Diabetes at children – the chronic metabolic disease which is characterized by violation of secretion of insulin and development of a hyperglycemia. Diabetes at children usually develops violently; is followed by bystry weight loss of the child at the increased appetite, unrestrained thirst and a plentiful urination. For the purpose of detection of diabetes at children the developed laboratory diagnostics is carried out (definition of sugar, tolerance to glucose, glikirovanny hemoglobin, insulin, S-peptide, At to β-cells of a pancreas in blood, a glucosuria, etc.). The main directions in treatment of diabetes at children include a diet and insulin therapy.
Diabetes at children
Diabetes at children – violation carbohydrate and other types of exchange which cornerstone the insulin insufficiency or/and insulin resistance leading to a chronic hyperglycemia is. According to WHO data, every 500th child and every 200th teenager has diabetes. At the same time in the next years increase in incidence of diabetes among children and teenagers for 70% is predicted. Considering wide circulation, a tendency to "rejuvenation" of pathology, a progrediyentny current and weight of complications, the diabetes problem demands cross-disciplinary approach with participation of experts in the field of pediatrics from children, children's endocrinology, cardiology, neurology, ophthalmology, etc.
Classification of diabetes at children
At patients of children's age doctors-diabetologam in most cases should face diabetes of the 1st type (insulin-dependent) which cornerstone absolute insulin insufficiency is. Diabetes of the 1st type at children usually has autoimmune character; of it it is characteristic existence autoantitet, destruction of β-cages, association with genes of the main complex of a gistosovmestimost of HLA, a full insulinozavisimost, tendency to ketoacidosis, etc. Idiopathic diabetes of the 1st type has unknown pathogenesis and more often is registered at persons not of the European race.
The diabetes reasons at children
The leading factor causing development of diabetes of the 1st type in children is hereditary predisposition what the high frequency of family cases and presence of pathology at close relatives (parents, sisters and brothers, grandmothers and grandfathers) testifies to.
However initiation of autoimmune process requires influence of a provocative factor of the external environment. The most probable triggers leading to a chronic lymphocytic insulit, the subsequent destruction of β-cages and insulin insufficiency are virus agents (Koksaki's viruses B, ECHO, Epstein-Barre, parotitis, a rubella, herpes, measles, rotaviruses, enteroviruses, a cytomegalovirus, etc.).
Besides, development of diabetes in children with genetic predisposition can be promoted by toxic influences, alimentary factors (the artificial or mixed feeding, food cow's milk, monotonous carbohydrate food and so forth), stressful situations, surgical interventions.
Secondary (symptomatic) forms of diabetes at children can develop at endokrinopatiya (Itsenko-Cushing's syndrome, a diffusion toxic craw, an akromegaliya, a feokhromotsitoma), diseases to a pancreas (pancreatitis, etc.). Diabetes of the 1st type at children is quite often accompanied by other immunopathological processes: system red a wolf cub, the sklerodermiya, rheumatoid arthritis, nodular periarteriit etc.
Diabetes at children can be associated with various genetic syndromes: Down syndrome, Klaynfelter, Pradera-Willie, Shereshevsky-Turner, Lourensa-Muna-Barde-Bidlya, Tungsten, horey Gentington, Fridreykh's ataxy, porfiriya and so forth.
Diabetes symptoms at children
Displays of diabetes at the child can develop at any age. Two peaks of a demonstration of diabetes at children – in 5-8 years and in the pubertatny period, i.e. during the periods of the strengthened growth and intensive metabolism are noted.
In most cases development of insulin-dependent diabetes in children is preceded by a viral infection: epidemic parotitis, measles, SARS, enteroviral infection, rotavirusny infection, viral hepatitis, etc. The sharp rough beginning is characteristic of diabetes of the 1st type at children, is frequent with bystry development of ketoacidosis and a diabetic coma. From the moment of the first symptoms before development of coma can pass from 1 to 2-3 months.
It is possible to suspect presence of diabetes at children on patognomonichny signs: to the raised urination (polyuria), thirst (polidipsiya), the increased appetite (polyphagia), decrease in body weight.
The mechanism of a polyuria is connected with the osmotic diuresis arising at the hyperglycemia of ≥9 mmol/l exceeding a kidney threshold and emergence of glucose in urine. Urine becomes colourless, its specific weight increases at the expense of the high content of sugar. The day polyuria can remain not distinguished. The night polyuria which at diabetes at children quite often is followed by an urine incontience is more noticeable. Sometimes parents pay attention to that fact that urine becomes sticky, and to linen of the child there are so-called "starched" spots.
Polidipsiya is a consequence of the increased release of urine and dehydration of an organism. Thirst and dryness in a mouth can also torment the child at night, forcing it to wake up and ask to drink.
Children with diabetes hunger constant, however along with a polyphagia at them it is noted by decrease in body weight. It is connected with the power starvation of cages caused by loss of glucose with urine, violation of its utilization, strengthening of processes of a proteoliz and lipoliz in the conditions of an insulinodefitsit.
In a diabetes debut at children dryness of skin and mucous, developing of dry seborrhea on a hairy part of the head, a skin peeling on palms and soles, zayeda in mouth corners, kandidozny stomatitis, etc. can already be observed. Pustulous damages of skin, , mycoses, an intertrigo, vulvita at girls and a balanopostita at boys are typical. If the diabetes debut at the girl falls on the pubertatny period, it can lead to violation of a menstrual cycle.
Diabetes complications at children
The course of diabetes at children extremely labilno is also characterized by tendency to development of dangerous conditions of a hypoglycemia, ketoacidosis and a ketoatsidotichesky coma.
The hypoglycemia develops owing to sharp decrease in the sugar in blood caused by a stress, excessive physical activity, insulin overdose, non-compliance with a diet etc. The hypoglycemic coma is usually preceded by slackness, weakness, perspiration, a headache, feeling of strong hunger, a shiver in extremities. If not to take a measure to increase in sugar of blood, at the child spasms, the excitement which is replaced by consciousness oppression develop. At a hypoglycemic coma the body temperature and HELL are normal, there is no acetone smell from a mouth, integuments damp, the content of glucose in blood
Diabetic ketoacidosis is a harbinger of a terrible complication of diabetes at children - a ketoatsidotichesky coma. Its emergence is caused by strengthening of a lipoliz and ketogenesis with formation of excess number of ketone bodies. At the child weakness, drowsiness increases; appetite decreases; nausea, vomiting, short wind join; there is an acetone smell from a mouth. In the absence of adequate medical measures ketoacidosis within several days can develop into a ketoatsidotichesky coma. This state is characterized by full loss of consciousness, arterial hypotonia, a frequent and low pulse, uneven breath, an anury. Serve as laboratory criteria of a ketoatsidotichesky coma at diabetes at children a hyperglycemia> 20 mmol/l, acidosis, a glucosuria, an acetonuria.
More rare, at the started or nekorrigirovanny course of diabetes at children, the giperosmolyarny or laktatatsidemichesky (lactic) coma can develop.
Development of diabetes at children's age is serious risk factor of emergence of a number of the remote complications: diabetic mikroangiopatiya, nephropathy, neuropathy, cardiomyopathy, retinopathy, cataract, early atherosclerosis, IBS, HPN, etc.
Diagnosis of diabetes at children
In detection of diabetes the important role belongs to the local pediatrician who regularly observes the child. At the first stage it is necessary to consider existence of classical symptoms of a disease (a polyuria, a polidipsiya, a polyphagia, weight loss) and objective signs. At survey of children existence of a diabetic flush on cheeks, a forehead and a chin, crimson language, decrease in turgor of skin pays attention. Children with characteristic displays of diabetes have to be transferred for further maintaining to the children's endocrinologist.
Final diagnosis is preceded by careful laboratory inspection of the child. The main researches at diabetes at children include definition in sugar level blood (including by means of daily monitoring), insulin, S-peptide, pro-insulin, glikozilirovanny hemoglobin, tolerance to glucose, blood BRAIDS; in urine - glucose and ketone bodies. As the most important diagnostic criteria of diabetes at children serve the hyperglycemia (higher than 5,5 mmol/l), a glucosuria, a ketonuriya, an acetonuria. For the purpose of preclinical detection of diabetes of the 1st type in groups with high genetic risk or for a difdiagnostika of diabet of the 1 and 2 type definition of At to β-cells of a pancreas and At to a glutamatdekarboksilaza (GAD) is shown. For assessment of a structural condition of a pancreas ultrasonography is carried out.
Differential diagnosis of diabetes at children is carried out with an atsetonemichesky syndrome, not diabetes, nefrogenny diabetes. Ketoacidosis and who needs to distinguish from a sharp stomach (appendicitis, peritonitis, intestinal impassability), meningitis, encephalitis, a brain tumor.
Treatment of diabetes at children
The main components of therapy of diabetes of the 1st type at children are insulin therapy, observance of a diet, correct way of life and self-checking. Dietary actions provide an exception of food of sugars, restriction of carbohydrates and animal fats, fractional food of 5-6 times a day, the accounting of individual energy needs. As important aspect of treatment of diabetes at children serves competent self-checking: awareness of gravity of the disease, ability to determine glucose level in blood, to correct an insulin dose taking into account the level of a glycemia, physical activities, errors in food. Training of parents and children with diabetes in methods of self-checking is carried out at "schools of diabetes".
Replacement therapy to the children having diabetes is carried out by medicines of human genetically engineered insulin and their analogs. The dose of insulin is selected individually taking into account degree of a hyperglycemia and age of the child. Well the insulin therapy providing introduction of the prolonged insulin in the morning and in the evening for correction of a basic hyperglycemia and additional use of insulin of short action before each main meal for correction of a postprandialny hyperglycemia proved in children's practice basis-bolyusnaya.
Modern method of insulin therapy at diabetes at children is the insulin pomp allowing to enter insulin in the continuous mode (imitation of basal secretion) and the bolyusny mode (imitation of post-alimentary secretion).
The most important components of treatment of diabetes of the 2nd type at children are the dietotherapy, sufficient physical activity, reception of oral antihyperglycemic medicines.
At development of diabetic ketoacidosis the infusional regidratation, introduction of an additional dose of insulin taking into account hyperglycemia level, correction of acidosis is necessary. In case of development of a hypoglycemic state the child needs to give urgently sacchariferous products (a sugar piece, juice, sweet tea, caramel); if the child is unconscious – intravenous administration of glucose or intramuscular introduction of a glucagon is necessary.
The forecast and prevention of diabetes at children
Quality of life of children in many respects decides on diabetes by efficiency of compensation of a disease. At observance of the recommended diet, the mode, medical actions life expectancy corresponds to average in population. In case of gross violations of doctor's instructions, diabetes decompensations early develop specific diabetic complications. Patients are for life observed by diabetes at the endocrinologist-diabetologa.
Vaccination of the children sick with diabetes is carried out to the period of kliniko-metabolic compensation; in this case it does not cause deterioration during the main disease.
Specific prevention of diabetes at children is not developed. Forecasting of risk of a disease and detection of prediabetes on the basis of immunological inspection is possible. At children of risk group on development of diabetes it is important to support the optimum weight, daily physical activity, to increase immunoresistance, to treat the accompanying pathology.