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DIABETES MELLITUS IN CHILDREN: CLINICAL FEATURES , DIAGNOSTICS AND TREATMENT. Prof. H.A. Pavlyshyn. Risk factors. Risk factors. Risk factors. Clinical classification of DM type 1. DM severity criteria. Mild form Absence of ketoacidosis in anamnesis
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DIABETES MELLITUS IN CHILDREN: CLINICAL FEATURES, DIAGNOSTICS AND TREATMENT Prof. H.A. Pavlyshyn
DM severity criteria • 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)
DM severity criteria • 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
DM severity criteria • 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
The main evident signs of the DM type 1: • hyperglycemia - glucose uptake by cells decreased - glucose utilisation by cells decreased • glycosuria • 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 - due to dehydration • polyphagia - excessive eating - hypothalamic control of appetite has insulin sensitive transport systems • weight loss • fatigue and weakness
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 or • 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
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.
Optimal therapy for diabetes mellitus must include • Insulin • A regimen for physical fitness • Psychological support • Nutritional management
Insulin has 3 basic formulations: • short-acting, regular insulin (aktrapid) • medium- or intermediate-acting (protaphan, isophane, lente) • and long-acting (ultralente)
The main rules of insulinotherapy im children: • 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); • Can be used insulin pompes
The catheter at the end of the insulin pump is inserted through a needle into the abdominal fat of a person with diabetes.
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.