Rus Articles Journal

Diabetes at children and teenagers of

We hurry all the time, we overcome stresses, we fight against a hypodynamia, we eat quick... And what followed it? The number of patients, for example, with the diabetes (D), obesity, a hypertensive illness grew up. Unfortunately, children and teenagers were not avoided by many diseases.

Diabetes “grew“ and “looked younger“

Total of patients with diabetes (both the first, and second type) in the world exceeded 150 million people; in Russia 2,5 million patients among adults are officially registered. Approximately as much the person are at a prediabetes stage. But actually the number of patients in two - three times exceeds official figures... Annually the number of patients increases by 5 - 7%, and each 12 - 15 years - doubles. Children`s statistics still sad - to 90 - x was noted years an incidence gain not Bol, than for 4%. After 2000 - to 46% of new cases a year. In the last decade growth of SD from 0,7 to 7,2 cases of an illness of SD on 100 000 teenagers.

Diabetes, in translation from Greek means “expiration“ and, therefore, diabetes literally means “the losing sugar“, was known in Ancient Egypt. In the 17th century sweet taste of urine at the patient with diabetes was for the first time described, it became the main sign for diagnosis of a disease later. In 1889 Langergans at microscopy of a pancreas found the specific congestions of cages called in a consequence by his name, however the scientist did not manage to explain their value for an organism. In the same 1889 Moehring and Minkowski caused diabetes in animals, having removed a pancreas. In 1921 for the first time Banting and Best in Toronto received insulin which at a dog with diabetes eliminated disease symptoms, and since 1922. the first patient with diabetes began to receive insulin injections. In 1960 the chemical structure of insulin of the person was established. In 1976 from insulin of a pig human insulin was synthesized, and in 1979 it was carried out full genno - engineering synthesis of human insulin.

As why

Diabetes, by definition of WHO, - a disease of endocrine system at which the condition of the chronic increased level of glucose of blood (hyperglycemia) which can develop as a result of action of many genetic, exogenous, etc. factors is noted. The hyperglycemia can be caused or a lack of insulin - pancreas hormone, or surplus of factors which counteract its activity. The disease is followed by deep violations of carbohydrate, fatty and proteinaceous exchanges and to development of insufficiency of various bodies and systems, especially an eye, kidneys, nerves, heart and blood vessels.

On modern representations, insulin-dependent diabetes (IZSD) of 1 type which develops at children`s and teenage age (generally till 30 years) is the disease developing against genetic (hereditary) predisposition at influence of factors of external environment. The reasons of diabetes of the first type are that production of insulin decreases or at all the beta - cells (Langergans`s cells) of a pancreas under the influence of, for example, viral infection, existence in food of toxic agents, such as nitrozoamin, a stress and other factors stops owing to death.

Diabetes of the second type which, elderly people generally are ill meets four times more often than diabetes of the first type. In this case a beta - cages produce insulin in usual and even large number in the beginning. However its activity is reduced (as a rule, from - for redundancy of fatty tissue which receptors have the lowered sensitivity to insulin). Further there can come reduction of formation of insulin. The reasons of development of diabetes 2 - go type - genetic predisposition, the obesity which is often connected with an overeating, and also diseases of endocrine system (pathology of a hypophysis, thyroid gland (hypo - and hyperfunction), bark of adrenal glands). In more exceptional cases of SD 2 types can also arise and as complication at viral diseases (flu, viral hepatitis, a herpes virus, etc.) zhelchekamenny and hypertensive illness, pancreatitis, pancreas tumors.

Classification of the diabetes (D) and violation of tolerance to
    glucose
  • 1 type - insulin-dependent diabetes (IZSD);
  • 2 type - insulinnezavisimy diabetes (INSD);
  • 3 the SD type with other syndromes or other reason;
  • 4 type - violation of tolerance to glucose (a so-called stage of prediabetes):
    • without obesity
    • with obesity
  • 5 type - diabetes of pregnant women.

to Estimate risks of a disease of diabetes

Experts - endocrinologists are sure that risk to ache with diabetes increases if in your family someone is ill or had diabetes. However the different figures defining probability of a disease are given in different sources. There are supervision that diabetes of the first type is inherited with probability of 3 - 7% in the area of mother and with probability of 10% in the area of the father. If both parent are ill, the risk of a disease increases several times - up to 70%. Diabetes of the second type is inherited with probability of 80% both on maternal, and on the fatherly line and if SD 2 types are ill both parent, the probability of its manifestation at children approaches 100%.

Therefore to a family where blood relatives have SD cases, needs to be remembered that the child is included into “risk group“, so it is necessary to minimize risk of development of this serious illness (prevention of an infection, a healthy lifestyle and food, etc.) .

Second on the importance the diabetes reason - the excess weight or obesity, this symptom is important both in the adult, and at children`s age. For a long time of the practice and supervision endocrinologists found out that nearly 90% sick with diabetes 2 - go type have obesity, and the expressed obesity can increase probability of developing of diabetes almost at 100% of people. Each 5 - 10 extra kilos in 5 - 10 time increase risk of development of various diseases: including it is warm - vascular, such as myocardial infarction and a stroke of a brain, diseases of joints and, certainly, diabetes.

the Third of the reasons playing a role in development of SD especially at children`s age are viral infections (a rubella, chicken pox, epidemic hepatitis and other diseases, t. h and flu). These infections play a role of the mechanism starting autoimmune process, at children with immunological violations (often not diagnosed earlier). Of course, at the majority flu or chicken pox will not become the beginning of diabetes. But if the child with obesity from a family where the father or mother are ill SD, then for it and flu poses some threat.

of One more of the reasons of development of SD are pancreas diseases at which there is a defeat a beta - cages, for example pancreatitis (a pancreas inflammation), a pancreatic cancer, a trauma of body, and also poisoning with medicines or chemicals. These diseases develop, generally at more advanced age. Also at adults an important role in developing of diabetes is played by a chronic stress and an emotional overstrain, especially, if the person I have excessive weight and patients in a family.

I Want to pay attention that at teenagers 2 types are risk factors of development of SD:

Now pediatricians and children`s endocrinologists are concerned by development in teenagers of a so-called “metabolic syndrome“: obesity + insulin resistance (a state at which at normal concentration of insulin decrease in consumption of glucose is noted by fabrics). Insufficient consumption of glucose fabrics leads to stimulation of cells of Langergans, development of new portions of insulin and development of a giperinsulinemiya), plus a dislipidemiya (the raised / changed level of lipids in blood), plus arterial hypertension.

the metabolic syndrome is revealed by

In the USA at 4,2% of teenagers among all teenage population (research 1988 - 1994) and young men are more subject to this syndrome, than girls. It was also revealed that violation of tolerance to glucose is noted at 21% of teenagers with obesity. In Russia there is no full-fledged statistics, however in 1994 within the State register of diabetes the Register of the children sick with diabetes living in Moscow was created. It is established that incidence of IZSD at children in 1994 made 11,7 people on 100 thousand children`s population, and in 1995 - already 12,1 on 100 thousand. It is sad dynamics.

In time to distinguish

Diabetes is among the diseases having a set of “masks“. If the illness (SD of 1 type) develops in children`s, especially at early age, then the latent (hidden) period often happens short - at the same time parents can pay attention only that the child suddenly began to drink and urinate much, including at night, emergence of enuresis is possible. At the child appetite can change: or there is a constant desire to eat or, on the contrary, full refusal of food. The kid quickly grows thin, becomes sluggish, does not want to play and walk. Both parents, and pediatricians because bright displays of an illness can not notice these symptoms (temperatures, cough and cold, etc.) no. Some children at early stages of diabetes can have skin diseases: eczema, furuncles, fungal diseases, develops periodontosis.

if the diagnosis is not made to

I in time, the condition of the child sharply worsens - diabetic ketoacidosis develops: thirst, dryness mucous increases and skin, children complain of weakness, a headache, drowsiness. There are nausea and vomiting which soon becomes frequent. In process of strengthening of ketoacidosis breath becomes frequent, noisy and deep, from the child smells of acetone. There can come frustration of consciousness up to a coma and if the little patient is not given the emergency help, then he can die.

of Difference of symptoms of SD of 1 type and SD 2 types at children and teenagers:

is burdened by
of SD 1 type of SD 2 type
Fast development of symptoms Slow development of symptoms
Frequent presence of ketoacidosis is rare with obesity In 85% with obesity
of 33% have a ketonuriya (existence of ketone bodies in urine, is normal of them is not present) and slight ketoacidosis
At 5% heredity on SD 1 of the type (1 - I is burdened and 2 - I lines of relationship) At 74 - 100% heredity on SD 2 of the type (1 - I and 2 - I lines of relationship)
Presence of other immune diseases of Insulinorezistentnost, arterial hypertension, dislipidemiya, polikistoz ovaries at girls

At teenagers at development of SD 2 types a clinical picture accrues slowly. The first symptoms of an illness can become the increased thirst (polidipsiya), increase in volume and frequency of urinations (poliuriya), emergence of night enuresis, an itch of skin and genitals, fatigue.

to Find and neutralize diabetes

various ways of treatment of SD Exist. The major purposes at treatment of diabetes - elimination of symptoms, optimum metabolic control, prevention of sharp and chronic complications, achievement of perhaps more quality life for patients.

to

the Basic principles of treatment - the diabetic diet, the dosed physical activity, self-checking behind glucose level in blood etc. are taught at schools of diabetes. Now such schools there is a set. Worldwide children with diabetes and their parents have an opportunity to gain knowledge of the disease, and it helps them to be full-fledged members of society.

the First school of diabetes works with

in Moscow with 1989 - go years. After initial training if necessary through 1 - 2 years teenagers or relatives of sick children can complete a repeated course for fixing and updating of knowledge of diabetes.

Non-drug methods of treatment of diabetes

the Dietotherapy at diabetes has to meet the following requirements: an exception of easily acquired carbohydrates (sugar, chocolate, honey, jam etc.) and low consumption of saturated fats. All carbohydrates have to provide 50 - 60% of caloric content of a daily diet, proteins no more than 15%, and the general content of fat should not exceed 30 - 35% of daily energy needs. To children of early age till 1 year calculation of food and the number of meals, including feedings up, is carried out by the form feedings (artificial, mixed, natural). It is necessary to notice that it is ideal to keep breastfeeding till 1,5 years.

Obligatory weight reduction is a first step to prevention and treatment of diabetes.

Should be explained with

also to the sick child need of self-checking and to train in carrying out it in house conditions with the help the test - strips (determination of level of glucose in blood and urine).

lasting diabetes over 5 years of Neobkhody careful control of arterial pressure, research of urine on an albuminuriya, annual consultation of patients in an office of vascular diagnostics of eye clinic for detection of a retinopathy. Two times a year the child has to be examined by the stomatologist and the ENT SPECIALIST - the doctor.

to little patients psychological assistance and support of adults is necessary for

, not gift the motto of many schools of diabetes - “Diabetes is a way of life“. But parents need to remember that the constant fear for the child and desire to preserve it against everything can be led to the fact that the child will begin to perceive too world around as the world which bears danger and threat continually.

Medicamentous methods of treatment of diabetes
  1. Treatment of diabetes 2 types begin

    with

    with purpose of sakharoponizhayushchy preparations in the form of tablets.

  2. Insulinoterapiya`s
  3. .

Insulin regulates the content of sugar in blood, promoting transformation of excessive amount of the sugar coming to an organism, to a glycogen. Receptors of insulin work as some kind of “locks“, and insulin can be assimilated to a key which opens locks and allows glucose to enter a cage therefore at IZSD treatment begins with an insulinoterapiya.

At adult patients with the long course of a disease accustoming to sakharoponizhayushchy preparations in the form of tablets often develops, and through 10 - 15 years from the beginning of a disease on average 2 types pass 10 - 15% of patients with diabetes to treatment with insulin.

At diabetes insulin is entered hypodermically, Inside it is impossible to accept insulin as digestive juice destroys it. For simplification of performance of injections use semi-automatic injektor - syringes - handles.

over time the need for insulin increases, appetite can change, at children it decreases more often. Therefore it is necessary to control especially carefully blood glucose, and also glucose and acetone of urine.

of Feature of a course of a disease

At most of children regress of a disease begins p with IZSD through 2 - 4 weeks from the moment of statement of the diagnosis and the correct therapy, even temporary remission when the need for insulin sharply decreases is possible. This phase can last about several months. Unfortunately, the need for insulin increases again and reaches through 3 - 5 years from the beginning of a disease of 0,8 - 1 PIECES/kg body weights. During puberty when there is a jump of growth and increase in body weight, the course of diabetes is characterized by lability and demands very careful control. After the end of the teenage period diabetes gains stable character again.

Often diabetes is the first of displays of pathology of all endocrine system. In the subsequent at children autoimmune diseases of other endocrine glands, first of all - a thyroid gland can develop. Bad compensation of diabetes leads to violation of all types of a metabolism and especially proteinaceous that in turn is followed by decrease in nonspecific protection and immunity. As a result frequency infectious damages of skin and mucous in the form of piodermiya and fungal infections develop, process of healing of wounds is at a loss.

at children`s age treat sharp complications of diabetes: ketoatsitoz, ketoatsidotichesky coma, gipoklemichesky states and gipoklemichesky coma, giperosmolyarny coma.

Other complications at children develop slowly. Vascular complications - mikroangiopatiya which development depends on genetic features of the child and compensation of a carbohydrate exchange are their cornerstone. Usually mikroangiopatiya develop through 5 - 7 years from the beginning of a disease. Complications can be shown in a look:

it is frequent at patients comes to light infectious complications, including tuberculosis.

the Disease of the child of SD, certainly, is a stress for all family. But at the strong union of a family and the doctor we will be able to provide to the child the correct physical and mental development, and also adequate social orientation. The children having this illness can actively participate in life of school, at the sufficient level of readiness together with parents can go to travel, go hiking, drive the car etc. Having matured, they will be able to have full-fledged families. And correct and in time the observed therapy of diabetes will allow to provide later development of complications.