Diebetes mellitus in children and adolescents
Diabetes in children and adolescents is usually caused by lack of insulin. When compared to diabetes in adults, biological, psychic and social differences can be found. It is characterized by high lability, tendency to hypoglycemia and to diabetic ketoacidosis, rapid development of chronic diabetic complications. First choice treatment is insulin administration, most often in several doses daily by means of insulin pens or insulin pump. Together with insulin of human structure, also insulin analogs with ultra-short (fast insulin) or on the contrary with very prolonged effect are used.
So called selfmonitoring is of great importance. It has been proven that the more often measurement of glycemia, the better compensation of diabetes. It means that it is necessary to check glycemia in so-called small profiles (3 - 4 measurements daily, before meal), and according to individual needs to add measurements of so-called big profiles of glycemia (e.g. 8 measurements including those after meal and during night). Information about instant value of glycemia helps to amend all parts of treatment to the needs of patient - insulin doses, diet and exercise. Proper filling in the diabetic diary is of great importance. Recently, new methods of continuous measurements of glycemia are introduced into the clinical practice. It is necessary to follow growth and overall development of child prospectively, actively search for diabetic chronic complications appearance (renal, nervous, ophthalmologic) and for often intercurrent diseases (thyroid gland, celiakia).
Of enormous importance in the care of diabetic children is so-called education nurse and clinical psychologist. Dividing competences and responsibility in treatment between adolescent and his/her family is of great importance. The decisions about putative changed work ability and choice of occupation, as well as for instance instructions on contraceptive methods are of great importance. Numerous clinics of pediatric diabetology organize regularly recondition stays ("diacamps"). Another important help to families of diabetic children is professional Association of parents and friends of diabetic children in the Czech Republic (www.diadeti.cz), which issues educational materials and organizes edifying stays. If family collaborates well, normal physical, psychological and social development of child can be reached today.
Author: Prim. MUDr. Jaroslav Škvor, CSc. (translated from Czech original)
