Outpatient Management of Diabetes Mellitus - Pediatric - Lecture Slides, Slides of Pediatrics

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Outpatient Management of

Diabetes Mellitus

The Face of IDDM In 1920 was not Encouraging

Islets of Langerhans

b-cell destruction Insulin Deficiency

Adipo- cytes

Muscle

Liver

Decreased Glucose Utilization Glucagon Increased Excess Protein Catabolism Increased Ketogenesis Gluconeogenesis

IncreasedLipolysis

Hyperglycemia Ketoacidosis

Polyuria Volume Depletion Ketonuria

Type 1 DM

• Autoimmune destruction

of the pancreatic islet

cell

• Hallmark = lymphocytic

infiltration of islets

• Progresses over years
• Leads to insulin

deficiency

• Later may also be

associated with glucagon

deficiency

Progression to Type 1 DM

Autoimmune destruction

“Diabetes threshold”

Honeymoon

100% Islet loss

Autoimmune markers (ICA, IAA, GAD

EPIDEMIOLOGY

• Most common metabolic disease in

childhood

• Annual incidence 15 new cases per 100,

in children < 18 yrs

• Frequency increases with increasing age.
• 1: 1400 at age 5 yrs
• 1: 400 at age 16 yrs
• Males and females equally affected
• No correlation with socioeconomic status

IDDM RISK OF CONCORDANCE

• Offspring of IDDM parent:

2-5% overall risk

• Offspring of diabetic mother:

2% risk

• Offspring of diabetic father:

5% risk

DIABETES MELLITUS

CLINICAL MANIFESTATIONS

• Classic Presentation:
  • Polyuria
  • Polydipsia
  • Polyphagia
  • Weight loss.
• Insidious
  • Onset of lethargy and weakness.
  • Duration of symptoms usually < 1 month.

DIABETES MELLITUS - TYPE I

Body Systems Involved

• GU Urinary frequency
• GI Nausea, vomiting, constipation

abdominal pain

• Respiratory Acidosis, Kussmaul breathing
• Cardiovascular Vascular collapse,

dehydration tachycardia

• CNS Cerebral edema
• Musculoskeletal Glycogen depletion, K loss

muscle weakness

IDDM: OPTIMIZING

GLYCEMIC CONTROL

• Hypoglycemia:
  • May be unaware
  • School grades
  • Early am symptoms
    • Headache
    • Nightmares
  • Look for at camp
• Reduce dose 10%
  • Hyperglycemia:
    • Few symptoms
    • Nocturia
    • Dawn phenomenon
    • Adolescent insulin

resistance

• Increase dose 10%

Treatment of T1 DM

• Insulin
• 1 u/kg/day – 1.3 u/kg/day in puberty
  • Standard 2 – 3 injections (NPH / Reg) / day
• Intensive Therapy
  • long acting at bedtime + short acting at meals
  • 4 – 6 shots / day
• Insulin Pump
• Diet – adequate calories / limit fat / complex CHO
• Exercise
• GOAL – Optimal glycemic control