Diabetes mellitus in children: clinical guidelines for type 1 and 2 disease

Parents of each child who has been diagnosed with diabetes receive clinical recommendations from the doctor, allowing them to develop the correct treatment strategy and correct the child’s lifestyle. However, doctor’s advice and prescriptions are far from spontaneous.

In the process of making a diagnosis and determining methods of treatment, the doctor relies on generally established norms and parameters adopted within the country or international medical associations to combat diabetes mellitus.

Clinical practice guidelines for diabetes mellitus in children

The recommendations of doctors regarding the treatment of type 1 and type 2 diabetes will be different, since the listed types of the disease differ in the peculiarity of the course and methods of treatment.

Type 1

Typically, most children have type 1 diabetes. Also, in young patients, acquired type 1 diabetes occurs, the development of which was provoked by severe stress.

If a child has type 1 diabetes (regardless of the nature of its origin), the main clinical recommendation will be the use of insulin.

This measure is necessary to stabilize the patient’s condition, as well as prolong his life. The sooner the parents take the right measures, the higher the baby’s quality of life will be, and the likelihood of a diabetic coma or ketoacidosis with subsequent death will decrease.

The dosage of insulin injections is determined on an individual basis, taking into account the age, weight and health of the child.

Usually, in the course of treatment, patients are prescribed intensified insulin therapy, when the daily dose of the drug is divided into several portions. It is important that the injected volume of insulin is sufficient to neutralize the accumulated glucose in the body, thereby simulating the natural behavior of the pancreas.

2 types

The second type of diabetes mellitus in children is much less common than the previous version.

As a rule, the lack of sensitivity of cells to insulin and a decrease in its production occurs as a result of stressful situations or metabolic disorders in older children. Babies almost never have type 2 diabetes.

The main medical recommendation for type 2 diabetes is strict adherence to the diet . In this case, treatment measures will be complementary rather than mainstream. But you can’t do without them either.

Exclude harmful foods from the child’s diet should be gradual so that the body does not experience food shock. During the period while the patient continues to consume contraindicated food, he needs to continue to use sugar-reducing drugs.

Children with type 2 diabetes are advised by doctors to keep weight under control. Eating a low-calorie diet and regular exercise will help you get rid of extra pounds and high sugar levels.

Diagnostic criteria

The normal blood sugar level is 3.3 to 5.5 millimoles per liter (mmol / L) after a night’s sleep, which lasts 8 hours, and during which the child does not eat.

If the examination showed that the level of sugar in the blood taken from the child on an empty stomach is 5.6 – 6.9 mmol / L, this indicates a high degree of likelihood of diabetes.

In such situations, the child is referred for an additional test. If the blood sugar level was 7.0 mmol / l during the second examination, it means that the patient will be diagnosed with diabetes mellitus.

Another way to determine if a child has diabetic abnormalities is to check fasting blood sugar after the child has consumed 75 g of glucose. The test is taken 2 hours after the child drinks the sweetened water.

The criteria for assessing the situation in this case will be as follows.

The indicator 7.8 – 11.1 mmol / l indicates impaired glucose tolerance.

A result exceeding the threshold of 11.1 mmol / L indicates the presence of diabetes mellitus. If the deviations from the norm are insignificant, the patient will be assigned a second examination, which will need to be completed in 2-3 weeks.

Clinical picture

The clinical picture of diabetes mellitus has a twofold manifestation. It all depends on the type of disease the child is suffering from. This is due to an acute or chronic lack of insulin in the body.

In the case of acute insulin deficiency, the child has the following symptoms:

• increased urine output;
• the presence of large volumes of glucose in the urine;
• increased blood sugar levels;
• constant feeling of thirst;
• loss of weight against the background of a constant feeling of hunger.

Extreme conditions indicative of acute insulin deficiency are ketoacidosis and even diabetic coma.

If the lack of insulin is chronic, the clinical picture will look like this:

• violation of the work of the National Assembly;
• the development of renal failure;
• violation of the blood circulation process due to a decrease in vascular tone;
• violation of metabolic processes;
• damage to small vessels of the brain.

The listed phenomena in the case of the chronic nature of the course of the disease will develop gradually.

DM patient management protocol

After the child is diagnosed, the doctor fills out a protocol in which he indicates:

• type of SD;
• phase of the disease (compensation or decompensation, with or without ketosis, coma);
• the presence of microangiopathies caused by the disease;
• the presence of complications;
• the duration of the course of the disease (in years);
• combination with other diseases of the endocrine system.

Children with diabetes or high blood sugar are registered.

Treatment features

Treatment of diabetes mellitus in young patients is multilevel and includes the following components:

• diet;
• the use of insulin injections;
• moderate physical activity;
• teaching the child the necessary skills;
• self-control of the condition at home;
• psychological support.

Diet therapy is one of the most important parts of this list. Without correction of the diet, it is impossible to achieve compensation for the disease.

The modern principles of the diet of a diabetic child are as follows:

• the correct ratio of nutrients: carbohydrates – 50-60%, fats – 25-30%, proteins – 15-20%; 

• complete rejection of refined and medium-fiber carbohydrates; 

• almost complete replacement of animal fats with vegetable; 

• adequate intake of foods containing vitamins and healthy dietary fiber; 

• provision of fractional meals (up to 6 times a day). 

So that the child does not suffer from psychological discomfort, it is advisable to adapt the menu of the whole family to the patient’s diet.

Classification of diabetic complications in children

Conventionally, complications caused by diabetes in children can be divided into acute and late.

Acute complications (ketoacidosis and coma) are the most dangerous in nature, since they usually take a few hours to develop, and the likelihood of death is quite high.

During ketoacidosis, large amounts of fats and ketone bodies accumulate in the blood, causing the body to poison itself.

As for coma, it can be caused either by an increase in blood sugar levels due to dehydration or an increase in lactic acid concentration caused by renal, vascular or liver failure.

Acute diabetic complications are eliminated in a hospital setting, and therefore require urgent hospitalization of the patient.

Late complications occur after 4-5 years after the onset of the disease in a child. In this case, the deterioration of the work of an individual organ or system occurs slowly.

The most common late complications include:

• retinopathy (gradual deterioration of vision); 
• angiopathy (thinning of the walls of blood vessels, leading to thrombosis or atherosclerosis); 
• polyneuropathy (gradual damage to the nerves of the peripheral system); 
• diabetic foot (the appearance of wounds and microcracks on the surface of the foot). 

Compliance with preventive measures allows you to slow down, and in some cases even completely prevent the development of late complications.