1. DIABETES MELLITUS IN CHILDREN: CLINICAL FEATURES, DIAGNOSTICS AND TREATMENT Prof. H.A. Pavlyshyn

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4. 4 Risk factors

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7. 7 Clinical classification of DM type 1. Severity Glycemic control Complication s - Mild - Moderate - Severe - Severe - Ideal - Optimal - Suboptimal - High risk for the life - Acute - Chronic

8. 8 DM severity criteria Mild form 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)

9. 9 DM severity criteria Moderate form 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

10. 10 DM severity criteria Severe form 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

11. 11 Laboratory criteria of glycemic control Glucose, (mmol/ L) IdealOptimal Subopti mal High risk for the life Fasting glycemia 3,6-6,14,0-7,0 > 8,0 > 9,0 After food glycemia4,4-7,0 5,0- 11,0 11,0- 14,0 > 14,0 Nightglycemia3,6-6,0 Not < 3,6 9,0 9,0 < 3,0 or > 11,0 Hb Alc, % < 6,05 < 7,6 7,6-9,0 > 9,0

12. 12 The main evident signs of the DM type 1: hyperglycemia hyperglycemia - glucose uptake by cells decreased - glucose utilisation by cells decreased glycosuria glycosuria polyuria 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 polydipsia - due to dehydration polyphagia polyphagia - excessive eating - hypothalamic control of appetite has insulin sensitive transport systems weight loss weight loss fatigue and weakness fatigue and weakness

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14. 14 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 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 DMor 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 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

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16. 16 Complications Trophic changes in the skin

17. 17 Complications Trophic changes in the skin

18. 18 Complications diabetic nephropathy

19. 19 Complications diabetic retinopathy

20. 20 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. 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.

21. 21 Optimal therapy for diabetes mellitus must include  Insulin  A regimen for physical fitness  Psychological support  Nutritional management

22. 22 Daily insulin doses for children: Age Insulin dose (Units/kg) Infants (< 1 year) 0,1 - 0,125 Toddlers (1-3 years) 0,15 – 0,17 3-9 years 0,2 – 0,5 9-12 years 0,5 – 0,8 > 12 years 1,0 and more

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25. 25 Insulin has 3 basic formulations: short-acting, regular insulin (aktrapid) short-acting, regular insulin (aktrapid) medium- or intermediate-acting (protaphan, isophane, lente) medium- or intermediate-acting (protaphan, isophane, lente) and long-acting (ultralente) and long-acting (ultralente)

26. 26 The main rules of insulinotherapy im children: In ketoacidosis should be used only regular insulin 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); 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 Can be used insulin pompes

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28. 28 The catheter at the end of the insulin pump is inserted through a needle into the abdominal fat of a person with diabetes.

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31. 31 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.

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