DM in pediatrics

Question 1

difference between type 1 and 2 DM

Answer 1

Type 1 diabetes mellitus (T1DM): results from deficiency of insulin secretion because of pancreatic β-cell damage by autoimmune mechanism .
Type 2 diabetes mellitus (T2DM): is a consequence of insulin resistance occurring at the level of skeletal muscle, liver, and adipose tissue, with various degrees of β-cell impairment.

Question 2

what is Impaired Glucose Tolerance (IGT)

Answer 2

Normal glucose:70-110mg/dl
This term refers to a metabolic stage that is intermediate between normal glucose homeostasis and diabetes.(110-126//140-199)
Or if symptoms with normal blood sugar,,or glocosuria without symptoms

Question 3

GENETIC DEFECTS OF β-CELL FUNCTION Maturity-Onset Diabetes of Youth

Answer 3

Onset 9-25 yr

AD inheritance

A primary defect in insulin secretion.

Diagnostic Criteria:
Diabetes in at least 3 generations with AD
Diagnosis before age 25 yr in at least 1 affected subject.
Respond to sulphanylurea instesd of insulin

Question 4

Type 1 Diabetes Mellitus (T1DM)

age and names

Answer 4

insulin-dependent diabetes mellitus (IDDM) or juvenile diabetes
with a median age of 7-15 yr, but it may present at any age.
Peaks of presentation occur in 2 age groups: at 5-7 yr of age and at the time of puberty.(because of hormone as growth hormone)

Question 5

ENVIRONMENTAL FACTORS that are associated with DM1

Answer 5

ENVIRONMENTAL FACTORS:

Viral Infections:
Congenital Rubella Syndrome…
Enteroviruses
Mumps Virus

The Hygiene Hypothesis: Possible Protective Role of Infections

Diet (breast feeding and early introduction of cow milk

Psychologic Stress(aggrevate preexisting autoimmunity )

vitamin D

Question 6

Natural History of T1DM stages

Answer 6

The natural history of T1DM involves some or all of the following stages:

1. Initiation of autoimmunity(at 2 y is detected in serum)
2. Preclinical autoimmunity with progressive loss of β-cell function 90%
3. Onset of clinical disease
4. Transient remission – honey moon stage
5. Established disease
6. Development of complications

Question 7

CLINICAL MANIFESTATIONS

Answer 7

Polyuria 
Polydipsia 
Hyperphagia and Weight loss.
Deafness and blindness
Drugs
Genetic disorder and autoimmune diseases
Approximately 20-40% of children with new-onset diabetes progress to DKA before diagnosis.
Diabetic ketoacidosis symptoms:
Abdominal discomfort or true pain. 
Nausea, and emesis
Dehydration
Kussmaul respirations (deep, heavy, nonlabored rapid breathing)
Fruity breath odor (acetone)
Diminished neurocognitive function, and possible coma.

Question 8

Falsely low HbA1c levels are noted

Answer 8

in hemolytic anemias, pure red cell aplasia, blood transfusions, and anemias associated with hemorrhage, cirrhosis, myelodysplasias, or renal disease treated with erythropoietin.

Question 9

AIM of Treatment:

Answer 9

Tight glycemic control
Avoiding hypoglycemia
Eliminate symptoms      
NL growth &development
Minimal effect on life style

Question 10

Dawn Phenomenon:

Answer 10

Dawn Phenomenon:
Is thought to be mainly caused by overnight growth hormone secretion and increased insulin clearance.

It is a normal physiologic process seen in most adolescents without diabetes, who compensate with more insulin output.

A child with T1DM cannot compensate.

The dawn phenomenon is usually recurrent and modestly elevates most morning glucose levels.

Question 11

Somogyi Phenomenon:

Answer 11

Somogyi Phenomenon:

A theoretical rebound hyperglycemia from late-night or early-morning hypoglycemia, thought to be from an exaggerated counterregulatory response.

Caused by having too much insulin in the blood during the night.