During the absence of insulin, with untreated diabetes mellitus in children, the disease ended in death in just a few months, at best, so to speak, in two years. The benefit of modern medicine allows you to avoid such effects. And an important condition for this is how quickly the disease was detected, the signs of diabetes mellitus in children were recognized.

Diabetes in children: course and prognosis.

Previously, almost every children's diagnosis of "diabetes" or intercurrent infection proved life-threatening, because the reduced tolerance of the body to carbohydrates contributed to the development of coma. More specifically, the immediate cause of death was tuberculosis, intercurrent infections, and in most cases the resulting coma.

What is diabetes in children?

Diabetes is a chronic disease of the endocrine system that appears due to the lack of insulin - a special pancreatic hormone. The purpose of insulin is to provide glucose to all cells of the human body. In a healthy person, the pancreas produces the hormone insulin, which in turn delivers the glucose dissolved in the blood inside the cells. With the development of diabetes mellitus, glucose alone cannot enter the cell, and is forced to remain in the blood, becoming an unnecessary element. In this case, glucose is the main source of nutrition for the body. Once in the body with food, it is transformed inside the cell into clean energy, which allows the body to work fully. Glucose can penetrate inside the cell only with the help of the hormone insulin.

If insulin in the body is not enough - sugar, that is, glucose, remains in the blood. As a result, the blood becomes thicker, and is not able to quickly transfer oxygen and nutrients to the cells. The walls of the vessels for nutrients become impenetrable, lose their elasticity. Such a "sugar" is a direct threat to the membranes of the nerves.

Diabetes in children is accompanied by a violation of all, without exception, types of metabolism in the body: carbohydrate metabolism, protein metabolism, fat metabolism, mineral metabolism and water-salt metabolism as well. From here and numerous complications of diabetes mellitus, serious and often enough for life dangerous, complications.

There are two types of diabetes that have significant differences, both in terms of clinical development, pathogenesis, and etiology, and in terms of maintenance and treatment.

The first type of diabetes is caused by insulin deficiency: the pancreas does not produce enough or does not produce it at all. The pancreas of a child simply cannot cope with its functions: the amount of the synthesized hormone does not process the incoming volume of glucose, and the level of sugar in the blood rises. In diabetes of this type, insulin therapy is always required - daily injections of insulin, administered in a strictly defined amount.

In the case of diabetes of the second type, insulin is produced in sufficient quantity, and more than the necessary norm happens. However, the hormone is almost useless, because the tissues in the body, for one reason or another, lose sensitivity to it, do not recognize insulin.

How does diabetic coma and hypoglycemia occur?

When diabetes mellitus develops in children, not only the conversion of sugar into glycogen, but also the burning of glucose in tissues slows down. Therefore, the body of the child has to use fat as an energy material. As a result, intensive release of fatty acids from fat depots and their very active breakdown, leading, in turn, to the accumulation in the tissues and blood of so-called ketone bodies, in particular: acetone, acetoacetic acid and beta-hydroxybutyric acid. The increased blood levels of these ketone bodies are nothing but poisoning of the body and, above all, of the central nervous system. Such a poisoning can result in the development of a severe complication - diabetic coma. In a diabetic coma, the patient’s vital functions are impaired, including breathing and blood circulation, if the appropriate measures are not taken on time, the child simply dies.

With appropriate monitoring and treatment, a diabetic child is currently able to lead the same lifestyle as his healthy peers. However, dangerous moments for a child’s life, such as coma and hypoglycemia, threaten a small diabetic throughout the entire period of the illness. In addition, diabetes in children, contains a distant, but inevitable danger that can significantly shorten the life of the patient in the end - diabetic changes of blood vessels. Read more about what is diabetic coma, and how it develops in children, can be found in the article: “What is diabetes from a scientific point of view? How does diabetic coma develop and why is it more dangerous for children? ”

A few words need to be said about hypoglycemia associated with insulin therapy. The fact is that hypoglycemia is an error if the beginning coma is mistakenly diagnosed, and to avoid such an error is almost impossible. You can meet with the appearance of hypoglycemia in the initial period and the labile period of diabetes, often with the selection of insulin therapy and the patient's diet, with increased insulin doses, after fasting or severe physical exertion and stress.

The initial signs of hypoglycemia are: dizziness, pallor, lethargy, excessive sweating, negative reactions of the child, tremor, after these first symptoms quickly appear convulsions and impaired consciousness.

Important signs that distinguish acidotic coma from hypoglycemia are: pale, moist skin, lack of toxic respiration, enhanced reflexes. When analyzing the first portions of urine, the sugar and acetone content in it can be revealed. The concentration of glucose in the blood is quite low, but the reaction of the blood is normal. In cases where the initial values ​​of the sugar content in the blood are high and unexpectedly sharply fall, the severe symptoms of hypoglycemia can appear even if the blood sugar level is normal. Frequently repeated, long-term hypoglycemic states can become the initial cause of cerebral lesions of the child’s body.

Manifestations, effects and symptoms of diabetes in children

With insufficient, not careful treatment slows down the development and growth of the child. Symptoms of diabetes in children are often accompanied by an increase in the liver, which is caused by accumulations of glycogen and fat. Such cases are particularly threatening susceptibility to ketosis, and the treatment of these "labile" patients is difficult. Conditions that are characterized by liver enlargement, dwarf growth, lipemia, increased susceptibility to ketosis, in the medical literature are known as Mauriac's syndrome.

With diabetes, as with other chronic diseases, all sorts of mental and behavioral disorders in children are frequent.

Diabetic vascular changes are no longer the symptoms of diabetes in children, but the late effects of the disease, which, as a rule, are already encountered by a therapist, and not by a pediatrician. During the first ten years of diabetes, they are quite rare, but in the next ten years, about 70-90% of patients with a diagnosis of "diabetes" have these complications. The prognosis of these vascular changes is very poor, they actually shorten the life of the patient, especially if the disease began at an early age. The most common complications of diabetes with age are: general arteriosclerosis, glomerulosclerosis, which quickly leads to renal failure (Wilson's disease), retinopathy and cataracts.

Diabetes in children: symptoms and signs of diabetes in children

The leading signs of diabetes in children, in most cases especially pronounced specifically in childhood diabetes, are:

• 1. Polyuria, which in young children is often perceived as the usual bedwetting. This is a common mistake, so you should be careful and know all the symptoms of diabetes.
• 2. Polydipsia, developing as a result of the painful feeling of thirst in a child with diabetes.
• 3. Fast-paced weight loss, despite the good, and even "brutal" appetite.
• 4. In diabetes, a rather large amount of urine is excreted. Her color is light, and high specific weight. The most obvious signs of suspected diabetes in children are sugar and acetone in the urine.
• 5. Signs of diabetes in children is the concentration of fasting sugar in the blood exceeding 120 mg%.

If parents do not pay attention to the initial signs of diabetes in children, then literally in a few weeks, at best months, and with the presence of intercurrent infections within a few days, the child may develop severe acidosis and diabetic coma.

Symptoms of diabetes in children, in general, are not particularly different from diabetes at any other age. The main signs of diabetes in children are elevated blood glucose levels. An increase in the blood sugar content accompanies his enhanced excretion in the urine. Extraction from the body of a large amount of fluid provokes dehydration of tissues, as a result - a serious thirst in sick children, which, by the way, is headed by the first obvious signs of diabetes in children. When the sugar level exceeds the normal values, the specific symptoms of diabetes in children appear: unquenchable thirst, feeling dry in the mouth, increased urine output, general weakness, blurred vision. However, these are subjective symptoms. The real threat arises when the concentration of glucose in the blood is high all the time.

When, after a meal, there is a periodic increase in blood glucose levels, it can be considered that this is the “first swallow”, the first serious signs of diabetes in children. These symptoms are called prediabet or, more simply, impaired carbohydrate tolerance. Objective signs of diabetes in children are consistently elevated levels of glucose in the blood (hyperglycemia), as already mentioned, and the result of this manifestation is the release of glucose in the urine (glycosuria).

As for the signs that can be recognized outside the laboratory, the main symptoms of diabetes in children are:

• 1. Excessive urine (polyuria) is often the first sign of diabetes. The increased amount of excreted urine is caused by glucose dissolved in the urine, which prevents the reabsorption of water at the level of the kidneys from the primary urine.
• 2. Severe, irrepressible thirst (polydipsia) - a consequence of increased fluid loss with urine.
• 3. "Wolf" appetite, signs of obesity or, conversely, loss in weight. A noticeable weight loss is an unstable symptom of diabetes, more characteristic of the first type of disease. The particular difference is that weight loss occurs even against the background of an enhanced child nutrition or even “brutal appetite,” which is also characteristic of diabetes. In this case, weight loss is a consequence of the inability of body tissues in the absence of insulin to process glucose. “Starving” tissues simply begin to process their own reserves of proteins and fats, the body, as it were, “eats” itself from the inside.

The above symptoms of diabetes in children are more characteristic of the first type of the disease. In this case, the symptoms of diabetes in children develop quickly, sometimes rapidly. In addition, the young and childish age is very characteristic of the first type of diabetes.

Diabetes of the second type is characterized by prolonged asymptomatic development and a slow increase in symptoms in the future. Therefore, the diagnosis of type 2 diabetes is more difficult in terms of the early detection of the disease. Patients often get children to the doctor not with symptoms, but with complications that have already occurred.

In some cases, diabetes of the second type has the following low specific symptoms of diabetes in children:

• 1. itching
• 2. skin suppurations, persistent,
• 3. difficult to treat inflammatory diseases  skin,
• 4. dry mouth
• 5. muscle weakness
• 6. constant fatigue, lethargy.

Signs of diabetes in children, to which parents should in any case pay special attention, are: prolonged healing of wounds, frequent symptoms, various suppurations, gingival bleeding, weakness, deterioration of visual acuity, constant moodiness and lethargy of the child.

Diagnosis of diabetes: medical signs of diabetes in children

Urine tests for glucose. If the reduction tests with urine have a positive result (there should not be normal sugar in the urine), it should be taken into account that the cause of transient glucosuria may be excessive consumption of sweets, strong excitement, some acute infectionor severe intestinal disorders. Permanent, non-diabetic mellituria, for example, due to renal glucosuria, or pentozurii, is characteristic of a course without hyperglycemia, without an increase in sugar level.

When it is established that the causes of the positive reduction tests are due to the elimination of glucose, then it is necessary to determine what the blood sugar level is, and be sure to conduct research on an empty stomach. If the level of sugar in the re-study above 120-130 mg%, with a high probability we are talking about the diagnosis of "diabetes".

Blood tests for glucose levels. The difficulty of diagnosis is that at first often the level of fasting sugar is normal. And if there are good reasons to suspect diabetes in children, then it is necessary to conduct a study of the sugar curve, which in the case of diabetes has an elongated and high shape. The patient is given to drink a solution with high content  glucose, and after one and two hours, analyze. When the blood sugar level, 2 hours after the corresponding load, above 120-130 mg%, the diagnosis is confirmed. With repeated sugar load, after taking the second dose of sugar, research shows again a sharp increase in its level in the blood.

Particular difficulties arise in the diagnosis of a child who is admitted to hospital in an unconscious state. In this case, there is a need to differentiate encephalitis, hypoglycemia, cerebral hemorrhage, circulatory failure, accompanied by severe exsiccosis, uremic coma. Crucial in this case are the urine and blood tests of a small patient.

Treatment of diabetes in children
  and care for a diabetic child

At the initial stages, the treatment of childhood diabetes must necessarily be carried out in a hospital, after which it may well be carried out on an outpatient basis, at home. The main goals of treatment are to achieve the disappearance of acetonuria and the almost complete disappearance of glycosuria, the desire for the lowest doses of insulin, by compensating it with dietary measures, and most importantly, providing the child with conditions for normal, full development and growth. Treatment of diabetes in children is not an easy task, it requires long efforts and great responsibility.

Treatment of childhood diabetes: diet therapy

Treatment of childhood diabetes, as well as an adult, is based on diet therapy. Treatment of diabetes in children with a diet, subject to the absence of acidosis, must be subordinated to the following principles:

• 1. First, calculate the necessary body's need of the child for energy, that is, in calories, as well as in proteins in accordance with age. Depending on the age, children need 60-90 calories per kilogram of weight, and 2-3 grams of protein per kilogram per day.
• 2. From the total number of calories you need to subtract the proportion that comes from proteins, the rest about 60% is covered with carbohydrates and about 40% with fats. In the case of such a calculation, for children who need 70 kilocalories per day, 1 kg of weight is required to give: protein - 3 grams, carbohydrates - 9 grams. and fat - 2.6 gr. In general terms, this ratio in the diet is similar to the nutrition of a healthy child at the same age.
• 3. With regard to the amount of carbohydrates consumed, a very important principle for the nutrition of a child with diabetes is a sharp limitation of the amount of crystalline, quickly absorbed sugar. Sugar from nutrition, in principle, it is better to exclude, the need for the body, as a rule, is more than covered by sugar, which is contained in fruits and milk.
• 4. In the case of severe acetonuria in a child with diabetes, the amount of fat in the diet is reduced, and carbohydrates, on the contrary, increase.

Treatment of diabetes in children: insulin therapy

The next step in the treatment of childhood diabetes, which is necessary to establish a balance in the metabolic processes of carbohydrates, is the correct determination of the amount of insulin needed for injections.

AT childhood, do not apply antidiabetic drugs that are administered orally. Treatment of diabetes in children with insulin replacement therapy is prescribed if the daily excretion of sugar is 5% higher than the sugar value of food (50% of proteins and all carbohydrates in food). In addition, insulin therapy also serves as an indication of the content of glucose in the blood, above 200 mg%, the presence of dystrophy, ketosis, and concomitant diseases.

• In the process of determining the dose of insulin should be aware that each insulin unit contributes to the absorption of 5 grams by the body. Sahara. Insulin is administered before eating for 15-30 minutes, the duration of insulin is 6-8 hours.

To determine the concentration of sugar, urine is collected three times a day for analysis, three “eight-hour portions”, and blood should also be examined three times a day if possible. And the daily doses of insulin in the future, and the need for insulin at the moment, depend on the results of these blood and urine tests. It is possible that at first a single dose in the morning will suffice, but it is often necessary to increase the frequency of insulin injections and to carry it out not only in the morning, but also in the afternoon and evening.

When the initial period is over, it is necessary to determine the need for insulin, which in the same doses will satisfy the needs of the body, for a sufficiently long time, without allowing fluctuations in blood glucose levels. In particular, it is important to avoid hypoglycemia. In order to stay in the methods of reducing sugar is sufficient, if the urine excretes glucose not more than 15-20 grams. per day.

Next you need to either stop and stick to a stable diet containing a specific amount of nutrients and providing the necessary variety of nutrition, or allow a free diet for the child. A free diet is one that corresponds to the age of the child, but limits the consumption of sugar and sweets based on it.

If the child’s health has stabilized, further treatment of diabetes in children implies a desire for a single dose of insulin containing its daily amount. The appropriate mixture of insulin acting quickly and acting slowly (zinc-protamine insulin) is given to the child in the morning. The maximum effect of zinc protamine insulin after injection is observed after 14-20 hours, and the effect lasts for a period of up to 24 hours. Given this, you need to determine the level of sugar several times during the day to avoid hypoglycemia.

Medical care for diabetic coma in a child

If a child has a state of coma, therapeutic measures should be as quick and effective as it is about a condition that threatens the life of the child. The prognosis in this case mainly depends on the severity of the condition and duration of loss of consciousness. To cope with this condition at home, of course, is not possible. Resuscitation may be required here. The main tasks in this case are as follows:

• 1. stimulation of the body on the absorption of sugar,
• 2. the fight against circulatory disorders, acidosis and exsicosis,
• 3. prevention of hypokalemia.

It is necessary, without delay, to start insulin therapy, as well as to ensure a long-term intravenous infusion of an isotonic solution of sodium chloride, sodium bicarbonate and 5% glucose to the child. If the diagnosis of a diabetic coma is confirmed, insulin should be injected subcutaneously immediately, in the amount of 15-30 units (depending on the child's age), a third part of the dose can be administered intravenously, and then 10-15 units of insulin are administered every 1-2 hours for 6 hours . During the first day, the child should receive 40-90 units of the drug, in the following days this dose is reduced under careful control of the sugar content, necessarily in the blood and in the urine.

The amount of bicarbonate solution is set using the Astrup apparatus, and in accordance with the Mellemgard-Siggaard-Andersen formula, its required amount is calculated in meq, which equals: 0.3 times the base deficit (meq) and multiplied by the body weight in kilograms. In severe cases, monitoring the results of treatment is required several times a day, by determining the base deficit, pH, and counting the amount of bicarbonate required. When the Astrup apparatus is not available, the required amount of bicarbonate is calculated from the number of its content in the plasma. In order to increase the content of bicarbonate in plasma, it is necessary to give sodium bicarbonate in an amount of 0.35 mEq per 1 meq / l. In this situation, the task does not include the immediate restoration of the pH level to normal, to begin with, it will be sufficient to achieve a pH of 7.2 and a bicarbonate content of 15 meq / l. When the blood circulation and kidney functions are restored, and the sugar begins to be absorbed, oxidation and the release of acids begin, then an overdose of sodium bicarbonate can again lead to hypokalemia in the postacidotic period and to secondary alkalosis. That is why bicarbonate should not be injected if the child is in the condition of only precommitants, when contact with him is maintained, and the values ​​of bicarbonate and pH do not indicate an immediate danger. In such cases, it should be limited to insulin, sodium chloride solution and glucose.

On the first day, the amount of liquid should be approximately 150 ml / kg. Following the first dose of insulin, a mixture of an isotonic saline solution with 5% glucose solution is given, in a 1: 1 ratio. As blood circulation, diuresis and acidosis improve, about 6-8 hours after the start of treatment, potassium is added to the liquid - 3-4 mEq / kg.

On the second day, the child is given a drink of sweet fruit juices, later - skimmed milk and cookies. Then conduct a study on the content in the blood and urine sugar. From the results of the study depends on what will be the daily dose of insulin, as a rule, it is necessary to give it, dividing parts into 3-5, with a progressive decrease. After the disappearance of ketosis, you can switch to insulin therapy and diet.

• Important! Do not re-inject insulin into the same area on the body, as this can lead to the development of lipodystrophy.

In addition, it is very important to educate parents and educate older children independently and in a timely manner to recognize the signs of beginning hypoglycemia, and to know the circumstances that may cause them. After some periods of time it is recommended to check the correctness of the prescribed dosage in the hospital, because with diabetes, the body's need for insulin changes. Appropriate psychological prevention is also of great importance, both for sick children and their parents. It is impossible to give in at critical moments to panic, you need to understand what is happening and calmly and carefully respond to the situation. Treatment of diabetes in children - a process that does not allow panic. You need to be strong, support your child and instill confidence that everything will work out. In the end, even with diabetes, you can live a full, full of joy, happiness and love life!

A little more about the treatment of diabetes in children:

Diabetes in children appears due to a violation of the breakdown of sugar (glucose) in the body. It is quite dangerous disease, mortality from which in the era before the use of insulin injections was almost one hundred percent.

How much children in our time live who are treated and control their health depends only on how early their parents turned to the endocrinologist and on the quality of the therapy. If everything is done correctly, then children live as much as a normal healthy person.

Energy production in a child’s body occurs with insulin. It is formed in the pancreas in the cells of the “islets of Langerhans” and is always produced in a different volume. For example, when eating food, it is produced vigorously, and during sleep, on the contrary, it is weaker.

When glucose from food enters the body, its amount increases dramatically, after which insulin begins to be released, which absorbs glucose and reduces the amount of sugar in the blood. It decreased - insulin stopped being produced. In a healthy baby it takes about two hours.

Types

There are two types of diabetes. They have different causes, symptoms, development and treatment.

• The first type. It starts when there is a lack of insulin in the blood. Cells produce little or no isolation. The body of a child simply does not cope with the processing of glucose, and increases. This type of diabetes is always corrected by administering insulin injections.
• Second type In this case, a normal amount of insulin is produced, but sometimes there is a surplus. The sensitivity to this hormone in the child’s body is lost, and it ceases to recognize it.

In children older than a year

Signs of

Usually, the symptoms of diabetes in children of one or two years of age are increasing at lightning speed, on average over several weeks. If you notice the following symptoms in your baby, then take him to the clinic and take the tests.

Never ignore such symptoms of diabetes in children, because the situation may worsen:

• Frequent trips to the toilet "in a small way". Diabetics usually drink a lot of fluid that must be removed from the body. If the child is often written at night, it is a very disturbing sign.
• Unusual weight loss. This is one of the first indicators of childhood diabetes. Diabetic children cannot get energy from the sugar that enters the body. Accordingly, the body begins to look for other sources of "recharging" and finds them in the subcutaneous fat and muscle mass.
• Frequent hunger. Children of one or two years old, patients with type 1 diabetes, are poorly saturated. Patients are always hungry, although they eat a lot. However, sometimes the appetite decreases. This symptom indicates an extremely life-threatening complication - diabetic ketoacidosis.
• The kid constantly wants to drink. Usually this symptom indicates the presence of type 1 diabetes in a child. When sugar is elevated, the body tries to dilute the glucose in the blood, dehydrating tissues and cells.
• Constant fatigue. The body of the child does not produce energy from glucose, respectively, the cells suffer from this and send the corresponding signals to the brain. They lead to a feeling of fatigue.
• Diabetic ketoacidosis. This is a life threatening diabetes complication. It is manifested by the symptoms: smell of acetone from the mouth, nausea, fast irregular breathing, drowsiness, abdominal soreness. If the parents do not take urgent measures in this case, the diabetic will fall into a coma and die. This usually happens fairly quickly.
• Fungus Girls with type 1 diabetes often have thrush. Usually it passes with the start of treatment.

The above signs of diabetes in children are sometimes observed with other diseases.

The reasons

Unfortunately, diabetes is a chronic disease that is not easily treated. Therapy depends on the reasons that led to the development of pathology in the baby.

The main causes of diabetes in children:

• Binge eating . When a child uncontrolledly eats a huge amount of "light" carbohydrates - chocolates, buns, sugar - then this greatly loads the body and provokes the release of insulin into the blood. The pancreatic cells responsible for the production of the hormone are quickly depleted and stop working. As a result, the amount of insulin in a child decreases and diabetes appears.
• Frequent colds. When a child is constantly sick, the ratio of antibodies produced by the body is broken. Immunity is inhibited, which begins to fight with its own cells, namely, insulin. This leads to the defeat of the pancreas and lower insulin levels in the blood.
• Heredity. Statistics show that children born to families of diabetics, the disease may also appear. Not necessarily children are born diabetics, the disease is able to make itself felt and in twenty - thirty years, sometimes after fifty.
• Immobility. Its result - a set of excess weight. Whereas during exercise, cells producing insulin are produced vigorously, which reduces glucose in the blood, preventing it from turning into fat.
• Excess weight . If a child eats too much sweet, then sugar does not translate into energy, but is converted into fat. As a result, fat cells "dazzle" receptors that recognize insulin with glucose. Insulin in the body a lot, but blood sugar is not processed.

Diagnostics

Here are the cases in which diabetes is diagnosed:

• With the manifestation of clinical symptoms: ketonuria, polydipsia, weight loss, hyperglycemia, polyuria.
• If fasting glycemia reaches 7 mmol / l, then a repeat test is done. A similar result a second time would indicate the presence of diabetes.
• When blood glucose after a meal is 11 mmol / l.

Diagnosis of diabetes in children can be supplemented by the following tests. The amount of sugar in the blood is determined on an empty stomach and after consuming 75 g of glucose dissolved in 300 milliliters of water. To determine the amount of sugar in the blood, the child for two hours every 30 minutes take blood from the finger.

What are the norms of testimony tests:

• If the child is healthy and has a normal glucose tolerance, fasting glucose will be less than 5.6 mmol / l, between half an hour and a half hours of dough - less than 11.1 mmol / l, a couple of hours after glucose consumption - less than 7.8 mmol / l.
• Impaired glucose tolerance will be diagnosed if fasting glucose is no more than 6.7 mmol / l, between half an hour and a half hours of the test is equal to or not more than 11.1 mmol / l, and after a couple of hours from 7.8 to 11, 1 mmol / l.

Diabetic coma

The disease has a very serious complication. It is called diabetic coma.

It manifests itself in sharp weakness, heavy sweating, trembling, hunger. A child may have double vision, numbness of the lips and tongue, "seasickness". At this critical moment, the mood changes dramatically - from calm to overexcited and vice versa.

Late reaction to these signs will lead to the fact that the patient will have hallucinations, a tremor, a strange behavior, as a result he will fall into a coma.

Be sure to give the child a candy cane that can be eaten if insulin levels go up. This will help prevent development.

To the note: - incompatibility of blood groups or Rh factor of mother and child. Very serious pathology that should be avoided.

Treatment

First type

Type 1 diabetes is ninety-eight percent of all cases of disease in babies. It is treated by the introduction of insulin replacement.

Also, the child must eat properly, without fasting. In addition to breakfast, lunch and dinner, eat vegetable food. Limit carbohydrate intake. A diet is needed to ensure a normal level of glucose and to avoid the complications that occur with an excess of or lack of insulin.

Usually, the treatment of diabetes in children is accompanied by the taking of insulin of a short-term action - “Actrapid”, “Protophan”, etc. It is injected with a syringe-pen under the skin, thus avoiding an overdose of the hormone. Children can even administer such drugs themselves. The question "how much to enter?" In this case does not arise.

Parents of diabetic children should definitely get a blood glucose meter at the pharmacy. This device allows you to measure blood sugar levels. All indications and the number of foods eaten by the child are recorded in a notebook, which is shown to the endocrinologist. So it will be easier for him to determine the optimal dose of insulin.

Treatment of diabetes of the first type is possible with pancreas transplantation. But this operation is an extreme measure.

Second type

Treatment of diabetes in children of the second type is also accompanied by a diet. It is based on completely removing fast carbohydrates - chocolates, buns, etc. from the child's diet. The diet cannot be disturbed, otherwise the blood glucose can increase dramatically.

To make it easier to follow the diet, came up with "bread units" - the amount of product that contains twelve grams of carbohydrates, increasing the amount of sugar in the blood by 2.2 mmol / l.

In many European countries, manufacturers specify bread units on the packaging of each product. It helps diabetics control their diet. Russia has not yet introduced a similar standard, but parents can calculate the content of "bread units" themselves. To do this, the number of carbohydrates available in one hundred grams of a single product is divided into twelve and multiplied by the weight that the child plans to eat. Get the number of "bread units".

Concomitant

Diabetes in children can be treated by complementing non-traditional methods of medical therapy.

• Physical Education . Dosed load will help reduce the amount of glucose in the blood and increase the body's insulin sensitivity. When parents plan the physical activity of the baby, they should give him an additional portion of carbohydrates before, during class and after their completion. Warning: do not overdo it! Excessive physical activity is contraindicated for sick children: diabetic coma may occur.
• Herbal Products. If a baby has diabetes of the second type, then fenugreek seeds, brewer's yeast, peas, broccoli, sage and okra will be useful for monitoring blood sugar levels.
• To reduce excess weight, chromium, aristolochic acid, Dubrovnik, Chitosan, momordica, and pyruvate can be given to a child.
• To suppress hunger, you can buy homeopathic oral sprays, adhesive systems in a pharmacy.

In infants

Symptoms

Parents of babies should be careful, because diabetes does not manifest itself immediately. Early signs of diabetes in children under one year:

• Nausea, drowsiness and lethargy.
• Frequent urination. A day can come out with three to six liters of liquid.
• From the mouth it smells like acetone.
• On the diapers are stains, similar to starch. In fact, it is sugar (there are many photos on the Internet that demonstrate this phenomenon).
• Weight loss
• Anxiety.
• Decreased pressure, rapid heartbeat.
• Diaper rash in external genital organs that do not pass.
• Long breaths

The symptoms described above usually appear in infants with type 1 diabetes. The disease of the second type in infants begins, as a rule, unnoticed. And babies are not hospitalized with symptoms, but with a developing disease.

Sometimes diabetic infants of the second type may show the following signs of the disease:

• Bleeding ulcers on the gums.
• Pustules on the skin.
• Scabies.
• Sores in the corners of the lips.
• Dryness of the mucous membrane of the mouth.
• Prolonged healing of bruises and wounds.

The reasons

In infants, diabetes may occur due to the following reasons:

• Diabetic mother.
• Mother taking certain medications during pregnancy.
• Prematurity

Treatment

To control diabetes in children who have not yet turned one year old, you should follow a low-carb diet without sugar. Grudnichkov need to feed, observing breaks.

Complementary food to a child under one year old who is ill with diabetes is administered in the same way as a healthy one. But there are some limitations. Babies should be lured first with vegetable juices and purees, and only then cereals and other carbohydrate-containing products are introduced.

If the baby is fed breast milk, it is allowed to feed it with food from the mother's diet. And it can only be products that are permitted to a sick child. For example, cooked in a double boiler vegetables.

Small diabetics of six to seven months can be given kefir without sugar, mashed boiled buckwheat, mashed potatoes, kissel on fructose, grated apple and cottage cheese. The maximum suitable time for feeding is six, nine, eleven, thirteen, sixteen, eighteen, twenty-two hours.

Endocrinologists can either ban the sick children altogether or allow a limited amount of semolina and rice porridge, sweets, buns. But the infant's diet should consist primarily of vegetables, dairy products and unsweetened fruit.

It is necessary to prevent diabetes in children from the very first day. Some tips:

1. The best thing a mother can do is to breastfeed a baby for at least one and a half years. Especially children whose parents have diabetes. Compounding with artificial mixtures in cow's milk sometimes adversely affects the health of the infant's pancreas.
2. Control the weight of the baby and prevent obesity.
3. Proper nutrition in the family. Try to eat properly the whole family, limiting the consumption of canned food, sweets, fried foods and products containing artificial colors. Be sure to eat more vegetables and fruits.

Summary

Diabetes in a child is a serious disease that cannot be ignored. As soon as the first signs of the disease are noticed, parents should rather show the baby to the endocrinologist. When identifying diabetes, moms and dads must strictly follow the doctor's instructions so that there are no complications.

Try to eat properly and teach your child your own example. This will help you avoid diabetes and other diseases.

Modern medicine  thanks to its capabilities, it avoids the fatal consequences of diabetes. The symptoms of diabetes in children are similar to those of adults, but treatment is different. Previously, the disease was destructive for young patients, but drug support provides the body with the ability to tolerate manifestations of the disease. What are the signs of diabetes in children? Symptoms, diagnosis and features of the disease in children of different age categories are presented below in the article.

Types of diabetes

Often the forms of the disease do not differ, but they are completely different. The types of diabetes include:

1. Type I - the reason lies in the genetic predisposition of children to the disease, sometimes caused by very strong stress. This is a congenital form of the disease, the child with this form of insulin-dependent and requires the support of the body with drugs. The processing of glucose by pancreatic tissues is difficult.
2. Type II - in this category, the person is insulin-independent. Acquired diabetes is associated with improper metabolism and subsequently insufficiency of insulin in the blood. The type of disease is characteristic of the older population.

The first signs and symptoms of diabetes in a child

Developing diabetes mellitus very quickly, within a few weeks. Why do you need to be attentive parents as soon as possible to identify the disease:

1. Thirst. When the blood sugar level is elevated, it feeds on water from the cells, causing dehydration. Especially children want to drink in the evening.
2. Frequent urination. Increased glucose adversely affects the kidneys, the process of reverse suction of the primary urine is reduced and the child has frequent urination, due to which the body gets rid of toxic substances.
3. Increased appetite. When a child eats a lot, but does not gain weight, and even loses weight sharply, this is a sign that glucose does not enter the cells, they starve.
4. Feeling unwell after taking a meal. Until the pancreas causes the glucose level to return to normal, the child has nausea, abdominal pain and even vomiting.
5. Sharp weight loss. This symptom manifests itself if glucose does not enter the cells completely and the body has to feed on the energy of subcutaneous fat.
6. Constant weakness Loss of strength, lethargy, apathy associated with impaired digestibility of glucose in the blood.
7. The smell of acetone from oral cavity. This phenomenon is due to the formation of ketone bodies in the blood after the breakdown of fats. The body needs to get rid of toxins, and it does so through the lungs.
8. Infectious diseases. Weakened immunity does not cope with protective functions, and the child often suffers bacterial and fungal infections.

Features of the disease, depending on age

Diabetes develops in children of any age. In the first months of life, this happens more rarely, but from 9 months the pubertal period begins, in which the first signs of diabetes in a child appear. Clinical manifestations  and therapy in different age periods differ. How does the disease, depending on age and how to determine diabetes in a child?

In infants

The acute onset of the disease in infants alternates with the prodromal period, which often goes unnoticed. It is difficult to diagnose diabetes in children under one year old, because thirst and frequent urination are difficult to detect. In some children, diabetes develops abruptly, with severe intoxication, vomiting and dehydration, and subsequently diabetic coma.

The second type of development of the disease occurs slowly. Babies under the age of 2 do not gain weight, although they eat well. After taking a meal, the child may become ill, but after drinking it becomes noticeably easier. The development of infections against the background of the disease contributes to the formation of diaper rash on the genitals, skin folds under the diaper. Diaper rash does not take a very long time, and if the urine of the child falls on the diaper, then drying out, they become starchy. When urine fluid gets on the floor or other surfaces, it becomes sticky.

Do preschoolers and younger students

Diagnosis of diabetes at the age of children from 3 years to 5 years, the younger school group is complicated. The disease is difficult to identify before the precoma or coma, because the symptoms are not always recognizable. Signs that are often noted in this age group:

• sharp exhaustion, dystrophy;
• increased abdominal volume (frequent swelling);
• flatulence;
• problem stool;
• dysbacteriosis;
• abdominal pain;
• the smell of acetone from the mouth;
• refusal to eat;
• the urge to vomit;
• deterioration of the body, complete rejection of sweets.

Children are prone to type 2 diabetes, which is associated with not proper nutrition, obesity, lack of exercise. More and more adolescents prefer junk food, and subsequently suffer from improper metabolism, hormonal disturbances and pancreatic functions. The load on the vessels provokes their weakening, there are additional complications of the disease. For this type of disease, you must follow a strict diet. The remaining signs of diabetes in younger children are not very pronounced.

Teenagers

In children older than 10 years, the incidence is more common than at younger age and is 37.5%. Detection of the disease, as in adult patients, is simpler, the symptoms are pronounced. The pre-pubertal and pubertal (13 years) periods are characterized by the following symptoms:

• increased diabetes;
• constant lack of fluid;
• enuresis;
• sudden weight loss;
• increased appetite.

It happens when the disease can exist, but has no pronounced signs, therefore it is detected in the course of clinical examination. The period of active development lasts up to six months. Schoolchildren are characterized by frequent fatigue, apathy, weakness of the whole organism, and the transmission of many types of infections. In adolescent girls may be disturbed menstrual cycle, itching in the genital area. Stress has a devastating state, the disease begins to develop even faster.

Diagnostic methods

There are no significant differences in the diagnosis of the disease in children from adults; therefore, the following methods of detection are used:

1. Blood test. Indicators that are particularly important in this study: the amount of protein, the amount of fasting blood glucose, glucose tolerance before and after meals, glycosylated hemoglobin. Immunological study of blood sampling is important: the presence of antibodies, which indicates the development of diabetes mellitus, is checked.
2. General analysis  urine. A sign of diabetes in children is a huge amount of glucose in the urine, its increased density. This fact also indicates that it is necessary to check the kidneys, which may have been affected. The presence of acetone in the urine is detected.
3. Hormone testing.
4. Pancreatography.
5. The study of the skin. Diabetics have a characteristic blush on the cheeks, forehead, chin, rash, the tongue becomes crimson.
6. Ultrasound examination of the pancreas.

Possible complications and consequences

To maintain the body, young patients are recommended diet, taking drugs of different specific actions, folk remedies. Parents should carefully monitor insulin intake, proper nutrition, and control. physical exercise, avoid the appearance of stress. What are the consequences of the disease if not treated?

1. Coma (hypoglycemic, hyperglycemic, lactic acid, ketoacidotic).
2. The defeat of organs and systems.
3. The development of infectious diseases.
4. Death due to severe disease.

Video: how does diabetes in children

Description of the disease

The disease manifests itself at different ages. Diabetes is also found in newborns. It is congenital, but its frequency is low. The disease is more common among children 6–12 years old. Metabolism in the body of a child, including carbohydrate, flows several times faster than in an adult. The state of the still unformed nervous system on this background affects the concentration of sugar in the blood. Than younger childthe harder the disease is.

Diabetes is diagnosed in 1-3% of adults. Children suffer from 0.1-0.3% of cases.

The development of diabetes in children is similar to the disease in adults. Features of the disease in childhood are associated with the state of the pancreas. Its dimensions are small: by 12 years, the length is 12 centimeters, weight is about 50 grams. The mechanism of insulin production is getting better by 5 years, so the period from 5-6 to 11-12 years is critical for the manifestation of diabetes.

In medicine, it is customary to divide diabetes mellitus into two types: insulin-dependent diabetes and insulin-independent diabetes (1 and 2, respectively). According to statistics, children more often identify diabetes mellitus according to the first type. It is typical for him low level  insulin production.

Signs and symptoms of diabetes in children

Parents should pay attention to some features in the child's behavior in order to see a doctor as soon as possible. Diabetes mellitus develops rapidly, if the necessary manipulations in time can occur diabetic coma.

The main signs of diabetes in children:

dry mouth and constant desire to drink;

frequent urination, with urine sticky;

a sharp decline in vision;

insatiability in eating amid weight loss;

weakness, fatigue and irritability.

The manifestation of one or more symptoms at the same time is the basis for seeking medical attention. He will prescribe the necessary tests, on the basis of which it is possible to establish an accurate diagnosis.

Symptoms of the disease include typical and atypical manifestations. Unusual symptoms may be noticed by parents. These are complaints on the part of the child about constant headaches, reduced academic performance and fatigue.

The main (typical) symptoms of diabetes in children:

polyuria, or urinary incontinence. Parents of young children mistakenly take this feature for common bedwetting at an early age. Therefore, it is important to know the first signs of diabetes;

polydipsia, accompanied by a painful thirst. The child can drink per day up to 10 liters of fluid, and dry mouth will persist;

drastic weight loss on the background of increased appetite, or polyphagia;

the appearance of itching on the skin, pustular formations. Integuments  become dry;

after urination appears in the genital area;

urine output increases (more than 2 liters per day). Its color is light. Urine analysis shows a high proportion and acetone content. Perhaps the appearance of sugar in the urine, it should not be normal;

a fasting blood test reveals an increase in blood sugar over 120 mg.

If you suspect diabetes in a child, timely diagnosis and proper treatment are extremely important.

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Causes of diabetes in children

The causes of diabetes in children are many. The main ones are:

heredity.  The disease is very common in relatives. Parents with diabetes are 100% likely to have children who will sooner or later receive the same diagnosis. The disease can manifest itself in the neonatal period, and at the age of 25, and at 50. It is necessary to control the blood sugar level in pregnant women, since the placenta absorbs it well and contributes to the accumulation in the developing organs and tissues of the fetus;

viral infections.  Modern medical science has proven that chickenpox, mumps (mumps) and viral hepatitis disrupt the pancreas. In such a situation, the development mechanism of the disease is presented in such a way that the cells of the human immune system simply destroy insulin cells. But the transferred infection will lead to the development of diabetes mellitus only in the case of burdened heredity;

binge eating. Increased appetite can cause. Especially it concerns easily digestible carbohydrate products: sugar, chocolate, sweet flour products. As a result of frequent intake of such food increases the load on the pancreas. The gradual depletion of insulin cells leads to the fact that it ceases to be produced;

low level of motor activity.  Low mobility leads to overweight. A constant exercise exacerbates the work of cells that are responsible for the production of insulin. Accordingly, the blood sugar level is within the normal range;

constant colds. The immune systemwhen faced with an infection, it begins to actively produce antibodies to fight it. If such situations are repeated often, the system wears out, and immunity is inhibited. As a result, antibodies, even if there is no target virus, continue to be produced, destroying their own cells. There is a malfunction of the pancreas, resulting in reduced insulin production.

Treatment of diabetes in children

Currently, medicine has not found a method that can completely cure a child from diabetes. The treatment provided aims at the normalization of metabolic processes in the body for a long time. Monitoring the patient’s condition on the part of the parents (or independently, depending on the child’s age) is carried out continuously.

Competent treatment, the absence of complications and a long normal state of the child allows us to predict favorable conditions for life and further work.

Modern medical science is working in the field of treatment of diabetes in several areas:

universal and painless ways of administering insulin to the child’s body are being developed;

methods for the transplantation of pancreatic cells responsible for insulin secretion are being investigated;

techniques are tested and medicationswhose tasks is the normalization of the modified immunological apparatus of the child.

The treatment of diabetes deals with endocrinologist.

The initial stage of the disease is amenable to correction in the hospital.

The following stages of diabetes require clinical examination

In children, treatment begins with the selection of an optimal diet, agreed with the doctor and adjusted depending on the severity of the disease. Requires compliance with the diet, because The child receives several drugs during the day. Their reception depends on meal times. The treatment regimen must be strictly adhered to, otherwise the effectiveness medicines  will decline significantly.

The caloric value of food is calculated in the following ratio: - breakfast - 30%, - lunch - 40%, afternoon tea - 10%, dinner - 20%. The special attention is demanded by calculation of carbohydrate food. The total amount per day should not exceed 400 grams.

Drug treatment

Drug treatment involves the use of insulin preparations and angioprotectors courses. Aids  Vitamin therapy, hepatotropic and choleretic drugs.

Insulin use

Insulin, which is used in the treatment of diabetic children, acts for a short time. Protophane and actropid preparations possess this property. The composition is injected subcutaneously with a special syringe pen. This is convenient and allows the child to learn to administer the drug at one time without help.

Pancreatic Transplantation

In particularly difficult cases, pancreas transplantation is used. Conduct either a complete replacement of the body, or part of it. But there is a danger of rejection, manifestations of immune reactions to a foreign organ and the development of complications such as pancreatitis. Doctors see promising transplantation using the embryonic pancreas, its structure reduces the risk of negative reactions.

Experiments on the transplantation of b-cells of the islets of Langerhans, which are based on b-cells of rabbits and pigs, turned out to be a short-term help. Suspensions injected into the portal vein allowed diabetic patients to do without insulin for less than a year.

Prevention of diabetes in children

Babies who are bottle-fed from the first days of life are more likely to get diabetes. The mixtures contain cow's milk protein, which inhibits the work of the pancreas. Breast milk is the first prophylactic method, which will reduce the likelihood of getting the disease. Feeding for up to a year and more will strengthen the child’s immunity and protect against infectious diseases that can trigger the development of diabetes.

In the case of older children, it is necessary to monitor the diet, its composition and regimen. The diet should be balanced and varied, exclude large amounts of fats and carbohydrates. Be sure to use fruits and vegetables.

Preventive measures are reduced to the definition of risk groups:the presence of diabetes in the family, metabolic disorders in the child and obesity. Children with similar symptoms are registered with an endocrinologist and are examined twice a year. If the diagnosis is established, follow-up care and monthly check-ups with the attending physician are scheduled to correct the treatment program, timely detect acute periods and prevent serious complications in the course of the disease.

The frequency and methods of examination methods are determined depending on the stage of the disease.

Patients with diabetes are annually examined by narrow specialists: an oculist, cardiologist, neuropathologist, nephrologist, surgeon and others. Electrocardiogram, urine analysis and those measures that will help to early stages  identify violations of organs and systems

Complete cure of diabetes is not possible. Competent and timely treatment will allow to achieve remission, and the child will be able to lead a normal life, developing in accordance with age.

Author of the article: Polyakova Elena Anatolyevna, pediatrician, specifically for the site of the site

There are two types of diabetes, the first with insulin dependence and the second without it. These two diseases are often confused by ordinary people, but, in fact, they are completely different diseases with different etiologies. Thus, the second type of diabetes occurs mainly in people of mature and elderly, suffering from overweight and obesity. In children is rare and, in fact, is a metabolic disorder. Diabetes of the first type is due to genetic predisposition and is to reduce the number of cells in the islets of the pancreas responsible for the production of insulin, a hormone that is necessary for the splitting of glucose in the body.

Diabetes in young children is one of the most common and severe endocrine diseases, most often children with diabetes of the first type. Despite the fact that the main cause of this disease is the presence of a corresponding gene in a child, unfavorable heredity does not always mean that the disease will manifest. So, if the mother is sick with diabetes, the probability of transmitting diabetes to the child is 5-7%, if the father is ill - 7-9%. Even if both are sick, the probability that a sick child is born does not exceed 30%. The disease can be activated at any age, but younger schoolchildren are most often affected. In the presence of a propensity for the development of the disease can be avoided by observing precautions and, if possible, excluding provocative factors.

Factors contributing to the manifestation of diabetes in children:

• children infectious diseasesMeasles These viruses can disrupt the pancreas. Therefore, measures aimed at preventing these diseases are also preventing diabetes;
• absence of breastfeeding  or its earlier termination. Infant formulas contain albumin, cow milk protein, which is structurally similar to insulin-generating beta cells. The cross-reaction of similar proteins leads to a reduction in the number of cells and the emergence of insulin deficiency;
• stresses, depressions lead to a weakened immune system. In the central nervous system failures occur and it begins to give incorrect signals to antibodies that block beta cells in the pancreas.

How to determine diabetes?

Unfortunately, pronounced clinical signs of diabetes in children appear when the disease takes quite serious forms. Therefore, the primary task of parents is to constantly monitor the child’s condition, to know what are the first signs of diabetes, to sound the alarm when suspicious symptoms appear. The main manifestation of the disease is an increase in blood sugar, but some symptoms can be noticed with the naked eye before the analysis.

How does diabetes in children:

Features of diabetes in children

The course of diabetes in children is similar to the course of this disease in adults, but there are some peculiarities. The formation of the pancreas, which is responsible for the production of insulin, is completed at about 5 years old, and it is between the ages of 5 and 11 that the probability of becoming ill with diabetes is highest.

In addition, the still imperfect nervous system of the child often fails, particularly hard reacting to stress and weakening the overall defenses of the body, which leads to the development of diseases.