Type 1 diabetes is a disorder of sugar, fat and protein metabolism caused by the destruction of pancreatic β-cells and the absolute lack of insulin secretion, which must be treated with insulin. According to a preliminary survey in 22 provinces and cities in China, the prevalence of children under 15 years of age is 0.6/100,000, which is lower than that in Western Europe and the United States. Diabetes is more common in the north and can occur at any age, with peaks in preschool and adolescence.
The exact etiology and pathogenesis of type 1 diabetes has not been fully elucidated. At present, it is believed that it is based on genetic susceptibility genes, and under the action of external environmental factors, it causes autoimmune reaction, resulting in damage and destruction of pancreatic β-cells, and clinical symptoms appear when insulin secretion is reduced to more than 90% of normal.
Clinical manifestations Patients with type I diabetes have an acute onset and are often triggered by infections or improper diet. The typical symptoms are polyhydramnios, polyuria, polyphagia and weight loss (i.e. “three more and one less”). However, in infants, excessive drinking and urination are not easily detected, and dehydration and ketoacidosis can soon occur. In children, enuresis can occur due to increased nocturia. Older children may also show signs of a significant decrease in fitness, such as lethargy, lack of energy and fatigue. About 40% of diabetic children are in ketoacidosis at the time of consultation. These children are often triggered by acute infection, overeating, delayed diagnosis, sudden interruption of insulin therapy and other factors. apathy, coma. It is often misdiagnosed as pneumonia, sepsis, acute abdomen or meningitis. In a few children, the onset of the disease is slow, with a predominance of mental fogginess, weakness, and weight loss.
Type 1 diabetes in children has a special natural course: 1. Acute metabolic disorder: from the appearance of symptoms to clinical diagnosis, the time is mostly within 1 month. About 20% of children show diabetic ketoacidosis; 20% to 40% are diabetic ketosis without acidosis; the rest are only hyperglycemia, glycosuria and ketonuria.
2. Temporary remission period: After insulin treatment, about 75% of children enter the remission period when clinical symptoms disappear, blood sugar drops and urine sugar decreases or turns negative. At this time, the pancreatic β-cells resume to secrete a small amount of insulin, and the need for exogenous insulin is reduced to less than 0.5U/kg, and a few children can even not use insulin at all. This temporary remission period usually lasts for several weeks and can be up to six months or more. This is only a temporary process and parents should not mistake that their child’s diabetes has been cured.
3.Intensification period: After the remission period, children with diabetes have higher blood sugar and urine sugar that are not easily controlled, and the insulin dosage is gradually or suddenly increased, which is called the intensification period. During the pubertal development period, the changes such as the increase of sex hormones enhance the antagonism to insulin, so the condition is not very stable during this period and the insulin dosage is higher.
4. Permanent diabetes: After puberty, the disease gradually stabilizes and insulin dosage is relatively constant, which is called permanent diabetes.
Pediatric endocrinologists make a clear diagnosis based on the above clinical symptoms, combined with blood glucose and other related tests.
Treatment Diabetes mellitus is a lifelong endocrine metabolic disease. Its treatment is comprehensive and includes insulin therapy, diet management, exercise and psychosomatic treatment. The objectives of treatment are: to eliminate clinical symptoms caused by hyperglycemia; to actively prevent and promptly correct ketoacidosis; to correct metabolic disorders and strive for stability; to enable the child to achieve normal growth and development and ensure normal life activities; and to prevent and diagnose complications (renal insufficiency, retinal and cardiac lesions caused by secondary damage to microvasculature) at an early stage.
Newly diagnosed children or children with diabetic ketoacidosis should generally be hospitalized. After the disease is controlled and stabilized, discharge can be arranged, with regular long-term outpatient follow-up and review.