Complications of diabetes in children
Last reviewed: 23.04.2024
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Diabetic angiopathies - the main cause of disability in patients with diabetes mellitus 1 - develop in chronic hyperglycemia and have common morphological features: aneurysmal changes in capillaries, thickening of the arterioles, capillaries and venules wall due to the accumulation in the basal membrane of glycoproteins and neutral mucopolysaccharides, proliferation of the endothelium and its desquamation into the lumen vessels, leading to their obliteration.
Diabetic retinopathy is the cause of blindness in the absence of quality long-term glycemic control. There are three stages of its development.
- I stage. Non-proliferative retinopathy: in the retina, microaneurysms, hemorrhages, edema, exudative foci.
- II stage. Pre-proliferative retinopathy - venous anomalies, a large number of hard and "cotton" exudates, many large retinal hemorrhages.
- III stage. Proliferative retinopathy is the formation of new vessels, the ruptures of which can lead to hemorrhage and detachment of the retina.
The initial stages of retinopathy may not progress for many years (up to 20 years). The factors leading to proliferative retinopathy are the duration of the disease with poor metabolic control, high blood pressure and genetic predisposition. In this regard, examination of the fundus should be conducted by an ophthalmologist with the help of ophthalmoscopy, stereophotography of the fundus or fluorescent angiography annually.
The most effective method of treating diabetic retinopathy is laser coagulation.
Diabetic nephropathy is a primarily chronic process, manifested first by hypertrophy and hyperfiltration of nephrons, then by microalbuminuria on the background of normal filtration and, finally, by progressive glomerulosclerosis with gradual development of chronic renal failure.
The clinically pronounced stage of nephropathy is always preceded by years of transient or permanent microalbuminuria - albumin excretion rate of 20 to 200 μg / min or 30 to 300 mg / day. To determine the rate of excretion of albumin, it is advisable to use a collection of a night portion of urine, when the effects of physical exertion, orthostasis, and fluctuations in blood pressure are excluded. It should be remembered that a number of factors lead to a false positive result (glomerulonephritis, urinary tract infections, intense physical exertion, menstrual bleeding). Screening of albumin excretion rate should be performed annually. If microalbuminuria remains constant or progresses (despite improved control of glucose and the absence of arterial hypertension), ACE inhibitors should be prescribed.
Diabetic neuropathy in children and adolescents is in the form of a distal symmetrical sensory-motor polyneuropathy. It is characterized by a symmetrical lesion of the sensory and motor nerve fibers of the distal lower limbs. The main manifestations of neuropathy in children: pain syndrome, paresthesia, decrease tendon reflexes. Less often, violation of tactile, temperature, pain and vibration sensitivity.
Restriction of joint mobility and stiffness of hands and fingers are often observed in children with type 1 diabetes mellitus; they are associated with the development of angiopathy in poor metabolic control.
Lipoid necrobiosis - rounded areas of skin lesions of pink color with unknown etiology. In children it is rare.
The main way to prevent and simultaneously treat chronic complications of diabetes mellitus is to achieve and maintain compensation for metabolic disorders with constant glycemic control.
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