Symptoms of diabetes in children
Last reviewed: 23.04.2024
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Dysonific stages of diabetes mellitus 1 do not have specific clinical symptoms. Clinical manifestation develops after the death of 80-90% of beta-cells and is characterized by the appearance of so-called "big" symptoms - thirst, polyuria and weight loss. And at the beginning of the disease, weight loss is noted, despite the increased appetite and increased nutrition. The first manifestation of polyuria may be night or daytime enuresis. Increasing dehydration causes dry skin and mucous membranes. Often join fungal and pustular skin diseases, girls can develop vulvitis. The subcutaneous fat layer is thinned, the turgor of tissues decreases. Growth of weakness, fatigue, reduced efficiency.
In a third of cases, the first clinical symptoms of type 1 diabetes are signs of diabetic ketoacidosis. There are three stages of diabetic ketoacidosis.
- I stage, ketosis. Against the background of symptoms of dehydration, the accumulation of ketone bodies in the body provokes nausea, vomiting, abdominal pain, loose stool (toxic gastroenteritis). At the same time, the mucous membranes are bright, the tongue is dry, covered with a thick coating. Characteristic rubioz (diabetic blush on the zygomatic arches, above the eyebrows, on the chin), the exhaled air has a characteristic smell of acetone.
- II stage - precom. It comes with decompensation of metabolic acidosis on the background of progressive dehydration. The clinical criterion for the onset of stage II is noisy toxic respiration (Kussmaul breathing). Due to erosive gastroenteritis, abdominal syndrome develops (abdominal pain, muscle tension in the anterior abdominal wall, positive symptoms of peritoneal irritation, repeated vomiting). The dryness of the skin and mucous membranes increases, acrocyanosis appears. Reduced blood pressure, tachycardia appears. At the same time, consciousness is preserved, but gradually becomes co-operative.
- III stage - coma. Characterized by a lack of consciousness, oppression of reflexes, a decrease in diuresis, cessation of vomiting, an increase in hemodynamic disorders. Against the background of symptoms of severe dehydration and microcirculatory disturbances, the patient is marked by rare noisy breathing, muscle hypotension, tachycardia, and heart rhythm disturbances. In the future, a drop in blood pressure is observed. With the failure to provide timely care, neurological disorders progressively increase. The final stage of CNS depression is coma. Absence or weak reaction of pupils to light testify to the developed structural changes in the brain stem.
Very rarely in children, the clinical manifestation of type 1 diabetes mellitus is terminated by a non-ketotic hyperosmolar coma that is characterized by severe hyperglycemia (above 40 mmol / l), lack of ketosis, non-ketotic acidosis, dehydration and loss of consciousness. In this case, blood osmolality due to hyperglycemia reaches 350 mosm / L and higher. Damage to the hypothalamic center of thirst due to high blood osmolality leads to the disappearance of thirst and further disruption of osmoregulatory mechanisms. The reasons for the development of such a variant of coma in children are unknown.
[Features of diabetes in young children
The onset of persistent diabetes mellitus 1 in children under the age of 6 months is almost never found. Newborns are sometimes observed syndrome of transient (transient) diabetes mellitus 1. Which begins with the first weeks of life, and after a few months spontaneous recovery occurs. It often occurs in children with low weight and is characterized by hyperglycemia and glucosuria, leading to moderate dehydration and sometimes to metabolic acidosis. It is assumed that in this case, the insulin response to glucose is reduced, the level of insulin in the blood plasma is normal. Treating transient diabetes with insulin, which is canceled, as a rule, after 2 months with repeated hypoglycemia.
Rare cases of congenital diabetes are caused by a genetic defect in insulin. The defect is a violation of the sequence of amino acids leucine-phenylalanine in the 25th position.