Fasting blood glucose: A method for learning how much glucose (sugar) there is in a blood sample taken after an overnight fast.
Blood Glucose Levels: Testing and Normal RangeSeveral different types of blood glucose tests are used.
SummaryConcurrent with the dramatic rise of obesity, pediatricians are diagnosing type 2 diabetes mellitus (T2DM) more and more frequently in children and adolescents.
Diabetes mellitus is characterized by elevation of blood glucose levels and can lead to increased risks for a host of medical disorders causing increased morbidity and mortality, including heart disease, stroke, peripheral neuropathy, renal disease, and blindness. T1DM is caused by autoimmune destruction of pancreatic beta-cells leading to insulin deficiency and requiring exogenous insulin for survival. Preceding the development of T2DM, insulin resistance and impaired beta-cell function occur.
To help focus clinical decision-making in a timely manner, the American Diabetes Association (ADA) and American Academy of Pediatrics (AAP) developed testing criteria aimed at screening high-risk children for T2DM.[5] The major criteria for performing screening are obesity in addition to 2 other risk factors (see Table 1). The ADA criteria for the diagnosis of T2DM (see Table 2) is the same for children and adults, and is based on fasting blood glucose, random blood glucose, or oral glucose tolerance testing (OGTT), which measures plasma glucose 2 hours after glucose ingestion.[6] The ADA recommends screening with a fasting plasma glucose, which is more convenient than OGTT. Pre-diabetes refers to elevated glucose levels that have not yet reached a diabetes range and includes impaired fasting glucose and impaired glucose tolerance. In the past, classification of diabetes as T1DM or T2DM could be made reliably based on clinical presentation. Currently there are no medications approved by the FDA to treat insulin resistance or pre-diabetes to prevent T2DM.
Management of children with T2DM is a collaborative effort among pediatric endocrinologists, diabetes nurse educators, pediatricians, nutritionists, physical education instructors, behavioral specialists, and the family. A major difficulty in treatment and management lies in the limited availability of pharmacologic options and long-term studies.
Although no other oral hypoglycemic medications have approval for pediatric use, rosiglitazone, an insulin sensitizer in the class of thiazolidinedione drugs, has been studied. The following recommendations (see Table 3) are drawn from ADA’s Standards of Medical Care. Currently there are no treatment outcome studies of hypertension or dyslipidemia in children with T2DM. The rapid rise of obesity and T2DM in children is an undeniable public health problem, as we have not yet seen the full effects of the earlier onset chronic complications associated with T2DM that will come at high cost to society.
Physicians should claim only the credit commensurate with the extent of their participation in the activity. Whereas T2DM occurred only in adults prior to the 1990s, the Centers for Disease Control and Prevention has estimated that 1 in 3 children born in 2000 will develop this condition.


Diabetes can be divided into 2 principal forms, type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM). Insulin resistance is strongly associated with obesity, and initially the pancreatic beta-cells compensate by increasing insulin secretion. Screening children at high risk for T2DM should start at 10 years of age or at onset of puberty, if puberty occurs earlier, and should be performed every 2 years. Of note, the World Health Organization recommends an OGTT as there are data showing that children with impaired glucose tolerance can still have normal fasting plasma glucose,[7,8] although large-scale studies are still needed to fully assess the progression of T2DM in children.
The Diabetes Prevention Program (DPP), a major multi-center research study and other large studies in adults have shown that people with insulin resistance or pre-diabetes can prevent or delay diabetes with lifestyle changes, including increased physical activity and nutritional modifications necessary to treat obesity, which is at the heart of the underlying problem. There are ongoing studies in adolescents to clarify the potential benefits of pharmacotherapy in preventing T2DM. Treatment needs to be individualized, since there is no single formula that is successful for all children and families with T2DM. Other than insulin, metformin is the only drug that is approved in the US by the Food and Drug Administration for pediatric patients with T2DM.
Metformin also cannot be used with radiographic contrast agents, as lactic acidosis may be precipitated. In one study of 195 children who were obese and diagnosed with T2DM, participants were randomized to rosiglitazone (maximum dose of 4 mg twice daily) or metformin (maximum dose of 1000 mg twice daily). These medications increase insulin secretion and are a mainstay of treatment of T2DM in adults.
In T2DM, initial ophthalmologic examination is recommended after diagnosis and annually thereafter.
Fasting lipid panel should be checked after glucose control has been established, then yearly thereafter. Hypertension is defined as systolic or diastolic blood pressure above the 95th percentile for age, sex, and height. Prevention and treatment of childhood obesity is paramount and requires efforts of all healthcare providers. The natural history of insulin secretory dysfunction and insulin resistance in the pathogenesis of type 2 diabetes mellitus.
Prevalence and concomitants of glucose intolerance in European obese children and adolescents. Type 2 diabetes and impaired glucose tolerance in European children and adolescents with obesity ¨C a problem that is no longer restricted to minority groups. 10-year follow-up of diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes Study.


Microvascular and macrovascular reactivity is reduced in subjects at risk for type 2 diabetes.
Lifestyle changes, however, can prevent T2DM in high-risk children and in patients whose elevated blood glucose levels are at pre-diabetes stage.
Antibody testing to detect markers of cellular-mediated immune destruction of pancreatic beta-cells can typically identify T1DM.
The first therapy, however, should always be lifestyle modifications, since weight loss and physical activity can be more effective than medication at reducing diabetes risk.
The study continued for 24 weeks and the reduction in Hb A1c from baseline was statistically significant in both groups, but not statistically significant between the 2 groups.
The study compared metformin and glimepiride in 263 children with T2DM and obesity and showed no statistically significant difference in Hb A1c reduction between the 2 groups. Screening for microalbuminuria with random spot urine for microalbumin-to-creatinine ratio should occur at diagnosis and annually thereafter. Lifestyle modifications should be initiated, but if hypertension does not improve, ACE inhibitors are the first-line therapy. Once T2DM is diagnosed, there are limited treatment options that make this an especially challenging condition. Kim has no industry relationships to disclose and does not refer to products that are still investigational or not labeled for the use in discussion. The etiology of T2DM is multifactorial and rooted in genetic and environmental factors including obesity, family history of T2DM, and ethnic background. Persistent microalbuminuria should be treated with an ACE (angiotensin converting enzyme) inhibitor. If hypertension persists, combination therapy with angiotensin receptor blockers, calcium channel blocker, cardioselective beta-blockers can be considered. There are currently several ongoing studies that will, in the near future, hopefully provide additional information on safe and effective pharmacological therapies that can be used in children. AnswersMy fasting plasma blood glucose levels always oscillate between 120 to 124 with 125 mg glycomet tablet.But the post lunch level never crossed 145 . Currently there are 4 different statins approved for use in pediatrics (simvastatin, lovastatin, atorvastatin, and pravastatin).



Glucose levels and pre-diabetes
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Comments

  1. 13.02.2015 at 23:32:52


    May antedate pregnancy but has normal feature of pregnancy; gestational diabetes mellitus results when.

    Author: EFE_ALI
  2. 13.02.2015 at 12:55:17


    Given (soda, juice, sandwich, snacks), complex post reaches all.

    Author: ARMAGEDON