Diabetes

Clinical guidelines for the diagnosis and treatment of diabetes in children

The parents of each child who has been diagnosed with diabetes receive clinical recommendations from the doctor, allowing him to develop the right treatment strategy and correct the baby’s lifestyle. However, the advice and prescriptions of a doctor are far from spontaneous.

In the process of making a diagnosis and determining the methods of treatment, the doctor relies on generally established norms and parameters adopted within the country or by international medical associations to combat diabetes.

Clinical guidelines for diabetes in children

The recommendations of doctors regarding the treatment of type 1 and type 2 diabetes will be different, since the listed types of the disease differ in their course and methods of treatment.

Type 1

As a rule, most children suffer from congenital type 1 diabetes. Also in young patients, acquired type 1 diabetes occurs, the development of which provoked severe stress.

If a child has been diagnosed with type 1 diabetes (regardless of the nature of his origin), the main clinical recommendation would be to use insulin.

This measure is necessary to stabilize the patient's condition, as well as prolong his life. The sooner the parents take the right measures, the higher the quality of life of the baby will be, and the likelihood of diabetic coma or ketoacidosis and subsequent death will decrease.

The dosage of insulin injections is determined individually, taking into account the age, weight and health of the child.

In the course of treatment, patients are usually given intensified insulin therapy, when the daily dose of the drug is divided into several portions. It is important that the amount of insulin injected is enough to neutralize the accumulated glucose in the body, thereby simulating the natural behavior of the pancreas.

2 types

The second type of diabetes in children is much less common than the previous version.

As a rule, the lack of sensitivity of cells to insulin and a decrease in its production occurs as a result of stressful situations or in case of metabolic disorders in older children. Infants almost never have type 2 diabetes.

The main medical recommendation for type 2 diabetes is strict adherence to the diet.. In this case, treatment measures will be more an addition than a basic approach. But do without them, too, will not work.

Exclude harmful foods from the diet of the child should be gradually, so that the body does not experience the food shock. During the period while the patient continues to eat contraindicated food, he needs to continue to use sugar-reducing drugs.

For children suffering from type 2 diabetes, doctors recommend keeping weight under control. Helping to get rid of extra pounds and high sugar levels will help compliance with a low-calorie diet, as well as the constant implementation of simple exercise.

Diagnostic criteria

The normal blood sugar level is 3.3–5.5 millimoles per liter (mmol / l) after a night's sleep, which lasts 8 hours and during which the child does not eat.

If the survey showed that the level of sugar in the blood taken from a child on an empty stomach is 5.6 - 6.9 mmol / l, this indicates a high degree of probability of having diabetes.

In such situations, the child is sent for additional analysis. If during the second examination the sugar level was 7.0 mmol / l, then the patient will be diagnosed with diabetes.

Another way to determine the presence of diabetic abnormalities in a child is to check the blood for fasting sugar after the child eats 75 g of glucose. The test is taken 2 hours after the child drinks the sweetened water.
Criteria for assessing the situation in this case will be as follows.

The indicator of 7.8 - 11.1 mmol / l indicates impaired glucose tolerance.

A result that exceeds the threshold of 11.1 mmol / l indicates the presence of diabetes. If deviations from the norm are insignificant, the patient will be scheduled for a re-examination, which must be passed in 2-3 weeks.

Clinical picture

The clinical picture of diabetes is twofold. It all depends on the type of disease that the child suffers. This is due to acute or chronic deficiency in the body of insulin.

In the case of acute insulin deficiency, the child has the following symptoms:

  • increased urine excretion;
  • the presence in the urine of large amounts of glucose;
  • increased blood sugar levels;
  • constant feeling of thirst;
  • weight loss on the background of the constant feeling of hunger.

Extreme conditions that indicate acute insulin deficiency are ketoacidosis and even diabetic coma.

If the lack of insulin is chronic, the clinical picture will be as follows:

  • violation of the NA;
  • development of renal failure;
  • violation of the blood circulation process by reducing the vascular tone;
  • violation of metabolic processes;
  • damage to the small vessels of the brain.

These phenomena in the case of the chronic nature of the course of the disease will develop gradually.

Protocol for the management of patients with diabetes

After the child makes a diagnosis, the doctor fills in a protocol in which he indicates:

  • type of diabetes;
  • phase of the disease (compensation or decompensation, with or without ketosis, coma);
  • the presence of microangiopathies caused by the disease;
  • the presence of complications;
  • the duration of the disease (in years);
  • combination with other diseases of the endocrine system.
Children with diabetes, or having elevated blood sugar levels, are registered.

Features of treatment

Treatment of diabetes in young patients is multi-level in nature and includes the following components:

  • diet;
  • use of insulin injections;
  • moderate exercise;
  • teaching the child the necessary skills;
  • self-monitoring at home;
  • psychological support.

Diet therapy is one of the most important components of this list. Without dietary correction, it is impossible to achieve compensation for the disease.

Modern principles of diabetic child diets are as follows:

  1. the correct ratio of nutrients: carbohydrates - 50-60%, fats - 25-30%, proteins - 15-20%;
  2. complete rejection of refined and carbohydrates containing medium fiber;
  3. almost complete replacement of animal fats with vegetable;
  4. sufficient intake of foods containing vitamins and healthy dietary fiber;
  5. providing fractional meals (up to 6 times a day).
So that the child does not suffer from psychological discomfort, it is desirable to adapt the menu of the whole family to the diet of the patient.

Classification of diabetic complications in children

Conventionally, the complications caused by diabetes in children can be divided into acute and late.

Acute complications (ketoacidosis and coma) are of the most dangerous nature, since they usually take hours to develop, and the probability of death is quite high.

During ketoacidosis, a large amount of fat and ketone bodies accumulate in the blood, causing the body to poison itself.

As for coma, it can be caused either by an increase in the level of sugar in the blood due to dehydration, or an increase in the concentration of lactic acid caused by renal, vascular or hepatic insufficiency.

Acute diabetic complications are eliminated in the hospital, therefore, require urgent hospitalization of the patient.

Late complications occur after 4-5 years since the onset of the development of the disease in a child. In this case, the deterioration of the individual body or system is slow.

The most common late complications include:

  • retinopathy (gradual deterioration of vision);
  • angiopathy (thinning of the walls of blood vessels, leading to thrombosis or atherosclerosis);
  • polyneuropathy (gradual damage to the nerves of the peripheral system);
  • diabetic foot (the appearance of wounds and microcracks on the surface of the foot).

Compliance with preventive measures can slow down, and in some cases even prevent the development of late complications.

Related videos

Dr. Komarovsky about diabetes in children:

The difficulty of diagnosing diabetes in children lies in the fact that little patients are not always able to clearly explain to parents what sensations they suffer from.

As a result, the disease in most cases is found already at a late stage of development, when a coma occurs in a child. In order to avoid such a development, parents need to monitor the behavior and well-being of their children.

Watch the video: "Management of Diabetic Ketoacidosis" by Michael Agus, MD for OPENPediatrics (November 2019).

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