Diagnosis of diabetes mellitus in children

Practically all children with a newly diagnosed disease have certain clinical symptoms. Hyperglycemia and glucosuria confirm the diagnosis of diabetes mellitus. The level of glucose in plasma of venous blood is higher than 11.1 mmol / l. In addition, most children diagnosed with ketonuria. Sometimes a child is diagnosed with an increase in glucose concentration above 8 mmol / L in the absence of symptoms of diabetes mellitus. If the postprandial glucose level (two hours after eating) is repeatedly higher than 11.0 mmol / l, the diagnosis of diabetes is unquestionable and does not require additional research. A convincing criterion for confirming the diagnosis of type 1 diabetes mellitus is the autoantibody to islet cells (1CA) and to the islet cell protein-glutamate decarboxylase in the blood serum.

For the diagnosis of atypical stages of diabetes, a standard glucose tolerance test is used. Tolerance to glucose is impaired if its level in whole capillary blood after 2 hours after oral loading with glucose (1.75 g / kg body weight) is within 7.8-11.1 mmol / l. In this case, the diagnosis of type 1 diabetes mellitus can be confirmed by the detection of autoantibodies in the serum.

Despite the fact that the symptoms of the disease are well known, it is often diagnosed with diabetes mellitus late. The state of young children is difficult to assess both parents and doctors, and ketoacidosis in young children can develop significantly faster than in older children. Abdominal pain in older children can be mistakenly regarded as a manifestation of acute appendicitis. Frequent and deep breathing observed in ketoacidosis can be mistakenly regarded as pneumonia, and polyuria as a manifestation of a urinary tract infection. Determining for the diagnosis in this case are hyperglycemia and glucosuria.

[1], [2], [3], [4], [5], [6], [7], [8], [9], [10]

Diagnostic criteria for diabetic ketoacidosis

• ketosis - hyperglycemia 11.1-20 mmol / l; glucosuria, ketonuria; blood pH is not lower than 7.3; BE to -10;
• precoma - hyperglycemia 20-40 mmol / l; glucosuria, ketonuria; blood pH 7.3-7.1; BE-10 ...- 20; K + Na + erythrocytes reduced; hemoglobin and hematocrit are increased;
• coma - hyperglycemia 20-40 mmol / l; glucosuria, ketonuria; Blood pH is below 7.1; BE is below -20; K and Na erythrocytes and blood serum are reduced, urea in the blood is increased; hemoglobin and hematocrit are increased, serum osmolality is 310-320 mosm / l.

[11], [12], [13], [14], [15], [16], [17], [18], [19], [20]

Differential Diagnosis of Diabetes Mellitus in Children

Differential diagnosis should be carried out with diabetes insipidus, accompanied by normoglycemia, aglucosuria and low relative density of urine, neurogenic polydipsia and polyuria, acetonemic vomiting in children with neuro-arthritic diathesis.

[21], [22], [23], [24], [25], [26], [27], [28], [29]