The management program for any child with diabetes mellitus should involve flexibility and 24 hour insulin coverage and should be able to fit into the child's life-style. The insulin treatment should be determined by the recognition that the effective duration of action of insulin in children may be somewhat different from that in adults. The effective action of insulin is described as the effect of a certain amount of insulin in lowering the blood glucose level over a period of time. Ideally the blood glucose level is maintained at less than 140mg.dL and n lower than 60mg/dL during the time of specific action of the insulin, based on past information regarding the duration of action of the intermediate-acting insulin is 24 hours or more, but in insulin-dependent children it does not appear to be the case. The duration of effective action for intermediate-acting insulin has been found to be 12 to 14 hours. Lente insulin is the longest acting of the intermediate-acting insulin, but it even lasts only for 14 to 16 hours.
In working with these insulin, it is wise to remember that lente insulin is 30% semilente and 70% ultralente. Lente insulin that mix with no other insulin other than regular derive their action from the size and number of crystals-small and numerous crystals= ultralente insulin. Pretamine zinc insulin (PZI) is seldom used today because of its very long duration of action and its very low tissue insulin levels, which may not saturate receptor sites on the cell membrane sufficiently well to effectively help the body utilize the glucose that may be present. The potential overlap of insulin action is unsuited for children, who are active one minute and very inactive the next. The balance that needs to be achieved between insulin, diet, and activity is most difficult when using this type of insulin. The intermediate-acting insulin (other than lente insulin) derive their delayed action from a protein tag. The most commonly used insulin are the intermediate-acting insulin, principally isophane, which are usually given in a single early morning dose combined with a small amount of short- acting insulin (usually regular).
Other types
This category includes secondary diabetes such as steroid-induced diabetes as well as primary diabetes associated with genetic syndromes, drugs or chemical-induced diabetes, and diabetes resulting from pancreatoctomy for hypoglycemia. Syndromes with insulin receptor abnormality are classified in this group.
Impaired glucose tolerance (IGT)
Formely called "asymptomatic diabetes" "subclinical diabetes", "borderline diabetes", or "latent diabetes". Biochemically intermediate between normal and diabetic glucose intolerance, it probably represents a stage in the development of insulin-dependent of noninsulin dependent. Because few of these individuals develop the full-blown disease, this classification tends to remove the stigma attached to the previous designations which affected the child's self concept as well as insurance and vocational efforts.
Stastistical risk classes
Individuals who do not have demonstrable impairment of glucose tolerance but who:
1. Had previous abnormality of glucose tolerance (formerly labeled "latent chemical diabetes" or "prediabetes") or spontaneous hyper-glycemia but who have normal glucose tolerance at the time of classification.
2. Have potential abnormality of glucose tolerance (previously termed "prediabetes" or "potential diabetes") and includes individuals presumed to be at risk for diabetes on genetic grounds and individuals who have circulating islet cell antibodies.
The most common endocrine disturbance in childhood, diabetes mellitus, caused by defective pancreatic hormone (insulin) secretion.
CUSHING'S SYNDROME
Classic clinical manifestation in children include progressive central obesity, marked failure of longitudinal growth, hirsutism, weakness, a nuchal fat pad (buffalo hump), acne, striae, hypertension and often hyperpigmentation (if ACTH is elevated). The etiology can be exogenous glucocorticoid administration or endogenous causes including adrenal adenoma, carcinoma, nodular adrenal hyperplasia, an ACTH-secreting pituitary microadenoma, resulting in bilateral adrenal hyperplasia, or a very rare ACTH-secreting tumor.
Spontaneous Cushing's Syndrome is rare in childhood. Latrogenic Cushing's syndrome is more common, produces similar clinical manifestations, and may be induced by the use of potent glucocorticoids for chronic inflammatory, neoplastic and collagen-vascular disorders and for suppression of the immune response.
Diabetes Insipidus
The cardiaral signs of this disease ate polyuria and polydipsia. Some patient may seek medical attention for nocturnal enuresis. Polyurea disturbs rest, sleep, play and even schooling, Appetite may be poor. Infants with diabetes insipidus may show hyperthermia, dehydration, electrolyte inbalance, asotemia, dehydration and potentially circulatory collapse. Other signs depend on the causative lesion and may include retardation, cachexia, obesity, sleep disturbance, precocious puberty, visual disturbances and emotional disorders.
Syndromes of endocrine system disorders
1. Syndrome of growth inhibition
2. syndrome of gigantism
3. syndrome of hyperfunction of endocrine gland
4. syndrome of hypofunction of endocrine gland
5. syndrome of hyperglycemia
6. syndrome of hypoglycemia
7. syndrome of mental retardation
In working with these insulin, it is wise to remember that lente insulin is 30% semilente and 70% ultralente. Lente insulin that mix with no other insulin other than regular derive their action from the size and number of crystals-small and numerous crystals= ultralente insulin. Pretamine zinc insulin (PZI) is seldom used today because of its very long duration of action and its very low tissue insulin levels, which may not saturate receptor sites on the cell membrane sufficiently well to effectively help the body utilize the glucose that may be present. The potential overlap of insulin action is unsuited for children, who are active one minute and very inactive the next. The balance that needs to be achieved between insulin, diet, and activity is most difficult when using this type of insulin. The intermediate-acting insulin (other than lente insulin) derive their delayed action from a protein tag. The most commonly used insulin are the intermediate-acting insulin, principally isophane, which are usually given in a single early morning dose combined with a small amount of short- acting insulin (usually regular).
Other types
This category includes secondary diabetes such as steroid-induced diabetes as well as primary diabetes associated with genetic syndromes, drugs or chemical-induced diabetes, and diabetes resulting from pancreatoctomy for hypoglycemia. Syndromes with insulin receptor abnormality are classified in this group.
Impaired glucose tolerance (IGT)
Formely called "asymptomatic diabetes" "subclinical diabetes", "borderline diabetes", or "latent diabetes". Biochemically intermediate between normal and diabetic glucose intolerance, it probably represents a stage in the development of insulin-dependent of noninsulin dependent. Because few of these individuals develop the full-blown disease, this classification tends to remove the stigma attached to the previous designations which affected the child's self concept as well as insurance and vocational efforts.
Stastistical risk classes
Individuals who do not have demonstrable impairment of glucose tolerance but who:
1. Had previous abnormality of glucose tolerance (formerly labeled "latent chemical diabetes" or "prediabetes") or spontaneous hyper-glycemia but who have normal glucose tolerance at the time of classification.
2. Have potential abnormality of glucose tolerance (previously termed "prediabetes" or "potential diabetes") and includes individuals presumed to be at risk for diabetes on genetic grounds and individuals who have circulating islet cell antibodies.
The most common endocrine disturbance in childhood, diabetes mellitus, caused by defective pancreatic hormone (insulin) secretion.
CUSHING'S SYNDROME
Classic clinical manifestation in children include progressive central obesity, marked failure of longitudinal growth, hirsutism, weakness, a nuchal fat pad (buffalo hump), acne, striae, hypertension and often hyperpigmentation (if ACTH is elevated). The etiology can be exogenous glucocorticoid administration or endogenous causes including adrenal adenoma, carcinoma, nodular adrenal hyperplasia, an ACTH-secreting pituitary microadenoma, resulting in bilateral adrenal hyperplasia, or a very rare ACTH-secreting tumor.
Spontaneous Cushing's Syndrome is rare in childhood. Latrogenic Cushing's syndrome is more common, produces similar clinical manifestations, and may be induced by the use of potent glucocorticoids for chronic inflammatory, neoplastic and collagen-vascular disorders and for suppression of the immune response.
Diabetes Insipidus
The cardiaral signs of this disease ate polyuria and polydipsia. Some patient may seek medical attention for nocturnal enuresis. Polyurea disturbs rest, sleep, play and even schooling, Appetite may be poor. Infants with diabetes insipidus may show hyperthermia, dehydration, electrolyte inbalance, asotemia, dehydration and potentially circulatory collapse. Other signs depend on the causative lesion and may include retardation, cachexia, obesity, sleep disturbance, precocious puberty, visual disturbances and emotional disorders.
Syndromes of endocrine system disorders
1. Syndrome of growth inhibition
2. syndrome of gigantism
3. syndrome of hyperfunction of endocrine gland
4. syndrome of hypofunction of endocrine gland
5. syndrome of hyperglycemia
6. syndrome of hypoglycemia
7. syndrome of mental retardation
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