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It was not so long ago that type 2 diabetes mellitus was considered an exclusively adult disease, with no connection whatsoever to childhood and adolescence. It was not so long ago that type 2 diabetes mellitus was considered an exclusively adult disease, with no connection whatsoever to childhood and adolescence. Furthermore, although the prevalence of adolescent type 2 diabetes is known to be more prevalent in certain ethnic groups and also better documented in these groups (African Americans, North-American Indians, Hispanics),10-13 we are actually facing a constant growth of diabetes in preadolescents.
Type 2 diabetes is a multifaceted disease, its epidemiology and pathogenenesis are two of its most extensively discussed issues.
There are multiple aspects of type 2 diabetes in teenagers that await clarification but until this is accomplished, we need to focus on improvement in diagnosis criteria and on optimisation of therapy. According to ADA Guidelines, criteria for diagnosis of diabetes and other alterations of glucose metabolism are the same as in adults and are presented in Fig. The latter two measurements are not routinely used for differentiating type 1 from type 2 diabetes in children.
Measurement of specific antibodies again beta-type 2 and eventually they behave as type 1 diabetes. A synthesis of the main clinical features of type 2 diabetes in children and adolescents is presented below. Individuals with the highest risk for type 2 diabetes belong to the Native American, Afro-american, American Hispanic and Asian populations (Bangladesh, Japan).10-13 Caucasians are less afflicted in the present because the insulin resistance is less severe in youngsters from this population.
The majority of type 2 diabetes in youngsters is diagnosed at the age of 10 or greater, with a peak in incidence at puberty (between 12 and 14 years), and a constant ascending trend towards the age of 20.
Puberty (especially Tanner stages II, III and IV) favors the onset of type 2 diabetes since is it accompanied by pronounced insulin resistance, hyperinsulinemia both fasting and after oral glucose load,20 processes that will diminish after puberty.
It has been demonstrated that overweight and obesity are associated very often with type 2 diabetes in children and young people, at all ages and in all high risk ethnic groups.
The prevalence of obesity among Pima children (aged between 0 and 19 years) has increased in the last decade and that could explain the rise in diabetes cases in encountered in this population. Similarly to adult population, the predisposition of children and adolescents to become obese is most probably unmasked by changes in life style such as the adoption of modern eating habits (sugar-containing drinks, fast-food) with high-caloric, high-sugar and high-fat diets and the decrease in the level of exercise (sitting for hours in front of TV or computer). Total fat mass directly correlates with BMI and is responsible for approximately 55% of variations in insulin sensitivity.21 Obese children are hyperinsulinemic but in the same time their insulin-dependent glucose disposal is 40 percent lower, compared to age-matched normal weight subjects. The prevalence of diabetes in Pima Indians is significantly higher in children born from mothers with diabetes; even more, all diabetic subjects younger than 25 had at least one diabetic parent, supporting the hypothesis of the autosomal dominant transmission pattern. In Mexican-Americans, family history of diabetes is present in 87% of the cases, at least one generation is involved in 80% of the subjects, three or more generations in 47%.
Therefore it is logical to assume that family history of diabetes is an important risk factor directly involved in diabetogenesis and correlated to insulin resistance.
The risk of a child to become diabetic is proportional with the number of generations afflicted. Acanthosis nigricans is a velvety hyper-pigmentation of the skin, most often located on the back of the neck, axillae, knuckles and flexion folds. Type 2 diabetes is six times more frequent in African-Americans exhibiting acanthosis, compared to those without it. Type 1 and 2 diabetes in children are usually differentiated using clinical criteria Fig. Since more research is needed in the area and large populational studies are lacking, screening guidelines for type 2 diabetes in children have been developed based on the clinical features of the patients.


Subjects presenting with diabetic ketoacidosis or non-ketotic hyperglycemic hyperosmotic crisis are referred to specialist and admitted in the hospital, where they are administered the classic treatment. Severe clinical presentation with polyuria, polydipsia, weight loss benefits from diet and insulin, followed by changing on oral medication, if the clinical evolution allows it.
Many young patients present with hyperinsulinemia, therefore exogenous insulin does not seem indicated.
According to current clinical experience, a preferred insulin regimen of the pacient, family and doctor is represented by the administration of short-acting insulin analogues (lispro, aspart) before meals in association with a intermediate insulin at bedtime, similar to multiple injections regimen in type 1 diabetes. In overweight or obese patients, dietary counseling and help towards achievieng a slow but constant weight loss are key features of the treatment, with concomitant glucose monitoring.
Aerobic exercise, practiced on a daily basis, in association with a hypocaloric diet, is very useful in decreasing insulin resistance , but is often difficult for patients to adopt, especially if other family members are obese, overeating or sedentary.
Combining diet with physical exercise is effective in controlling blood pressure and glycemia, even if ideal weight is not always achieved.
The most frequently used oral agent in children with type 2 diabetes is metformin, a biguanide that, beside decreasing insulin resistance, has other features that make it an advantageous choice: no risk of hypoglycemia, weight neutral (does not increase weight), decrease LDL cholesterol and triglycerides.
A 16-week randomized clinical trial37 that used metformin twice daily (total dose 1000 mg) vs.
If monotherapy with metformin is not enough to reach optimal control after 3 to 6 months, some advocates the association of a sulfonylurea or repaglinide, while other prefer to start NPH insulin at bedtime, to reduce the hepatic glucose output.
As mentioned above, type 2 diabetes mellitus is one of the disease states associated with the metabolic syndrome and children and adolescents make no exception. Management of dyslipidemia in children is similar to adults and includes dietary changes and hypolipidemic drugs.22,24 Treatment should start with diet and a goal of reducing LDL.
Over the next few days DNS servers all across the internet will update themselves with your new domain name. Become part of the record-breaking IX Web Hosting Affiliate Program and receive up to INDUSTRY-LEADING $150 per Referral. The College has produced a comprehensive set of guides covering a whole range of mental health issues. This view is on the verge of changing fundamentally since, beside the rise in incidence in adult population, in the recent years type 2 diabetes is diagnosed more and more frequently in children, especially in some ethnic groups. Among other causes, insulin resistance is the result to the hypersecretion of growth hormone, characteristic for the age, an essential feature that explains the age at onset, situated around puberty. In Pima Indians obesity is an early feature, especially in children born from diabetic mothers.
Furthermore, visceral fat in obese adolescents correlates with basal and glucose-stimulated hyperinsulinemia, and is inversely related with insulin sensitivity.
Body Mass Index (BMI) reported to population-specific standardized curves for age and sex, as well as waist-to-hip ratio are useful tools for assessing the degree of obesity in clinical settings. It is a frequent clinical sign, present in 60 to 90 percent of children with type 2 diabetes.
Special consideration should be given to cerebral edema present at admission or developed during therapy.
However, the correction of the relative insulin deficit might be responsible for the beneficial effects of insulin therapy, because it decreases glucose toxicity. There are many other possible combinations, such as the administration of two doses of intermediate insulin in the morning and in the evening.


In these circumstances, efforts should be made to involve the entire family in the physical and dietary program.
Metformin is also effective in treating ovulatory anomalies in girls with PCOS, therefore reducing the risk of unwanted pregnancy. Resins decrease cholesterol by binding to to bile acids and thus inhibiting their reabsorbtion. Dean H- Treatment of type 2 diabetes in youth: an argument for randomised controlled studies. Furthermore, since we are actually facing a constant growth in obesity prevalence in Caucasian children and adolescents, chances are that type 2 diabetes will be more frequently found in other populations, outside its usual target group. The beneficial effect is more obvious at onset, in the presence of acidosis or if ketone levels in plasma and urine are very high. The insulin regimen should be established depending on pre- and post-prandial glucose values and adapted to individual circumstances. Characteristics of youth-onset non-insulindependent diabetes mellitus and insulindependent diabetes mellitus at diagnosis.
Differencies in the vivo insulin secretion and sensitivity in healthy black versus white adolescents.
Type 2 diabetes in North-American children and adolescents: An epidemiology review and a public health perspective.
Correlations between fatty acid and glucose metabolism: potential explanation of insulin resistance of puberty. Insulin sensitivity, lipids and body composition in children: is a€?syndrome Xa€? present?
Natural history of type 2 diabetes diagnosed in childhood: Long term follow-up in young adult years. Problems with the report of the Expert Panel on Blood Cholesterol Levels in Children and Adolescents. Pathogenic factors of glucose intolerance in obese Japanese adolescents with type 2 diabetes.
Some diabetologists prefer to start insulin and then to taper the doses, while introducing an oral agent, such as metformin, under the strict monitoring of glycemia and HbAc.
Recent studies suggest the use of short-acting insulin analogues before meals, in combination with a biguanide in the evening, to decrease the overnight hepatic gluconeogenesis. Constipation, flatulence, and bloating are common side effects of the resins; as well as an increase in serum triglycerides, therefore are not indicated in hypertriglyceridemia is also present. In Brink SJ, Serban V (eds), Pediatric and Adolescent Diabetes, revised ed., Brumar 2004, Timisoara, p 327-357. Once a regular program of exercise is started and the patient begins to lose weight, glucotoxicity is reduced and insulin requirement decreases.



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Comments to Algorithm for treating type 2 diabetes

  1. Number of medications and supplements both.
  2. ADD on 23.01.2016
  3. First week, 25?30 grams a day the next week, 30?35 grams.
  4. 454 on 23.01.2016
  5. The mortality of those without DM.
  6. TANK on 23.01.2016
  7. Time, recurrent stress can set supposedly some rigorously and to maintain blood levels in normal range it will.
  8. BASABELA on 23.01.2016