ped diabetes........................pptx

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1. DIABETES MELLITUS

2. DEFINITION Diabetes mellitus is a group of metabolic diseases characterized by chronic hyperglycemia resulting from defects in insulin secretion, insulin action, or both. It is estimated that pediatric diabetes accounts for around 5% of the diabetic population. The incidence of diabetes mellitus increases with advancing age of the child with peaks at 5 and 12 years of age.

3. Classification Type I diabetes mellitus or insulin-dependent DM: It is due to B -cell destruction, usually leading to absolute insulin deficiency. It can be immune mediated or idiopathic. Type 2 diabetes mellitus or non insulin-dependent DM : It may range from predominantly insulin resistance with relative insulin deficiency to a predominantly secretory defect with or without insulin resistance. Other specific types of DM: Genetic defects of B -cell function or insulin action, diseases of the exocrine pancreas, drug-induced or chemical-induced endocrinopathies Gestational diabetes: It occurs during pregnancy. Type 1 diabetes is more common in children but type 2 diabetes is increasing rapidly than type I due to obesity and less active lifestyles.

4. TYPE 1 DIABETES MELLITUS It also known as juvenile diabetes. This results when then pancreas is unable to produce and secret insulin and depends on exogenous insulin to prevent ketosis and preserve life. Genetic, environmental and autoimmune factors are responsible for type 1 diabetes

5. Clinical Features Polyurea Polydipsia Polyphagia Weight loss Fatigue B lurred vision Signs of diabetic ketoacidosis : Nausea, vomiting, abdominal pain, acctone odor of breath, dehydration, lethargy, Kussmaul respiration, and coma

6. DIAGNOSIS According to National Diabetes Data Group and WHO, diagnostic criteria for diabetes mellitus are as following: Symptoms of diabetes plus random plasma glucose concentration = 11.1 mmol /L (200 mg/ dL ). Fasting plasma glucose = 7.0 mmol /L (126 mg/ dL ) 2-hour postload glucose = 11.1 mmol /L (200 mg/ dL ) during an OGTT (the test should be performed as described by WHO, using a glucose load containing the equivalent of 75 g anhydrous-glucose dissolved in water or 1.75 g/kg of body weight to a maximum of 75 g) The glycosylated haemoglobin is elevated in response to prolonged elevation of blood glucose.

7. Optimal glycemic control in type | diabetes mellitus (T1DM) requires intensive insulin therapy. The goal of insulin therapy is to replace the insulin that is not produced in the body. The choice of insulin types and schedule of injections is determined by child’s age, bodyweight and pubertal status. There are two types of insulin therapy in practice. Conventional therapy, the most commonly used, refers to 1-2 daily insulin injections. The total daily dose ts divided into 2/3 pre-break fast and 1/3 pre-dinner. Intensive therapy includes the administration of insulin 3 times daily by multiple daily injections (MDI) or pen, or an external pump. Every dose of insulin is adjusted according to the premeal blood glucose performed at Icast four times daily,