Childhood diabetes

Childhood diabetes can be of two types, the most frequent is type 1 diabetes, which is insulin dependent because it requires external insulin supply. It occurs in more than 90% of cases of diabetes diagnosed in children under fourteen.

It is an endocrine system disorder characterized by low insulin production by the pancreas that It causes the accumulation of high levels of sugar (glucose) in the blood. It is usually of autoimmune origin, since the same body causes the destruction of the cells of the pancreas that are no longer functional.

On other occasions, insulin production is normal and cells cannot use it correctly due to a defect. This usually occurs mainly in type 2 diabetes.

Diagnostic criteria for childhood diabetes

The diagnosis of childhood diabetes is made by measuring blood glucose levels (fasting blood glucose) that should not exceed 126 mg / dl, following the criteria of the International Association of Pediatric and Adolescent Diabetes ADA-ISPAD 2014.

Yes, fasting, blood glucose is high, other tests are done to confirm childhood diabetes, find out its type and rule out other diseases that also present with hyperglycemia since, the treatment of these diseases is different and the prognosis will be worse the longer they take to be detected.

It should start with Immediate treatment to control blood glucose and avoid the appearance of ketoacidosis, which can complicate the prognosis and leave sequelae in patients.

Frequency and age of onset of childhood diabetes

Childhood diabetes mellitus type 1 is increasingly common between 0 and 14 years. 10 to 25 cases are diagnosed per 100,000 children up to 14 years, Appreciating a significant increase in children under 5 years.

The highest figures have been found in Castilla La Mancha and the lowest in Asturias, although the increase has been experienced in all Autonomous Communities.

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Signs and symptoms of childhood diabetes type 1

To avoid diagnostic errors, Blood glucose levels are measured two different days. The following will be considered positive for childhood diabetes type 1:

• Blood sugar, greater than 200 mg / dl.
• Blood glucose after eight hours of fasting, greater than 126 mg / dl.
• Glycemia after two hours after eating carbohydrates, greater than 200 mg / dl

Patients with childhood diabetes They usually present the 3 P chart:

Based on that, the typical picture of childhood diabetes that arrives at the emergency department usually presents:

• Polyuria that is sometimes responsible for bedwetting (urinating in bed).
• Polydipsia
• Weightloss, due in part to ketonemia (accumulation of acid radicals due to improper sugar metabolism), which causes anorexia.
• Sometimes there are abdominal pain nonspecific and even vomiting.
• Does not usually present fever.
• Great involvement of the general condition, drowsiness, thinness and sunken eyes.
• Quick and shallow breathing through the open mouth, which causes dry tongue.
• The breath smells like "green apples," due to ketonemia.
• It usually maintains normal blood pressure and central pulses.

Differential diagnosis of childhood diabetes

Although the most common cause of hyperglycemia is diabetes mellitus, we must also consider the possibility of other pathologies as:

• Tables that show hyperglycemia and glycosuria (presence of glucose in the urine).
• Stroke.
• Intravenous therapy
• Dehydration with high levels of sodium in the blood.

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Tables presenting ketoacidosis:

• Acute abdomen.
• Acetylsalicylic acid (aspirin) poisoning.
• Recurrent ketosic hypoglycemia.

Tables presenting severe ketoacidosis:

Childhood diabetes treatment

The treatment of this disease has as an object control metabolic levels and avoid complications, both acute and chronic, which may affect the development of children with childhood diabetes.

In the treatment of childhood diabetes education and training of the child and family is very important to achieve good levels of disease control that avoid complications.

exist three fundamental pillars in the treatment of diabetes:

• Insulin: to provide adequate doses of this hormone that the body cannot produce or use correctly.
• Diet: to avoid overloading the insulin system by regulating the contribution of carbohydrates that are provided with ingestion.
• Exercise: to increase the expenditure of glucose by the muscle and achieve a balance between the ingested and the spent.

The treatment Childhood diabetes has evolved a lot in recent years. The pharmaceutical industry has insulins of various types, with fast and slow actions, which allow a correct control of the disease.

Advances and expectations of the treatment of childhood diabetes

A great effort has also been made in the training and education of children. Some of the challenges achieved have been:

• Simplify insulin application devices.
• Edit educational materials enjoyable for children.
• Convene training courses, workshops and summer schools that help children know and normalize the disease.

The advances that are expected in the near future will make the life of the diabetic child easier, with systems and procedures, both diagnostic and therapeutic, that require less punctures and less frequency in the supply of insulin.

Everything makes us think that new gene therapies and advances in the synthesis of insulin compounds will improve the lives of patients and the prognosis of childhood diabetes.