Juvenile Diabetes

Diabetes Mellitus

Diabetes Mellitus is a condition of glucose intolerance caused by a lack of insulin synthesis, which results in hyperglycemia and irregularities in the metabolism of carbohydrates, proteins, and fats.

Types

1. Type- I( insulin dependent) diabetes mellitus
   It occurs mainly in childhood (juvenile onset diabetes) through there is no age bar. It results from autoimmune destruction of beta cells characterized by a gross deficiency of insulin. The majority of type-I cases are idiopathic.

2. Type-II diabetes mellitus
   It is uncommon in children and has no connection to an autoimmune disorder. But because of severe obesity, a sedentary lifestyle, high calorie intake, and a family history of diabetes, the incidence of Type-II diabetes mellitus is now rising quickly.

Causes

• Nearly 95% of cases of pediatric diabetes mellitus are idiopathic, with an utter lack of insulin resulting from a congenital inborn metabolic defect.
• Beta cell dysfunction due to genetic abnormalities.
• Autoimmunity responses.
• A contagious illness like the measles, coxsackie's, or cytomegalovirus.
• Children who are exposed to environmental pollutants such rodenticides or large amounts of cow's milk protein are also more likely to develop diabetes mellitus.
• Using steroids to treat pancreatic disease

Etio- pathogenesis

An autoimmune response causes an inflammation of a pancreatic beta cell. The beta cells appear to be stimulated by the inflammatory process to create aberrant Human Leukocyte Antigens. When lymphocytes identify an antigen as foreign and kill it, more beta cell protein is released, which can produce more human leukocyte antigens and trigger a continuing immunological response that finally kills all beta cells that secrete insulin. The autoimmune response is triggered by HLA-DR3 and HLA-DR4, which are genetically determined to be present in the pancreas. It results in an insulin shortage, which prevents glucose from entering cells and raises blood sugar levels. This facilitates the transfer of bodily fluid from the intracellular space and creates an osmotic gradient.

Clinical presentation

• Polyuria
• Polydipsia
• Polyphagia
• Nocturia
• Enuresis
• Decrease of weight overall weakness
• Tiredness and bodily pains
• Fainting attack
• Pin abdomen
• Nausea
• Vomiting
• Irritability
• Dry skin
• Poor wound healing
• Skin infection
• Vulvovaginitis in girls
• Cherry red lip
• Kussmaul breathing
• Acetone breath
• Sunken eyeballs
• Rigid abdomen
• Rapid weak pulse
• Hypothermia
• Dehydration
• Decreased blood pressure

Diagnosis

• Classical phenotype history and disease history
• Inspection of the body
• Blood sugar tests: If a random blood sugar reading of 200 mg/dl or higher on two different occasions combined with clinical signs or symptoms, or if a fasting blood sugar reading of 126 mg/dl or higher on two occasions is suggestive and 160 mg/dl is diagnostic.
• Oral glucose tolerance test with oral glucose intake of 1.75 gm/kg of ideal body weight in questionable situations (maximum 75gm)
• Checking the presence of sugar and ketone bodies in the urine

Mangement

• Until the child's condition has stabilized, hospitalization is required. Inform the child, the family, and the parents about home care and follow-up. Then, you can continue your treatment at home.
• Insulin therapy:
  The main form of treatment for diabetes mellitus is insulin therapy. After 12 to 16 weeks of therapy, the dose can be reduced to 0.5 units/kg/day from the initial 1- 1.75 units/kg/day requirement. The entire dose is administered in divided doses, i.e., two thirds in the morning and one third at night. For children, the doses of insulin therapy are adjusted based on periodic evaluations of blood glucose levels and urine sugar. Each person takes a medication 30 minutes before eating.
• Diet therapy:
  Depending on the metabolic state, blood sugar level, and extra requirements for growth and development, a recommended diet should be given. Up to 55–60 percent of total calories must be made up of carbs. On a diet, it is best to stay away from concentrated carbohydrates like candy, sugar, sweets, chocolates, and cake. You can continue to consume natural sources of fructose, such as fruits, vegetables, or honey.
• Others:
  Micronutrients (magnesium, zinc, fruits, should be included in diet plan) (magnesium, zinc, fruits, should be included in diet plan). Dietary changes that are noticeable should be avoided. To prevent hypoglycemia, the diet should include three main meals, three mid-meals, and snacks.
• Exercise:
  Exercise routines typically involve brisk walking, jogging, swimming, aerobics, and sports like tennis. Children should learn how exercise affects blood sugar levels and how to adjust their diet and insulin dosage.

Prevention of complication

• Early detection of complications' signs and symptoms
• Early diagnosis and therapy
• Regular prescription medication
• Routine exercise
• Follow-up care: Children should receive follow-up care every three to four months and as needed.
• Emotional and social development: Long-term care requires providing children and family members with health education and emotional support. Therefore, instruction on self-administration of insulin, identifying complications, the need for follow-up, diet, exercise, and other supportive facilities should be provided.