1. Hyperglycaemias, hypoglycaemias Erhardt Éva MD, PhD

2. 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

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

4. 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

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

7. 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)

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

10. Insulin pharmacokinetics

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

16. Impaired Insulin Action in Puberty

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

19. Glycaemic indeces Food 90-100% 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

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

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

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

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