DIABETES MELLITUS [TYPE 1]

 

DIABETES MELLITUS [TYPE 1]

Diabetes 

Diabetes Mellitus (Type 1)

Is an autoimmune disorder that causes Pancreatic B-cells destruction.

The destruction leads to insulin deficiency that result in hyperglycemia and disrupt energy storage and metabolism.

Risk factors 

• Family history & Genetic Predisposition increase the risk
• Environment factors like Viral Infections
• Congenital Rubella Syndrome
• Prenatal infection with rubella is associated with β-cell autoimmunity in up to 70%, with development of T1DM in up to 40% of infected children.
• Enteroviruses
• Mumps Virus (Refer Childhood Infections)
• The Hygiene Hypothesis: Possible Protective Role of Infections
• Diet. 
• Cow milk increase the risk of T1DM.
• AVit D, Vit E, Vit C, Zink deficiencies have also been linked with increased risk.
• Psychogenic strsss

Symptoms of T1DM

• Insulin Deficiency first causes Postprandial Hyperglycemia
• Glycosuria occur when serum glucose level exceeds the renal
• threshold for glucose reabsorption (180mg/dl)
• Glycosuria will cause will cause osmotic diuresis leading to Dehydration.
• Polydipsia occurs as the patient tries to compensate for the fluid loss.
• Weight loss result from the catabolic state and loss of calories through glycosuria and Ketonuria.

T1DM can presentation 

→ Classic New Onset (Hyperglycemia Without Acidosis)

S/S

• Re-emergence of bedwetting, Nocturia, and a need to leave classes in school to use the bathroom are complaints that suggest polyuria.
• Polydipsia
• Weight loss

→ Silent Presentation

• Diagnosis before onset of clinical symptoms which typically occurs in children with family history of T1DM due to close monitoring.

→ Diabetic ketoacidosis (DKA)

May be the first manifestation of T1DM.

Resulting from a severe deficiency of insulin or insulin effectiveness which in turn causes burning of fatty acids and formation of acidic Ketone Bodies.

Characterized by 

• ketonemia, 
• ketonuria and 
• Metabolic acidosis.

The entire process evolves in short period of time (form few weeks in infants to few months in Adolescents).

usually follows some kind of precipitants like

COMMON CAUSE 

• Pneumonia (History of Caught, Fever and Fast breathing) and
• Urinary tract infections (History of fever, Urgency, Frequency, Burning sensation during urination, discharge from urine.)
• Stress
• Trauma
• Drug Discontinuation or
• Inadequate therapy (common In adolescent age due to physiologic changes)
• Myocardial Infarction (Rare in pediatrics age group) and Cerebrovascular accident (also Rare in pediatrics age group)

Symptoms Include

• Three poly symptoms Plus
• Abdominal Pain or Discomfort
• Nausea and Vomiting – which exacerbates the dehydration by preventing fluid intake.
• If severe, they may present with altered mental status or even comma.

CLASSIFICATION Of DKA 

                  Normal. 

CO2(mEq/L,venous) 20-28

pH(venous) 7.35-7.45

        Mild

Oriented,alert butfatigued

CO2(mEq/L,venous) 16-20

pH(venous) 7.25-7.35

       Moderate       

Kussmaul;oriented but sleepy; arousable

CO2(mEq/L,venous) 10-15

pH(venous) 7.15-7.25

       Severe

Kussmaul or depressed respirations; sleepy to depressed sensorium to coma

CO2 (mEq/L,venous) <10

pH (venous) <7

COMPLICATIONS OF T1DM

The complications of Diabetes can be an Acute or Chronic

Acute Complications include

o Diabetic ketoacidosis

o Hypoglycemia

o Hyperosmolar Hyperglycemic state (More common in T2DM

patients)

Chronic Complications:

o Since these complications take longer time to manifest, they are

not common in pediatrics age group.

The chronic Complications can be classified as

o Vascular complications

o Macrovascular Complications

o Coronary Heart Disease

 o Cerebrovascular Diseases

o Peripheral arterial Diseases

o Microvascular Diseases

o Diabetic Retinopathy

o Diabetic Nephropathy

 o Diabetic Neuropathy

o Non-Vascular Complications

o Cataract

o Infections

o Skin changes

o Hearing loss etc..