Diabetes type 2 Type 2 diabetes is associated with hereditary factors and lifestyle risk factors including poor diet, insufficient physical activity and being overweight or obese. People with type 2 diabetes may be able to manage their condition through lifestyle changes; however, diabetes medications or insulin replacement may also be required to control blood sugar levels. Type 2 diabetes occurs mostly in people aged over 40 years old; however, the disease is also becoming increasingly prevalent in younger age groups.
See Clinical Presentation for more detail. Diagnosis Blood glucose Blood glucose tests using capillary blood samples, reagent sticks, and blood glucose meters are the usual methods for monitoring day-to-day diabetes control.
An international expert committee composed of appointed representatives of the American Diabetes Association, the European Association for the Study of Diabetes, and others recommended HbA1c assay for diagnosing diabetes mellitus. Insulin therapy All children with type 1 diabetes mellitus require insulin therapy.
Most require 2 or more injections of insulin daily, with doses adjusted on the basis of self-monitoring of blood glucose levels. Insulin replacement is accomplished by giving a basal insulin and a preprandial premeal insulin. The basal insulin is either long-acting glargine or detemir or intermediate-acting NPH.
The preprandial insulin is either rapid-acting lispro, aspart, or glulisine or short-acting regular. It has real benefits for a child with diabetes. Patients should be encouraged to exercise regularly. See Treatment and Medication for more detail. Background Most pediatric patients with diabetes have type 1 diabetes mellitus T1DM and a lifetime dependence on exogenous insulin.
Diabetes mellitus DM is a chronic metabolic disorder caused by an absolute or relative deficiency of insulin, an anabolic hormone. Insulin is produced by the beta cells of the islets of Langerhans located in the pancreas, and the absence, destruction, or other loss of these cells results in type 1 diabetes insulin-dependent diabetes mellitus [IDDM].
A possible mechanism for the development of type 1 diabetes is shown in the image below. Possible mechanism for development of type 1 diabetes. Most patients with type 2 diabetes mellitus have insulin resistance, and their beta cells lack the ability to overcome this resistance.
Other patients may have inherited disorders of insulin release, leading to maturity onset diabetes of the young MODY or congenital diabetes. See Etiology and Epidemiology. Hypoglycemia Hypoglycemia is probably the most disliked and feared complication of diabetes, from the point of view of the child and the family.
Children hate the symptoms of a hypoglycemic episode and the loss of personal control it may cause. See Pathophysiology and Clinical. All treatments for hypoglycemia provide recovery in approximately 10 minutes.
Occasionally, a child with hypoglycemic coma may not recover within 10 minutes, despite appropriate therapy. Under no circumstances should further treatment be given, especially intravenous glucose, until the blood glucose level is checked and still found to be subnormal.
Overtreatment of hypoglycemia can lead to cerebral edema and death. If coma persists, seek other causes. Hypoglycemia was a particular concern in children younger than 4 years because the condition was thought to lead to possible intellectual impairment later in life. Persistent hyperglycemia is now believed to be more damaging.
In a child with diabetes, blood sugar levels rise if insulin is insufficient for a given glucose load. See Pathophysiology, Clinical, and Treatment. In the absence of insulin, however, severe hyperglycemia, dehydration, and ketone production contribute to the development of DKA.
The most serious complication of DKA is the development of cerebral edema, which increases the risk of death and long-term morbidity.
Very young children at the time of first diagnosis are most likely to develop cerebral edema. DKA usually follows increasing hyperglycemia and symptoms of osmotic diuresis. Users of insulin pumps, by virtue of absent reservoirs of subcutaneous insulin, may present with ketosis and more normal blood glucose levels.Among 54 patients enrolled in the Atlanta VAMC Endocrinology Telehealth Clinic, 32 patients had type 1 diabetes (Figure).
Of the 32 patients with type 1 diabetes, 17 had follow-up visits at 6 months, and 9 had follow-up visits at 12 months. Conclusion This study provided benchmark estimates on the national prevalence of diagnosed type 1 diabetes (%) and type 2 diabetes (%) among US adults.
Among US adults with diagnosed diabetes, type 1 and type 2 diabetes accounted for % and %, respectively. Diabetes is presently classified into two main forms, type 1 and type 2 diabetes, but type 2 diabetes in particular is highly heterogeneous. A refined classification could provide a powerful tool to individualise treatment regimens and identify individuals with increased risk of complications at diagnosis.
This network meta-analysis of randomized clinical trials that involved compares the effect of SGLT-2 inhibitors vs DPP-4 inhibitors vs GLP-1 agonists on mortali. Type 1 and 2 diabetes (diabetes mellitus) symptoms may include increased urination, thirst, weight loss, fatigue, nausea, vomiting, skin infections, and blurred vision.
Risk factor for diabetes, diabetes statistics, medications, and healthy lifestyle information are provided. In a population of patients with type 2 diabetes and a broad cardiovascular risk profile, SGLT2 inhibitor use was associated with reduced cardiovascular disease and cardiovascular mortality compared with use of other glucose-lowering drugs—a finding consistent with the results of clinical trials in patients at high cardiovascular risk.