Hyperglycaemias, hypoglycaemias Erhardt Éva MD, PhD

Classification of diabetes mellitus n Type 1 diabetes mellitus (IDDM) n Type 2 diabetes mellitus (NIDDM) n Gestational diabetes mellitus n Specific diabetes forms („Secunder”) e.g. syndromes associated with DM because of some medicine (e.g. steroid) abnormalities of insulin receptors

Prevalence of IGT and T2DM in obese children * Erhardt, Molnár and Soltész 2002 ** Sinha et al NEJM 2002

Clinical manifestations of T1DM 1. Major symptoms (3P) polyuria polyuria polydypsia polydypsia Polyphagia Polyphagia 2. Others weight loss weight loss fatigue fatigue vulvovaginitis, balanitis vulvovaginitis, balanitis enuresis enuresis visual disturbances visual disturbances

Etiology (genetics) of T1DM HLA region ( 40-50% ) Insulin gene (10-15% ) CTLA4 PTPN22

The HLA Region (6p21.31) DP DQ DR B C A Class II (1.1 Mb) Class III Class I (2.2Mb) Complement and Cytokines Class I-like genes and pseduogenes Frequent Recombination is Rare Telomere Centromere Recombination is Rare (0.7Mb)

Main elements of the therapy  Insulin  Diet  Regular sports, movements  Education of the patients

Insulin pharmacokinetics

Conventional intensive insulin therapy (ICT) Basic-bolus Long term insulin effect Regular diet

Impaired Insulin Action in Puberty

Diet - Distribution carbohydrate – 50% protein – 20% fat – 30% (polyunsaturated fats) - Importance of fibre - Glycaemic indices

Glycaemic indeces Food % Potato, honey, soft drink 70-90% whire bread, grapes, paste 50-70% corn, rice, banana, black bread 30-50% milk, yoghurt < 30% fructose, bean, peas, nut, tomato

Complications of diabetes mellitus AcutHypoglycaemiaHyperglycaemia-DKALate Micro- és macrovascular RetinopathyMicroalbuminuria-nephropathyNeuropathy(gastroparesis)

Hypoglycaemia with unconsciousness GlucaGen HypoKit Glucagon 1 mg < 8 years 0,5 ampulle (0,5 mg) > 8 years 1 ampulle (1 mg)

Symptoms of diabetic ketoacidosis  Polyuria  Polydypsia  Dehidration  Ketonuria  Kussmaul breathing  Stomache, vomiting

Follow up HbA1c: glicated haemoglobin  6-8 week (3 months)  Normal range 4-6%  Good < 7,5%