Covers type 1 diabetes in children, from autoimmune development and staged progression through symptoms and diagnostic thresholds to insulin regimens and glycaemic targets. It then takes hypoglycaemia treatment, diabetic ketoacidosis with its management and cerebral oedema warning, and a comparison table of type 2, MODY, neonatal and secondary diabetes. It ends with long-term screening and dental care advice.
Topic 17 of 30 in the MU Sofia syllabus for Paediatrics and Infectious Diseases (Dental Medicine, Year 4). The free AceMed note covers it in 7 sections, about 563 words (4 min of reading), with 16 flashcards.
In this note
Introduction
Type 1 diabetes
Treatment
Hypoglycaemia
Diabetic ketoacidosis (DKA)
Other types of diabetes
Long-term care
Introduction
Most diabetes in children is type 1: autoimmune destruction of the pancreatic β-cells, so the child has no insulin and needs it for life. Its incidence is rising, with peaks at 4–6 and 10–14 years. Type 2 diabetes is increasing in obese teenagers, and a few children have monogenic diabetes.
Type 1 diabetes
How it develops
Genetic risk (HLA-DR3/DR4) plus triggers lead to islet autoantibodies (GAD65, IA-2, insulin, ZnT8). Stage 1: two or more antibodies, normal glucose; stage 2: abnormal glucose; stage 3: symptoms. Teplizumab can delay stage 3 in children at stage 2.
Symptoms
Polyuria (new bedwetting), polydipsia, weight loss, tiredness, thrush.
About a third present in diabetic ketoacidosis; in toddlers the signs are easily missed.
Diagnosis
Fasting glucose ≥ 7.0 mmol/L (126 mg/dL), or random glucose ≥ 11.1 mmol/L (200 mg/dL) with symptoms, or HbA1c ≥ 48 mmol/mol (6.5%). In a child with symptoms and high glucose, refer the same day.
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