regular insulin (aktrapid) medium- or intermediate-acting (protaphan, isophane, lente) medium- or intermediate-acting (protaphan, isophane, lente) and long-acting (ultralente) and long-acting (ultralente)

26 The main rules of insulinotherapy im children: In ketoacidosis should be used only regular insulin In ketoacidosis should be used only regular insulin Optimal frequency of injections is 4-5 times per day (if 4 times – 9 a.m.(regular), 13 p.m.(regular), 18 p.m. (regular), 22 p.m (medium-acting); if 5 times – 6 a.m.(regular), 9 a.m.(regular), 14 p.m. (regular), 19 p.m. (regular), 23 p.m (regular); Optimal frequency of injections is 4-5 times per day (if 4 times – 9 a.m.(regular), 13 p.m.(regular), 18 p.m. (regular), 22 p.m (medium-acting); if 5 times – 6 a.m.(regular), 9 a.m.(regular), 14 p.m. (regular), 19 p.m. (regular), 23 p.m (regular); Can be used insulin pompes Can be used insulin pompes

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28 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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31 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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