Diabetes Mellitus in Children and Adolescents
Diabetes mellitus is a lifelong disorder characterized by alteration in the metabolism of glucose and other energy-yielding fuels due to an absolute or relative insufficiency of insulin. This lack of insulin plays a primary role in the metabolic derangeme
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Kristin A. Sikes and William V. Tamborlane
Abstract
Diabetes mellitus is a lifelong disorder characterized by alteration in the metabolism of glucose and other energy-yielding fuels due to an absolute or relative insufficiency of insulin. This lack of insulin plays a primary role in the metabolic derangements linked to diabetes, including hyperglycemia. Hyperglycemia in turn, plays a key role in the microvascular and macrovascular complications of diabetes. Keywords
Type 1 diabetes • Type 2 diabetes • Insulin pump • Hypoglycemia • Diabetic ketoacidosis • Insulin therapy
Introduction Diabetes mellitus is a lifelong disorder characterized by alteration in the metabolism of glucose and other energy-yielding fuels due to an absolute or relative insufficiency of insulin. This lack of insulin plays a primary role in the metabolic derangements linked to diabetes, including hyperglycemia. Hyperglycemia in turn, plays a key role
K.A. Sikes, M.S.N., C.P.N.P., C.D.E. (*) Pediatric Endocrinology, Yale-New Haven Hospital/Yale University School of Medicine, 2 Church Street South, Suite 404, New Haven, CT 06519, USA e-mail: [email protected] W.V. Tamborlane, M.D. Pediatrics, Yale School of Medicine, Yale-New Haven Children’s Hospital, New Haven, CT, USA
in the microvascular and macrovascular complications of diabetes. Diabetes mellitus can be classified into at least three subclasses: type 1 diabetes (T1D), once known as insulin-dependent diabetes mellitus; type 2 diabetes (T2D), once known as non-insulindependent diabetes mellitus; and secondary diabetes that is linked to another identifiable condition or syndrome. Currently, the majority of children diagnosed with diabetes have T1D, but the rates of T2D in the pediatric population are increasing dramatically, particularly in the high-risk population of overweight/obese adolescents of Hispanic, Native American, and African-American descent. T1D occurs when pancreatic b-cells are destroyed in an autoimmune response that is currently the focus of many research studies. This autoimmune-mediated cellular destruction ultimately leads to a complete absence of endoge-
S. Radovick and M.H. MacGillivray (eds.), Pediatric Endocrinology: A Practical Clinical Guide, Second Edition, Contemporary Endocrinology, DOI 10.1007/978-1-60761-395-4_28, © Springer Science+Business Media New York 2013
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508 Table 28.1 Diagnosis of diabetes Fasting plasma glucose ³126 mg/dL (7.0 mmol/L) or Plasma glucose ³200 mg/dL (11.1 mmol/L) at 2 h on an oral glucose tolerance test or Random plasma glucose ³200 mg/dL (11.1 mmol/L) with classic symptoms of hyperglycemia or A1c ³6.5 %—this test should be performed using a method, that is certified by the National Glycohemoglobin Standardization Program and is standardized to the Diabetes Control and Complications assay
nous insulin secretion. Children with T1D are completely dependent on exogenous insulin in order to prevent progressive metabolic decompensation (i.e., ketoacidosis) and death. T1D usually has a prolonged asymptomatic stage in whic
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