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## Risk Reduction for Diabetes in Children There has been a marked increase in diabetes mellitus in children, correlating with increasing obesity and lack of exercise. This is especially true for minority children. Until recent years, Type 1 (insulin-dependent) diabetes was most common in children...

## Risk Reduction for Diabetes in Children There has been a marked increase in diabetes mellitus in children, correlating with increasing obesity and lack of exercise. This is especially true for minority children. Until recent years, Type 1 (insulin-dependent) diabetes was most common in children and Type 2 (insulin-presenting) diabetes was more common in adults but now 8-45% of children presenting with diabetes have Type 2. It is difficult to determine the type with initial diagnosis. Most cases are diagnosed during puberty, when hormone changes affect insulin, but children as young as 4 have been identified. Since obesity is a significant risk, health risk reduction efforts are aimed at improving diet and increasing exercise. But intervention aimed at the whole family is often more effective than tailoring diet and exercise just to the needs of the child. The family should work with a nutritionist. Screening with fasting blood sugar is normally done about every 2 years for those at risk or presenting with symptoms. ## Ketoacidosis Ketoacidosis is a complication of diabetes mellitus. Inadequate production of insulin results in glucose being unavailable for metabolism, so lipolysis (breakdown of fat) produces free fatty acids (FFAs) as an alternate fuel source. Glycerol in both fat cells and the liver are converted to ketone bodies (β-hydroxybutyric acid, acetoacetic acid, and acetone), which are used for cellular metabolism less efficiently than glucose. Excess ketone bodies are excreted in the urine (ketonuria) or exhalations. The ketone bodies lower serum pH, leading to ketoacidosis. Symptoms are: * **Kussmaul respirations:** hyperventilation to eliminate buildup of carbon dioxide, associated with "ketone breath." * **Fluid imbalance**, including loss of potassium and other electrolytes from cellular death, resulting in dehydration and diuresis with excess thirst. * **Cardiac arrhythmias**, related to potassium loss, can lead to cardiac arrest. * **Hyperglycemia**, with glucose levels above normal. Normal glucose values: * Neonate: 40-60 mg/dL * 12 months: 60-100 mg/dL **Treatment includes:** * Insulin therapy by continuous infusion initially * Rehydration and electrolyte replacement * Glucose monitoring * Ketone monitoring ## Acute Hypoglycemia Acute hypoglycemia (hyperinsulinism) can cause damage to the central nervous and cardiopulmonary systems, interfering with development of the brain and causing neurological impairment. Causes may include: * Pancreatic islet tumors/hyperplasia * Persistent hyperinsulinemic hypoglycemia of infancy (PHHI) in infants of diabetic mothers, usually apparent in the first 3 months * Genetic defects in chromosome 11 (short arm) * Severe infections, such as Gram-negative sepsis, endotoxic shock * Toxic ingestion of alcohol or drugs, such as salicylates * Excess dosage of insulin