"Management of Diabetes in Children
Joseph I. Wolfsdorf
• and Katharine C. Garvey
Endocrinology: Adult and Pediatric, Chapter 49, 854-882.e6"
Most children with type 1 diabetes present with classic symptoms of polyuria, polydipsia, and weight loss.
Common characteristics of pediatric type 2 diabetes include obesity, a positive family history, acanthosis nigricans, and presentation during puberty.
Distinguishing between type 1 and type 2 diabetes is not always possible at diagnosis and cannot be based on ketone status, body weight, or insulin requirement.
Overview of Diabetes Management
The choice of initial therapy, irrespective of the type of diabetes, should be based on clinical assessment of the metabolic state.
Subsequent therapy is guided by the patient’s response to treatment.
A multidisciplinary diabetes team (physician, diabetes nurse educator, registered dietitian, and behavioral specialist) is essential for successful management of pediatric diabetes.
Management of Type 1 Diabetes
Successful management of type 1 diabetes requires meticulously balancing insulin replacement with diet and exercise.
Technological innovations have made it possible to achieve tighter blood glucose control with reduced risk of severe hypoglycemia in children with type 1 diabetes.
Widespread achievement of target hemoglobin A1c levels remains a major challenge.
The diabetes team must set realistic and attainable goals for each patient while providing encouragement and support.
Management of Type 2 Diabetes
Pediatric type 2 diabetes has emerged as a major new challenge.
Intensive intervention is required both for glycemic control and management of comorbidities such as obesity, dyslipidemia, hypertension, and microalbuminuria.
A family-centered approach to lifestyle modification is essential.
Patients with ketosis, random blood glucose ≥250 mg/dl, or hemoglobin A1c >9% should be treated initially with insulin; metformin is added after hydration and stabilization of blood glucose.
For asymptomatic or mildly symptomatic patients, lifestyle modification plus metformin is recommended.
Diabetes Monitoring
Self-monitoring of blood glucose is the cornerstone of diabetes care.
Blood glucose data are used to adjust the treatment regimen to achieve glycemic targets.
Hemoglobin A1c is used to monitor long-term glycemic control and is a measure of risk for the development of diabetes complications.
Joseph I. Wolfsdorf
• and Katharine C. Garvey
Endocrinology: Adult and Pediatric, Chapter 49, 854-882.e6"
Diabetes Presentation
Most children with type 1 diabetes present with classic symptoms of polyuria, polydipsia, and weight loss.
Common characteristics of pediatric type 2 diabetes include obesity, a positive family history, acanthosis nigricans, and presentation during puberty.
Distinguishing between type 1 and type 2 diabetes is not always possible at diagnosis and cannot be based on ketone status, body weight, or insulin requirement.
Overview of Diabetes Management
The choice of initial therapy, irrespective of the type of diabetes, should be based on clinical assessment of the metabolic state.
Subsequent therapy is guided by the patient’s response to treatment.
A multidisciplinary diabetes team (physician, diabetes nurse educator, registered dietitian, and behavioral specialist) is essential for successful management of pediatric diabetes.
Management of Type 1 Diabetes
Successful management of type 1 diabetes requires meticulously balancing insulin replacement with diet and exercise.
Technological innovations have made it possible to achieve tighter blood glucose control with reduced risk of severe hypoglycemia in children with type 1 diabetes.
Widespread achievement of target hemoglobin A1c levels remains a major challenge.
The diabetes team must set realistic and attainable goals for each patient while providing encouragement and support.
Management of Type 2 Diabetes
Pediatric type 2 diabetes has emerged as a major new challenge.
Intensive intervention is required both for glycemic control and management of comorbidities such as obesity, dyslipidemia, hypertension, and microalbuminuria.
A family-centered approach to lifestyle modification is essential.
Patients with ketosis, random blood glucose ≥250 mg/dl, or hemoglobin A1c >9% should be treated initially with insulin; metformin is added after hydration and stabilization of blood glucose.
For asymptomatic or mildly symptomatic patients, lifestyle modification plus metformin is recommended.
Diabetes Monitoring
Self-monitoring of blood glucose is the cornerstone of diabetes care.
Blood glucose data are used to adjust the treatment regimen to achieve glycemic targets.
Hemoglobin A1c is used to monitor long-term glycemic control and is a measure of risk for the development of diabetes complications.
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