What Are the Signs of Diabetes in Toddlers?

Pediatric diabetes is an endocrine and metabolic disease caused by insufficient insulin secretion. It is mainly caused by disorders of carbohydrate, protein and fat metabolism. Clinical manifestations are polydipsia, polyuria, polydipsia and wasting. Children are prone to ketoacidosis, and vascular disease often causes eye and kidney involvement in the later stages. Diabetes in childhood can be seen in all ages, more common in school and adolescent development, and there is no gender difference. According to different causes, childhood diabetes can be divided into: primary diabetes and secondary diabetes, and primary diabetes is divided into: insulin-dependent diabetes mellitus (IDDM) also known as type 1 diabetes; non-insulin-dependent diabetes mellitus Diabetes (NIDDM) is also known as type 2 diabetes. Secondary diabetes: pancreatic disease, abnormal hormone receptors, impaired glucose tolerance. Diabetes is more common in children with insulin dependence. At present, the incidence of type 2 diabetes in children has increased, insulin sensitivity is reduced, and insulin secretion levels are higher than in normal people.

Basic Information

Visiting department: Pediatrics, Endocrinology
Multiple groups: Children ages 5 to 7 and 10 to 13

Common causes: Related to autoimmunity, viral infection, genetic susceptibility
Common symptoms: Polyuria, drink more, eat more, lose weight

Causes of pediatric diabetes

Diabetes is an autoimmune disease. It has an innate genetic background and is caused by a variety of factors.

Autoimmune response

Both humoral and cellular immunity have been shown to be related to diabetes. In newly diagnosed insulin-dependent diabetes mellitus, antibodies to pancreatic islets were detected in two-thirds of children. Some children can also detect insulin receptor autoantibodies and islet cell membrane antibodies.

2. Environmental factors

(1) The virus infects Coxsackie B virus, EB virus, mumps virus, etc.

(2) Premature and excessive intake of cow's milk products, of which casein is used as an antigen, triggers the occurrence of diabetes. Bovine insulin in milk can cause an immune response that disrupts human -cell function.

(3) Drug and chemical factors.

3. Genetic susceptibility

It is hereditary, and the histocompatibility complex gene located on the short arm of chromosome 6 of white blood cells has been proved to be a susceptibility gene.

Clinical manifestations of pediatric diabetes

Onset can occur at all ages, as small as 3 months after birth, but it is more common in the two groups of 5-7 years old and 10-13 years old, and there is no gender difference in prevalence. The incidence of diabetes in children in China is about 0.6 per 100,000

The onset of diabetes in children is often rapid, with sudden manifestations of significant urine, drink, meals, and weight loss. Referred to as "three more and one less". School-age children can drink 3 to 4 liters or more of water per day and often thirst at night. Increased appetite but weight loss. Young people often attract parents' attention with enuresis and weight loss. Infants and young children often have symptoms of enuresis. Drinking more urine is easily overlooked, and some do not come to the clinic until ketoacidosis occurs.

About half of children with childhood diabetes start with ketoacidosis, and the younger the age, the more severe the symptoms of ketoacidosis. Nausea, vomiting, abdominal pain, loss of appetite and consciousness, lethargy, and even total coma may occur. The symptoms of "three more and one less" are ignored. There are also dehydration and acidosis. When severe acidosis occurs, deep breathing and irregular rhythms occur. Breathing with keto. If children are not diagnosed and treated properly, their lives will be in danger.

Pediatric Diabetes Examination

Blood test

(1) Glucose measurement is based on venous plasma (or serum) glucose. In 1997, the American Diabetes Association (ADA) established the criteria for diagnosing diabetes: normal fasting blood glucose <6.1mmol / L (110mg / dl), fasting blood glucose 6.1 to 6.9mmol / L is impaired fasting blood glucose; L, or oral glucose tolerance test (OGTT) 2 hours blood glucose level> 11.1mmol / L, you can diagnose diabetes. Glucose tolerance test is not a routine method for the diagnosis of clinical diabetes.

(2) Plasma C-peptide measurement The C-peptide measurement can reflect the insulin secretion function of endogenous islet cells and is not affected by the injection of foreign insulin. Contribute to the typing of diabetes. C-peptide values were significantly lower in children with type 1 diabetes.

(3) Glycated hemoglobin (HBAlc) is the true sugar part of blood sugar, which can reflect the average blood glucose concentration in the past 2 months. It is a reliable, stable and objective indicator for judging blood glucose control over a period of time. There is some relevance. Normal HBAlc <6%; HBAlc maintained at 6% to 7%, indicating good control, diabetes complications did not occur or have occurred but did not progress; HBAlc 8% to 9% is acceptable for control; HBA1c 11% to 13% is Poor control and significantly increased complications of diabetes. Therefore, the American Diabetes Association requires that HBAlc in children with diabetes be controlled within 7%.

2. Urine test

(1) Diabetes in severe cases often has diabetes before treatment. Mild cases are only seen after meals or under stress such as infection. Many chronically ill patients have no diabetes due to elevated blood glucose, although they have high blood sugar. Therefore it is more meaningful to collect urine for a quantitative test.

(2) Proteinuria reaction: The degree of early kidney involvement in diabetic patients. Diabetic children have albuminuria negative or occasional albuminuria when there is no complication. The excretion rate of albuminuria is 30mg ~ 300mg / d, which is called microalbuminuria. , Indicating that the patient has early diabetic nephropathy, the albuminuria excretion rate> 300mg / d, said clinical or a large amount of albuminuria.

(3) Urinary ketone bodies are positive in severe cases or eating disorders with ketoacidosis.

(4) Cast urine is often found at the same time as a large amount of proteinuria, mostly transparent casts and granular casts. Found in diffuse glomerulosclerosis.

3. Other inspections

(1) Except for tuberculosis.

(2) B-ultrasound examination of the liver and pancreas.

(3) Ophthalmological examination of the fundus.

Pediatric Diabetes Diagnosis

It can be diagnosed according to the children's obvious excessive drinking, polyuria, polyphagia and weight loss, fasting blood glucose 7.0mmol / L, oral glucose tolerance test for 2 hours, blood glucose value 11.1mmol / L, or blood glucose 11.1mmol / L at any time. diabetes. A family history of diabetes can help diagnose diabetes. It should be distinguished from diabetes, dehydration, and coma.

Pediatric Diabetes Treatment

The purpose of children's diabetes treatment: eliminate symptoms and stabilize blood sugar; maintain children's normal growth and sexual development; prevent middle and late complications.

Diet therapy

(1) Hot card supply The total hot card supply per day is equal to 1000 kcal + (age-1) × (70-100) kcal. Reasonable dietary treatment is the basis for the treatment of all diabetic patients. The calorie intake should be suitable for the age, weight, daily activities and daily meals of the child. Also consider the growth and development of the child.

(2) The dietary composition of the protein accounts for about 15% to 20% of the total calories, mainly animal protein; the fat is mainly composed of vegetable oil, about 30%, and the unsaturated fatty acids; the carbohydrates are mainly rice and cereal 55% of total calories;

(3) The distribution of three meals is generally suitable for a small number of multiple meals. Two snacks can be added between meals to avoid hypoglycemia. Eat more cellulosic foods to make the absorption of sugar slow and uniform, thereby improving sugar metabolism. Breakfast is 1/5, Chinese is 2/5, and dinner is 2/5

2. Insulin replacement therapy

(1) The regular insulin (RI) of the commonly used insulin dosage form is fast-acting; the globin insulin (NPH) is medium-effect: protamine neo-insulin is medium-long-acting (PZI)

(2) Common methods of insulin use Two subcutaneous injections per day. Two-thirds of the total amount is injected 30 minutes before breakfast and 1/3 is injected 30 minutes before dinner. Each injection mixes short-acting and medium-long-acting insulin. (According to the ratio of 3: 1 or 4: 1), mix in the order of short-acting first and then long-acting, and then inject.

(3) The upper arm, thigh, and abdomen of the insulin injection site are rotated in order. The injection points are 2 cm apart, avoiding two injections at the same site within a month.

(4) Adjustment of insulin metering In the case of relatively stable diet and exercise, it is generally adjusted once every 2 to 3 days, each time it is increased or decreased by 2 units, and only one period is adjusted each day.

Children with type 1 diabetes need to be treated with insulin for life.

3. Exercise Therapy

Exercise is essential for children's normal growth and development. Exercise is more important for children with diabetes. Exercise increases the sensitivity of muscles to insulin, while accelerating the use of glucose is conducive to blood glucose control. Exercise can lower blood lipids, enhance physical fitness, and reduce complications.

4. Prevention of infection.

Prognosis of pediatric diabetes

The prognosis of diabetes depends on whether blood sugar is well controlled. Those whose blood glucose level is higher than the ideal range for a long time are prone to various chronic complications.

Management of Diabetes in Children with Diabetes

1. Popularize diabetes knowledge, let children and parents understand what diabetes is, the purpose and principles of treatment.

2. Diabetes is a life-long and tedious treatment of special diseases. Parents and children should be encouraged to establish confidence in the disease and provide psychological treatment to the children.

3. Diabetes requires long-term treatment, most of which are treated at home. This requires medical staff to teach parents and children how to measure micro blood glucose and urine glucose, how to draw insulin, and how to inject insulin correctly.

4. Tell the children and parents about the symptoms of hypoglycemia and how to help themselves.

5. Know the knowledge and clinical symptoms of preventing ketoacidosis.

6. Establish a diabetes specialist clinic, guide diet treatment, establish family records, and help them solve problems in a timely manner.