Hyperglycemia

Diabetes mellitus is the most common endocrine disorder of childhood, affecting about 2/1,000 school-age children in the U.S. The absolute or relative lack of insulin results in an abnormal metabolic state, including hyperglycemia. Children with diabetes are at risk for the acute complications of dehydration and diabetic ketoacidosis (DKA), and for the long-term complications of retinopathy, nephropathy, neuropathy, atherosclerosis, and ischemic heart disease.

Differential Diagnosis

• Type I diabetes mellitus
  –Most common form of diabetes in children
  –Prevalence: 1.9/1,000
  –Autoimmune-mediated destruction of pancreatic islets (β-cells)
  –Absolute insulin deficiency
  –Often presents with ketosis and DKA

• Type II diabetes mellitus
  –Increasing prevalence in children, especially among obese
  –In children, onset usually in mid-puberty
  –More frequent in blacks, Hispanics, Pacific Islanders, Asians, and Native Americans (Pima Indians)
  –Strong association with family history of type II diabetes
  –Insulin resistance and inadequate insulin secretion results in relative insulin deficiency

• Maturity-onset diabetes of the young (MODY)
  –Infrequent
  –Autosomal dominant disease
  –Onset usually between 9 and 25 years old
  –Genetic defects in enzymes or nuclear transcription factors involved in islet cell development or the regulation of insulin secretion
• Drug- or chemical-induced diabetes
  –Glucocorticoids, β-adrenergic agonists, phenytoin, asparaginase, cyclosporine, tacrolimus, vacor, pentamidine, diazoxide, nicotinic acid, thyroid hormone, thiazides
• Other endocrinopathies: Cushing disease, acromegaly, pheochromocytoma
• Exocrine pancreatic diseases
  –Cystic fibrosis
  –Hemochromatosis
• Pancreatectomy
• Physiological stress (trauma, infection)
• Infections
  –CMV
  –Congenital rubella
• Genetic syndromes: Prader-Willi syndrome, Down syndrome, Turner syndrome, Klinefelter syndrome, Wolfram syndrome

Workup and Diagnosis

• History
  –Classic symptoms: Polyuria, polydipsia, weight loss
  –Also polyphagia, nocturia, secondary enuresis, intermittent blurry vision
  –Nausea, vomiting, abdominal pain with ketoacidosis
  –Mental status changes with severe acidosis and dehydration
  –Family history of DM, autoimmune, endocrinopathy

• Physical exam
  –Vital signs, weight, body mass index
  –Ketoacidosis: Funduscopic exam (blurred optic discs with cerebral edema), Kussmaul respirations, fruity odor to breath, tachycardia/hypotension/poor perfusion, severe dehydration, mental status changes
  –Type II diabetes: Obesity and acanthosis nigricans

• Diagnostic criteria for diabetes
  –Random plasma glucose >200 mg/dL
  –Fasting plasma glucose >126 mg/dL
  –Or 2-hour plasma glucose during the oral glucose tolerance test >200 mg/dL
  –Lab abnormalities must be present on two different days or in the presence of symptoms of diabetes (polyuria, polydipsia, weight loss)

• Other tests
  –Hb_A1c, urinalysis for glucose and ketones
  –If suspect DKA, check electrolytes and blood gas
  –To help distinguish type I from type II diabetes, check fasting insulin, C-peptide, and β-cell autoantibodies

Treatment

• Initial management
  –Fluid to correct dehydration
  –Insulin to correct hyperglycemia and acidosis
  –Intravenous therapy required if patient in DKA
• Long-term management: Goal is to normalize blood glucose and HbA1c to decrease risk of acute and chronic complications
• Type II diabetes
  –Absolute daily insulin requirement
  –Monitor blood glucose (metabolic control)
  –Attention to dietary intake (carbohydrate counting)
• Type II diabetes
  –Weight management via diet changes and exercise
  –Most require medication (insulin and/or metformin)
  
• Prognosis
  –Chronic hyperglycemia increases long-term risk of microvascular (retinopathy, nephropathy, neuropathy) and macrovascular (atherosclerosis and ischemic heart disease) complications

Book Source Details

• Book Title: In A Page: Pediatric Signs and Symptoms
• Author(s): Jonathan E. Teitelbaum, Kathleen O. Deantonis, Scott Kahan
• Year of Publication: 2007
• Copyright Details: In A Page: Pediatric Signs and Symptoms, Copyright © 2007 Lippincott Williams & Wilkins.

Other Book Chapters Related to Gestational diabetes

Read excerpts from these other book chapters related to Gestational diabetes:

Copyright Details: In A Page: Pediatric Signs and Symptoms, Copyright © 2008 Williams & Wilkins.

More About Causes of Gestational diabetes

• Back to symptom: Gestational diabetes: Introduction (review 4 causes)
• Next Book Extract About Gestational diabetes: Polydipsia (In A Page: Pediatric Signs and Symptoms)
• All Book Extracts: All Online Book Extracts for Gestational diabetes

More About This Book: Title: In A Page: Pediatric Signs and Symptoms Authors: Jonathan E. Teitelbaum, Kathleen O. Deantonis, Scott Kahan Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 1-4051-0427-9

 » Next page: Polydipsia (In A Page: Pediatric Signs and Symptoms)

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• GLYCOSURIA (Differential Diagnosis in Primary Care)
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• Polydipsia (Handbook of Signs & Symptoms (Third Edition))

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