Diabetes mellitus in children. Preparing for surgery for diabetes

Diabetes mellitus is the most common endocrinological disease in children. Type 1 diabetes prevails. • Symptoms: – polydipsia; – polyuria; – weight loss; – hyperglycemia; – glucosuria; – ketoacidosis.

• Chronic complications of diabetes are not common in children. Their disease is characterized by sharp fluctuations in blood glucose levels and a tendency to ketoacidosis. More often, diabetic ketoacidosis develops against the background of acute systemic pathology, including surgery, however, the manifestations of ketoacidosis can resemble the clinical picture of an acute abdomen.

Preparation for surgery for diabetes in children :
• In the perioperative period, all efforts should be aimed at maintaining blood glucose levels as close to normal as possible, which requires the participation of a diabetologist.
• Schemes of perioperative management, despite some differences, necessarily provide for a joint infusion of glucose, insulin and potassium.
With brief interventions , soon after which the child is likely to be able to eat and drink, glucose and insulin infusion are not needed. 

• Breakfast is canceled.
• Enter half the usual dose of insulin.
• Every hour, determine the level of glucose in the blood.
• Insulin therapy according to the usual scheme is resumed simultaneously with the start of a meal.

• Perioperative management during prolonged surgical interventions:
– the child is hospitalized the day before;
– the operation is prescribed in the morning in the first place;
– measure the levels of glucose and electrolytes in the blood;
– before dinner, short-acting insulin is administered (long-acting or medium-acting insulin cannot be administered);
– before going to bed or 4 hours after dinner (whichever comes first), an on / in infusion of a solution is started, including: 500 ml of 10% glucose in 0.18% NaCl, 10 mmol of potassium chloride, 12 units of short-acting insulin. The infusion rate is 50 ml / kg / day.

• If the operation is scheduled for daytime, the child should have breakfast. Before breakfast, short-acting insulin is administered. 4 hours after breakfast, an intravenous infusion of glucose, insulin and potassium is started. Blood glucose levels are determined every 2 hours before surgery and every hour during surgery. • If the glucose level exceeds 10 mmol / l, the dose of insulin is increased to 16 units per 500 ml of solution. • If the glucose level is below 5 mmol / l, the dose of insulin is reduced to 8 units per 500 ml of solution. • The infusion of glucose, insulin and potassium is continued until the resumption of food intake and the transition to the usual regimen of insulin therapy. 

Mucopolysaccharidoses are a group of diseases caused by the deposition of glycosaminoglycans in the tissues. There are seven types of mucopolysaccharidoses. All of them are inherited recessively, with the exception of Hunter syndrome, which refers to X-linked diseases. Antenatal diagnosis of mucopolysaccharidoses is possible. For treatment in some cases (for example, with Gunther and Gurler syndromes), bone marrow transplantation is used; it does not cure, but usually stops the progression of the disease. 

Gurler’s syndrome (mucopolysaccharidosis type IH) is manifested in the first year of life by enlargement of the head, gross facial features and stunting. A short neck, clouding of the cornea, mental retardation, hydrocephalus, deafness and scoliosis, which cause restrictive respiratory disorders, are also characteristic. Without bone marrow transplantation, patients usually die in the first ten years of life due to cardiomyopathy or damage to heart valves. 

Gunther’s syndrome (mucopolysaccharidosis type II), as well as Hurler’s syndrome, is manifested by dwarfism, gross facial features, corneal opacity, heart damage and hydrocephalus, but, in addition, may be accompanied by retinal pigment degeneration.