Diabetes is a chronic disease defined by hyperglycemia caused by insulin deficiency. (Chapter 71 provides a detailed discussion of diabetes mellitus.). This may be the result of a lack of insulin production, as in type 1 diabetes mellitus (T1DM) or the body’s ineffective use of the insulin it produces, as in type 2 diabetes mellitus. The most common form of diabetes in children is T1DM.
The World Health Organization and International Diabetes Foundation have established the diagnosis of diabetes as meeting any of the following criteria: (1) fasting (≥8 hours) plasma glucose above 126 mg/dL; (2) plasma glucose above 200 mg/dL 2 hours after a glucose load as given by an oral glucose tolerance
test; (3) any random plasma glucose above 200 mg/dL along with the presence of symptoms of diabetes, including increased thirst and urination or unexplained weight loss, or (4) a hemoglobin A1C ≥6.5%.Diabetes is one of the most common chronic diseases in the United States.
Approximately 8.0% of the U.S. population meets
criteria for diabetes. It is estimated that about 150,000 people in the United States younger than 20 years of age have diabetes;about one in every 500 children and adolescents has T1DM. There is a bimodal distribution of age at onset, with a peak age at presentation around age 5 years and another at early puberty.This chapter focuses on the care of acutely ill children with T1DM presenting with diabetic ketoacidosis (DKA), a complication of T1DM in which hyperglycemia, dehydration, electro-lyte derangement, ketonemia, and acidemia result from absolute insulin deficiency. DKA can be the presenting manifestation of T1DM in up to 25% of children; it is also seen in children with known T1DM secondary to failure of or noncompliance with insulin therapy
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