Hyperglycemia

Pathophysiology of diabetic ketoacidosis. (From Glaser NS, Styne DM. Endocrine disorders. In Behrman R, Kliegman R, editors. Nelson essentials of pediatrics. 3rd edition. Philadelphia WB Saunders 1997 with permission.) present with DKA is generally preserved within the normal range because of the impermeability of the blood-brain barrier to hydrogen ions 53,54 . Laboratory abnormalities in diabetic ketoacidosis A diagnosis of DKA can be made when the serum glucose concentration is more...

Diego Ize Ludlow MD Mark A Sperling MD

Division of Endocrinology, Diabetes, and Metabolism, University of Pittsburgh School of Medicine, Children's Hospital of Pittsburgh, 3705 Fifth Avenue, 4A-400, Pittsburgh, PA 15213-2583, USA Classification, the systematic grouping of disease entities by etiology or other categories, is useful because it guides the thinking of physicians, informs their actions, and provides value to their patients. A classical example is anemia, in which hemoglobin of approximately 6 g dL or less is associated...

Elka Jacobson Dickman MDa b Lynne Levitsky MDab

ADepartment of Pediatrics, Massachusetts General Hospital for Children and Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA Pediatric Endocrine Unit, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA Most cases of diabetes in childhood are immunologically mediated and eventually lead to complete insulin deficiency. Oral therapies for children with type 1 autoimmune diabetes mellitus (T1DM) are experimental and of unproven efficacy. Eight percent to 45 of...

Michael J Haller MDa Mark A Atkinson PhDb Desmond Schatz MDc

ADivision of Pediatric Endocrinology, University of Florida College of Medicine, PO Box 100296, Gainesville, FL 32610, USA hTke Center for Immunology and Transplantation, University of Florida College of Medicine, Room R3-128, ARB, Gainesville, FL 32610-0275, USA cDiabetes Center, University of Florida College of Medicine, PO Box 100296, Gainesville, FL 32610, USA Type 1 diabetes mellitus (T1D) is a heterogeneous disorder characterized by autoimmune-mediated destruction of pancreatic beta cells...

Risk factors of youth type 2 diabetes mellitus

The risk factors for youth T2DM are discussed under the following four broad categories (1) genetics, (2) environment, (3) ethnicity, and (4) insulin resistance phenotype. Genetics family history of type 2 diabetes mellitus The cause of T2DM is heterogeneous, including social, behavioral, and environmental risk factors in addition to a strong hereditary component 42,56 . Although few susceptibility genes have been identified thus far 57 , the genetic component of T2DM is evidenced by the strong...

Etiology

Over the past 30 years, the ability to predict the development of T1D has improved dramatically with the combined use of genetic, autoantibody, and metabolic markers. The most often cited model of the natural history of T1D suggests that genetically susceptible individuals with a fixed number of beta cells are exposed to a putative environmental trigger that induces beta cell autoimmunity 11 . The development of islet reactive autoantibodies is a marker of ongoing autoimmune disease, but it is...

Info

Treat the patient as a whole, including obesity, insulin resistance, dyslipidemia, hypertension, and psychosocial disorders all conditions frequently present in youth who have T2DM. Finally, as we gain more experience both clinical and research our approaches to some of these problems and recommendations may change over time. In addition to research, public health measures to increase activities of children and youth, along with public education campaigns for healthy eating may have a profound...

Presentations classic silent and diabetic ketoacidosis

Pathophysiology Dka

The presentation of new-onset T1D is distributed among three typical patterns classic new onset, silent diabetes, and diabetic ketoacidosis (DKA). Although most children present with classic new-onset diabetes, in many locations, DKA still accounts for 20 to 40 of all new diagnoses 78 . Silent diabetes, which is less commonly seen at diagnosis, is typically seen in children either involved in diabetes research studies or picked up by families in which one member already has the disease....

Type 2 Diabetes Mellitus in Youth The Complete Picture to Date

Neslihan Gungor, MD, Tamara Hannon, MD, Ingrid Libman, MD, PhD, Fida Bacha, MD, Silva Arslanian, MD* Division of Pediatric Endocrinology, Metabolism, and Diabetes Mellitus, Children's Hospital of Pittsburgh, 3705 Fifth Avenue, Pittsburgh, PA 15213, USA Type 2 diabetes mellitus (T2DM) historically was considered a disease of adults, with autoimmune type 1 diabetes mellitus (T1DM) accounting for almost all cases of pediatric diabetes. T2DM was recognized as a disease of the pediatric age group by...

Stuart A Weinzimer MDa Kristin A Sikes MSNb Amy T Steffen BSb William V Tamborlane MDac

ADepartment of Pediatrics, Yale University School of Medicine, PO Box 208064, New Haven, CT 06520-8064, USA hYale Pediatric Diabetes Research Program, Yale School of Medicine, 2 Church Street South, Suite 312, New Haven, CT 06519, USA cGeneral Clinical Research Center, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06520-8064, USA Continuous subcutaneous insulin infusion (CSII) pump therapy was introduced to treat patients with type 1 diabetes (T1DM) more than 25 years ago...

Anna Casu MD Massimo Trucco MD Massimo Pietropaolo MD

Division of Immunogenetics, Department of Pediatrics, Rangos Research Center, Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, 3460 Fifth Avenue, Critical to the success of intervention strategies is the identification of individuals at risk of developing the disease in an effort to delay or prevent the clinical onset of type 1 diabetes mellitus (T1DM). The ability to predict T1DM progression with 50 to 80 accuracy is the sine qua non for the accomplishment of...

Christopher Ryan PhDa Nursen Gurtunca MD FCPb Dorothy Becker MBBChb

ADepartment of Psychiatry, University of Pittsburgh, Western Pennsylvania Psychiatric Institute and Clinic, Pittsburgh, PA 15213, USA bDivision of Endocrinology, Department of Pediatrics, Children's Hospital of Pittsburgh, University of Pittsburgh, 3705 Fifth Avenue, 4A 400, Pittsburgh, PA 15213, USA Hypoglycemia is the most common acute complication associated with the treatment of type 1 diabetes. At the very least, it can be an unpleasant experience for many children, because they begin to...

Meranda Nakhla MD Constantin Polychronakos MD

Department of Pediatrics, Division of Pediatric Endocrinology, McGill University Health Center, Montreal Children S Hospital, 2300 Tupper, Suite C-244, Montreal, Quebec H3H1P3, Canada The latest version of the American Diabetes Association practice guidelines 1 distinguishes no fewer than 59 causes of diabetes mellitus. This array of etiologies can be dazzling even to the specialist but can be made manageable by putting it in statistical perspective and reducing it to the two basic physiologic...

Sarah J Glastras MBBS Hons BSc Psychol Honsa Fauzia Mohsin Mbbs Fcpsa Kim C Donaghue MBBS PhD FRACPab

AInstitute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Locked Bag 4001, Westmead NSW 2145, Sydney, Australia b'Department of Medicine, University of Sydney, NSW 2006, Sydney, Australia Microvascular complications of diabetes include retinopathy, nephropathy, and neuropathy. Such complications can have devastating long-term effects, including blindness caused by diabetic retinopathy, renal failure caused by diabetic nephropathy, and disabling pain caused by diabetic...

Il12b

Absolute risk for type 1 diabetes mellitus according to DR DQ genotypes DR 3 4, DQ 0201 0302 DR 4 4, DQ 0300 0302 DR 3 3, DQ 0201 0201 As indicated, non-HLA genes are also associated with T1D. For example, the IDDM2 locus has been mapped to a variable number of tandem repeats located upstream of the insulin gene. Disease association studies in case control and family cohorts show that the number of tandem repeats is associated with T1D risk, with shorter repeats conferring higher risk and...