Diabetes Mellitus
I have the privileged to attend the Conference of the Japanese Society of Pediatric Endocrinology in Yokohama Japan last October 9-12, 2024.
One of the lectures that interests me was the topic on Diabetes Mellitus.
The lecture of Dr. Jachyun Kin of the Department of Pediatric of Seoul National University Hospital was in English so I was able to understand.
Dr Kin stated that Diabetes Mellitus is a group of metabolic disorder of carbohydrate metabolism.
The glucose is both underutilized as an energy source and overproduced due to inappropriate gluconeogenesis and glycogenolysis thus resulting to hyperglycemia.
He further stated that children are not little adults and that children with diabetes are not little adults with diabetes. Which means, these children should be managed and treated well at their age.
Globally, the incidence of diabetes has a 2 fold increase in 20 years. This could be due to the lifestyle change that this generation is exposed to.
What is the difference between type 1 diabetes and type 2 diabetes?
Type 1 diabetes is due to an autoimmune B cell destruction that results to absolute insulin deficiency including latent autoimmune diabetes of adulthood; whereas, type 2 diabetes is due to a progressive loss of adequate B cell insulin secretion frequently in the background of insulin resistance.
The criteria for the diagnosis of Diabetes Mellitus are the following:
– fasting plasma glucose > 126 mg/dl (npo for at least 8 hrs)
– 2hours plasma glucose of > 200mg/dl during ogtt
– hbA1C > 6.5%
– classic symptoms of hyperglycemia, hyperglycemic crisis with a random glucose of >200mh/dl
Also, the following symptoms are common in diabetes mellitus:
– polyuria (always urinating)
– polydipsia (always thirsty)
– polyphagia ( always eating)
– weight loss
– fatiguability
– diabetic ketoacidosis(dka) could be the initial presentation in 40-50% of childhood and adolescent with type 1 diabetes
Dr. Jachyun Kin mentioned that in diabetic ketoacidosis their is hyperglycemia, the blood glucose is more than 200mg/dl, the venous ph is < 7.3 and the serum bicarbonate is <18mmol/l. The goal of treatment on this case is to:
– correction of acidosis and severe ketosis
– correct the dehydration
– restore blood glucose to near normal
– monitor complications and its treatment
– medical and nutritional therapy
As a whole, diabetes education is very important to avoid the complications of the:
– thyroid
– dyslipidemia
– nephropathy
– retinopathy
– and neuropathy.
So to conclude, diabetes mellitus is more of a lifestyle disease so management is geared towards:
– diabetes education
– Diabetes ketoacidosis management
– ambulatory care as Outpatient
– transition of adolescent patients to adult clinic
– proper nutrition
– and exercise