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 Vol. 18 No. 11, November 1997
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(Pediatrics in Review. 1997;18:383-393.)
© 1997 American Academy of Pediatrics

Diabetes Mellitus

Francine Ratner Kaufman, MD*
* Associate Professor of Pediatric Endocrinology and Metabolism, University of Southern California School of Medicine, Childrens Hospital Los Angeles, Los Angeles, CA. Dr. Kaufman is a paid consultant with MiniMed, Inc, a paid consultant with Ivax, Inc, and the recipient of royalties on the patent for the use of uncooked cornstarch to diminish hypoglycemia in diabetes (Zbar).


   IMPORTANT POINTS
 

  1. Type 1 diabetes is due to absolute insulin deficiency and most frequently results from autoimmune destruction of beta cells of the pancreas. Type 2 diabetes is due to a combination of insulin resistance and relative insulin deficiency and frequently is associated with obesity.
  2. Among the risk factors for the development of type 1 autoimmune diabetes are genetic susceptibility, certain viruses and chemical toxins, and specific immune factors.
  3. Diabetic ketoacidosis, which is a major source of morbidity and mortality among children and adolescents who have type 1 diabetes, is managed by correction of dehydration and electrolyte disturbances and delivery of carefully controlled insulin. Risk factors for cerebral edema, the gravest complication of treatment, include young age and initial presentation of diabetes.
  4. Long-term diabetes management involves multiple blood glucose measurements, administration of two or more insulin injections per day, adjustment of insulin dosage, and balancing of food and exercise. Insulin regimens are based on the child's age and developmental stage and must be adjusted to changes in exercise and activity patterns as well as growth.
  5. The results of the Diabetes Control and Complication trial showed a significant reduction in mean blood glucose levels, glycated hemoglobin concentrations, and diabetic complications in those who received intensive management compared with those who received conventional management, although there was a higher risk of severe hypoglycemia in the former group.


   Introduction
 
Diabetes mellitus is a severe metabolic disturbance that results from insulin deficiency, impairment of insulin action, or both. The hallmark of diabetes is hyperglycemia. Acute hyperglycemia with ketoacidosis can lead to life-threatening problems, such as severe electrolyte disturbance, cerebral edema, and vascular collapse. Chronic elevation of blood glucose levels can result in long-term complications that damage various organs, including the eyes, kidneys, nerves, heart, and blood vessels. Overtreatment of hyperglycemia can cause hypoglycemia, which may be severe . . . [Full Text of this Article]




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