pediatric diabetes
Introduction
Introduction to Pediatric Diabetes Pediatric diabetes, mostly type 1 or insulin-type diabetes, is an endocrine and metabolic disease caused by insufficient insulin secretion. It is mainly caused by carbohydrate, protein and fat metabolism disorders, causing hyperglycemia and urine sugar. Children are prone to ketosis. Acidosis, often with vascular disease in the later stage, eye and kidney involvement. Children 5 to 6 years old and 10 to 14 years old are frequently ill, and children under 5 years old are rare. At present, the incidence of type 2 diabetes in children is also increasing, insulin sensitivity is reduced, and insulin secretion levels are higher than normal. basic knowledge Proportion of disease: incidence rate of specific population 0.04% Susceptible people: children Mode of infection: non-infectious Complications: diabetic ketoacidosis, diabetic nephropathy
Cause
Pediatric causes of diabetes in children
1. It is generally believed that heredity is an important cause of diabetes in children. According to some statistics, one of the parents has diabetes, the incidence of offspring is 3% to 7%; both parents are diabetic, and the incidence rate of offspring can reach 30% to 50%. In addition, environmental factors and immune factors are recognized as closely related to the onset of diabetes.
2. Pathophysiology. Insufficient or complete lack of insulin secretion leads to reduced glucose utilization, while some anti-regulatory hormones such as glucagon, adrenaline, cortisol, and growth hormone are increased, which promotes hepatic glycogen breakdown and increased gluconeogenesis, lipolysis, and protein breakdown. Accelerated, eventually leading to elevated blood sugar and increased blood osmotic pressure.
When the blood glucose concentration exceeds the renal threshold of 10mmol/L (180mg/dl), it leads to osmotic diuresis, clinical symptoms of polyuria, polydipsia, and diabetes. In severe cases, electrolyte imbalance and dehydration may occur. In addition, fat decomposition accelerates, too much free fatty acid, and finally ketone body is produced, forming ketoacidosis.
3. Environmental factors. Over the years, it has been reported that the incidence of insulin-dependent diabetes mellitus is associated with the infection of various viruses, such as rubella virus, ribitis virus, coxsackie virus, and brain myocardium.
In short, environmental factors may include viral infections, chemical poisons in the environment, and certain components in nutrition, which may cause B-cell toxic effects on people with susceptibility genes, stimulate changes in immune function in the body, and finally lead to the development of insulin-dependent diabetes. . Environmental factors are extremely complex and may play an important role in the difference in the incidence of insulin-dependent diabetes mellitus among ethnic groups in various regions.
In addition, severe mental and physical stress and infection and stress may play an important role in the difference in the incidence of insulin-dependent diabetes. In addition, severe mental and physical stress and infection and stress can significantly aggravate the metabolism of insulin-dependent diabetes mellitus in insulin-dependent diabetes mellitus. Stress can produce low insulin resistance and elevated blood sugar, causing some people with susceptibility to develop. Ketoacidosis.
Prevention
Pediatric diabetes prevention
1. Genetic factors cannot be avoided, but expectant mothers need moderate exercise during pregnancy to avoid huge fetuses caused by overnutrition, which may increase the risk of fetal disease. Pregnancy care has a huge impact on the health of the fetus.
2, the occurrence of many children with diabetes is related to the unreasonable diet structure, so to ensure that the family's healthy diet structure can avoid many diseases. Light diet, less greasy food, try not to eat fried foods, have positive significance for the prevention of disease.
3. Studies have shown that daily intake of a certain amount of vitamin D in children can reduce the risk of diabetes. Vitamin D can promote the growth and development of children, so the right amount of supplement has certain benefits.
Complication
Diabetic complications in children Complications diabetic ketoacidosis diabetic nephropathy
Enuresis, weight loss, vomiting, abdominal pain, loss of consciousness, lethargy, severe cases can occur coma, dehydration, acidosis, diabetic ketoacidosis, and various infections, etc., long-term disease control, long-term poor control of growth, backwardness Short, liver enlargement and intelligent backwardness, called diabetic pygmy (Mauriac syndrome), late cataract, visual impairment and retinopathy, leading to blindness, proteinuria, hypertension, diabetic nephropathy, and ultimately renal failure .
Acute complication
(1) ketoacidosis: ketoacidosis can occur in patients with type 1 diabetes who develop infection, delay diagnosis, overeating or interrupted insulin therapy. The younger the age, the higher the clinical manifestations of ketoacidosis. As mentioned above, newly diagnosed type 1 diabetic patients with ketoacidosis onset, while neglecting the symptoms of diabetes, are easily misdiagnosed as pneumonia, asthma or acute abdomen should be identified.
(2) Hypoglycemia: Hypoglycemia occurs in patients with type 1 diabetes after insulin therapy. The insulin is more than the required amount, or the meal cannot be eaten on time after the injection of insulin, or hypoglycemia or hypoglycemia can occur after the meal is not added in time. When you have palpitations, sweating, hunger, tremors, dizziness or disturbance of consciousness, or even complete coma, hypoglycemia can not cause timely death, and repeated episodes of hypoglycemia and coma can cause brain damage, causing seizures and mental retardation.
(3) Infection: Diabetic patients can develop any infection at any time. Diabetes should be diagnosed and treated promptly after infection. If toxic shock occurs in severe infection, if only pay attention to rescue shock and neglect the diagnosis and treatment of diabetes It should be vigilant against serious consequences.
(4) Diabetic non-ketotic hyperosmolar coma: hyperosmolar coma occurs in children with type 1 diabetes. Most patients have hyperosmolar coma when they have diabetes on the basis of neurological diseases. Hyperglycemia and hyperosmolar coma can not be diagnosed as hyperosmolar coma when hyperglycemia and hyperosmolar coma occur during treatment. Sometimes patients with type 1 diabetes have increased plasma osmotic pressure >310mmol/kgH2O due to severe dehydration, while blood and urine When the ketone body is not significantly increased or coma, it can be diagnosed as a hyperosmolar state of diabetes.
2. Interim complications
Metabolic control of type 1 diabetes is not good. Some complications can occur within 1 to 2 years after the disease. For example, subcutaneous fat atrophy or hypertrophy at the injection site affects insulin absorption, and joint activity limitation, osteoporosis, cataract, and repeated Hypoglycemia and ketoacidosis occur.
3. Chronic complications
Microvascular complications are more common in the late ten or even years after type 1 diabetes. When the retinopathy is severe, it can cause blindness. Diabetic nephropathy can eventually lead to renal failure. If the control of diabetes is strengthened, microvascular complications can be delayed or avoided. The occurrence and development of the disease.
DCCT (diabetes control and complication trial) studies have shown that the average daily blood glucose <8.3mmol / L (150mg / dl), HbAIc <7.5% can reduce the annual incidence of albuminuria 56% and reduce the occurrence of retinopathy 70%.
Symptom
Symptoms of Diabetes in Children Common Symptoms Drinking nausea, polyuria, abdominal pain, ketoacidosis, islet cell destruction, diabetes, weight loss, appetite, loss of stomach, rotten apple flavor
Symptoms of diabetes in children, such as those occurring in adults, often have symptoms of polyphagia, polydipsia, and polyuria. The long-term complications are eye, heart, kidney, and nervous system damage caused by microvascular disease. When a baby has diabetes, polydipsia and polyuria are difficult to detect. Infant patients may have sudden enuresis due to more nocturia. Because enuresis is quite common in young children, it may be ignored by parents. Pediatric enuresis specialist clinics for urine bed must be routinely checked for urine, in order to screen out the childhood diabetes hidden in "encapture".
Pediatric diabetes is an acute onset and can usually be diagnosed within 3 months. The fatal danger of childhood diabetes is ketoacidosis, not long-term complications caused by microvascular disease. The younger the child, the higher the incidence of ketoacidosis. Ketoacidosis often manifests as polyuria, vomiting, abdominal pain, severe dehydration, stagnation or even coma.
Examine
Pediatric diabetes examination
1. Blood glucose measurement: Blood glucose is measured by venous plasma (or serum) glucose. The criteria for diagnosis of diabetes established by the American Diabetes Association (ADA) in 1997: normal fasting blood glucose <6.1mmol/L (110mg/dl), fasting blood glucose 6.1 ~6.9mmol / L is impaired fasting blood glucose; such as fasting blood glucose 7.0mmol / L, or oral glucose tolerance test (OGTT) 2h blood glucose value > 11.1mmol / L, can diagnose diabetes, glucose tolerance test is not used as a diagnosis of clinical diabetes The usual means.
2. Determination of plasma C-peptide: C-peptide determination can reflect the secretory function of endogenous islet cells, which is not affected by foreign insulin injection, and contributes to the classification of diabetes. The C-peptide value of children with type 1 diabetes is significantly lower.
3. Glycosylated hemoglobin (HBAlc): is the true sugar part of blood sugar, which can reflect the average concentration of blood glucose in the past 2 months. It is an objective indicator to judge the blood sugar control in a period of time, and has certain correlation with diabetic microvascular and neurological complications. , normal human HBAlc <6%, HBAlc maintained at 6% to 7%, diabetes complications did not occur or have occurred but not progress, HBAlc>8%, diabetes complications increased significantly, therefore, the American Diabetes Association requires diabetes HBAlc control At <7%, >8%, measures should be taken.
4. Islet cell antibody (ICA), insulin autoantibody (IAA), glutamate decarboxylase (GAD) antibody assay: In the early stage of diabetes, 89.5% of children with ICA, GAD antibody positive, only 54.3% positive in the late stage, GAD ratio ICA is sensitive, and most of the above antibodies can be positive in the early stage of the disease. As the disease progresses, the destruction of islet cells is increasingly aggravated, and the titer can be gradually decreased. When the cells are completely destroyed, the antibodies disappear.
5. Glucose in urine and ketone body determination: Urine sugar measurement can only reflect the urine sugar excretion in a certain period of time, and because of the high level of kidney threshold, urine sugar test paper quality, so urine sugar should still be determined Blood sugar, ketone body including acetoacetate, acetone, beta hydroxybutyric acid composition, urine urinary ketone body positive.
6. Should do chest X-ray, B-ultrasound, ECG examination.
Diagnosis
Diagnosis and diagnosis of diabetes in children
diagnosis
Diagnosis can be based on the cause, symptoms and related tests.
What needs to be diagnosed is:
1. Children with type 2 diabetes
Insulin resistance is mainly accompanied by insufficient relative insulin secretion, or insulin secretion with or without insulin resistance. It is a polygenic genetic disease, accounting for about 8% of children with diabetes. In recent years, the incidence rate has increased, more common in children over 10 years old. Obesity, hyperinsulinemia (Acanthosis nigricans) and family history of type 2 diabetes are risk factors for the development of this type of diabetes in children. About 1/3 of children have no clinical symptoms, sometimes due to obesity, after giving glucose tolerance test It was found that there was no ketoacidosis, but it also occurred under stress. The blood C-peptide level was normal or increased. All kinds of autoantibodies were negative for ICA, IAA, GAD, diet control, exercise or oral hypoglycemic agents. effective.
2. Juvenile Diabetes (MODY)
It is a special type of non-insulin-dependent diabetes mellitus, which is a special type of non-insulin-dependent diabetes mellitus. It is clinically characterized by an age of onset of less than 25 years, a history of family diabetes of more than three generations, and no insulin treatment for several years after onset. It has been found that MODY has five types and related genes for the treatment of type 2 diabetes.
3. Neonatal temporary diabetes
It is associated with pancreatic -cell hypoplasia and enzyme system dysfunction. This disease is rare and can be seen in children with small gestational age. The mother often has a history of diabetes and is sensitive to insulin therapy.
4. Renal diabetes
Children with urine glucose positive and normal blood glucose, mainly due to abnormal renal glucose excretion function, this disease can be seen in Fanconi syndrome, proximal tubular dysfunction, benign familial renal glucosuria.
