Characteristic features of endocrine and metabolic disorders in children : • Almost all types of diabetes are insulin-dependent. • Hypoglycemia should be excluded whenever a child suddenly becomes ill. • Congenital hypothyroidism is relatively common and is detected during routine biochemical screening (Guthrie’s test). • Congenital metabolic disorders alone are rare, but are expected in a wide range of differential diagnoses.
The prevalence of diabetes in children has been steadily increasing over the past 20 years and is currently affecting approximately every 2 out of 1000 children under 16 years of age.
Most likely, this may be due to changes in environmental risk factors . There is significant racial and geographical variability: the condition is more common in northern countries with the highest prevalence in Finland.
Almost all children are insulin-dependent (type 1 diabetes). Type 2 non-insulin-dependent diabetes due to insulin resistance tends to appear in childhood, as severe obesity is becoming more common. Almost all sick children have insulin-dependent diabetes ( type 1), type 2 diabetes is very rare.
The classification of diabetes in children according to the etiology :
• Type 1. Insulin-dependent diabetes mellitus:
– Most cases of diabetes in childhood.
• Type 2. Non-insulin-dependent diabetes mellitus:
– Usually observed in older children, prone to obesity, with a positive family history, without a tendency to ketoacidosis. More common in some ethnic groups.
• Type 3. Other specific types of diabetes mellitus:
– Genetic defects in the functioning of b-cells (DZTM, various subtypes).
– Genetic disorders in the mechanism of action of insulin.
– Caused by taking medications, such as glucocorticoids.
– Caused by an infection, such as congenital rubella.
– Exocrine pancreatic insufficiency, for example, cystic fibrosis.
– Endocrine diseases, for example, Cushing’s syndrome.
– Genetic / chromosomal syndromes, for example, Down and Turner.
• Type 4. Gestational diabetes.
Etiology of diabetes in children
Both genetic predisposition and environmental triggers contribute. Hereditary addiction is manifested in the following examples. • The identical twin of someone with diabetes has a 30-50% chance of developing this disease. • The risk of developing diabetes for a child is increased if parents suffer from insulin-dependent diabetes (1 in 20–40 if their father suffers, 1 in 40–80 if their mother suffers). • An increased risk of diabetes among those who have HLA-DR3 or HLA-DR4 and a low risk for those who have DR2 and DR5.
Molecular mimicry probably occurs between the triggering factor of the environment and the antigen on the surface of the b-cells of the pancreas. Triggers that can contribute to this reaction include viral infections, the outbreaks of which, according to estimates, are most likely to occur in spring and autumn, and diet [probably cow’s milk proteins].
As a result of this , an autoimmune process occurs that damages the b-cells of the pancreas and leads to absolute insulin deficiency. Markers for b-cell destruction include antibodies to islet cells and antibodies to glutamic acid decarboxylase (DHA). There is a relationship with other autoimmune disorders, such as hypothyroidism.
Clinical signs of diabetes in children
The disease is atypical for children under 1 year of age, but its prevalence has been steadily increasing during early school age until it reaches a peak by 12-13 years of age. Unlike adults, in children the clinical manifestation occurs only in the form of polyuria lasting several weeks, excessive thirst (polydipsia) and weight loss; young children may also develop nocturnal enuresis. Most children are diagnosed at this early stage of the disease.
Severe diabetic ketoacidosis has become a less common clinical manifestation (<10% in some areas of the UK), but emergency diagnosis and treatment are required. Diabetic ketoacidosis may not be mistakenly diagnosed if hyperventilation is falsely mistaken for pneumonia or abdominal pain for appendicitis.
Diagnosis of diabetes in children
The diagnosis is usually confirmed in a child with symptoms by establishing a high level of blood glucose (> 11.1 mmol / L according to the current WHO definition), glucosuria and ketonuria. When in doubt, fasting blood glucose (> 7 mmol / L) or detecting elevated glycosylated Hb (HbAlc) is helpful.
A glucose tolerance diagnostic test is rarely required in children. Type 2 diabetes should be assumed if there is a family history in children from Asia and children with severe obesity and signs of insulin resistance (acantokeratoderma – skin on the neck or armpits of a thick dark color, skin marks or polycystic ovary in girls in adolescence )
Symptoms and signs of diabetes :
• Early signs of diabetes in children : – The most common are the classic triad. – Excessive fluid intake (polydipsia). – Polyuria. – Weight loss. – Less common. – Enuresis (secondary). – Cutaneous sepsis. – Candida and other infections.