Type 1 Diabetes Mellitus In Children

Type 1 diabetes mellitus results from autoimmune destruction of pancreatic beta cells causing absolute insulin deficiency.

Children may present with classical osmotic symptoms or initially with diabetic ketoacidosis.

• Polyuria
• Polydipsia
• Nocturia or secondary enuresis
• Weight loss despite appetite
• Fatigue
• Recurrent candidiasis

DKA adds:

• Vomiting
• Abdominal pain
• Dehydration
• Kussmaul respiration
• Acetone breath
• Altered consciousness

Diabetes can be diagnosed by:

• Fasting plasma glucose 7.0 mmol/L or greater

• Random plasma glucose 11.1 mmol/L or greater with classical symptoms

• 2 hour glucose 11.1 mmol/L or greater during OGTT

• HbA1c 6.5% or greater, where the assay and clinical circumstances are appropriate

Children with type 1 diabetes require lifelong insulin.

Typical total daily insulin requirements after stabilization are approximately 0.5 to 1 unit/kg/day, but requirements vary substantially with age, puberty, honeymoon phase, diet and activity.

A basal bolus regimen generally divides insulin into:

• Long acting basal insulin

• Rapid acting insulin with meals, calculated according to carbohydrate intake and correction requirements

Education must include glucose monitoring, insulin administration, carbohydrate counting, hypoglycaemia treatment, sick day rules and ketone monitoring.