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Diabetes in Children and Adolescents
RV Jayakumar, Nisha Bhavani, Praveen V Pavithran
CHAPTER 1:
Definition, Epidemiology, Diagnosis, and Classification of Diabetes
INTRODUCTION
HISTORY
EPIDEMIOLOGY OF TYPE 1 DIABETES MELLITUS
A BRIEF HISTORY OF TODAY'S CLASSIFICATION SYSTEM
CURRENT CRITERIA FOR DIAGNOSIS OF DIABETES MELLITUS
CLASSIFICATION
Type 1 Diabetes Mellitus and the Present International Classification
Immune-mediated Type 1 Diabetes Mellitus
Idiopathic Type 1 Diabetes Mellitus
Type 2 Diabetes of Young
CONCLUSION
CHAPTER 2:
Type 1 Diabetes Mellitus
INTRODUCTION
EPIDEMEOLOGY
GENETICS AND PATHOPHYSIOLOGY OF TYPE 1 DIABETES MILLETUS
Genetics
Major Histocompatibility Complex Genes
Nonmajor Histocompatibility Complex Genes
Pathogenesis of Type 1 Diabetes Mellitus
AUTOANTIBODIES ASSOCIATED WITH TYPE 1 DIABETES MELLITUS
Glutamic Acid Decarboxylase
Insulinoma-associated Protein-2
Zinc Transporter Autoantibody
Insulin Autoantibodies
ROLE OF ENVIRONMENTAL FACTORS IN THE PATHOGENESIS OF TYPE 1 DIABETES MELLITUS
PREDICTION OF TYPE 1 DIABETES MELLITUS
PHASES OF TYPE 1 DIABETES MELLITUS IN CHILDREN AND ADOLESCENTS
Clinical Features
Partial Remission or Honeymoon Phase in Type 1 Diabetes Mellitus
Chronic Type 1 Diabetes Mellitus with Lifelong Insulin Dependence
DIAGNOSIS
Differential Diagnosis of Type 1 Diabetes Mellitus
MANAGEMENT OF TYPE 1 DIABETES MELLITUS
Blood Glucose Monitoring
Nutrition
Exercise
Insulin
Complications of Treatment of Type 1 Diabetes Mellitus with Insulin
Sick Day Rules
Treatment of Acute Complications
Glycemic Targets
Psychological Care
Special Issues in Type 1 Diabetes Mellitus
Infants and Toddlers (0–2 years)
Developmental Issues (3–7 years)
Developmental Issues (8–11 years)
Developmental Issues in Adolescents
NEWER THERAPEUTIC ADVANCES
CONCLUSION
CHAPTER 3:
Type 2 Diabetes in Children
INTRODUCTION
EPIDEMIOLOGY OF TYPE 2 DIABETES MELLITUS IN YOUNG
DIAGNOSIS OF TYPE 2 DIABETES IN THE YOUNG
DIFFERENTIATING TYPE 1 AND TYPE 2 DIABETES
Screening for Type 2 Diabetes in Children
ETIOPATHOGENESIS
CLINICAL PRESENTATION
MANAGEMENT OF TYPE 2 DIABETES IN CHILDREN
Treatment Options
Nonpharmacological Therapy
Pharmacological Therapy
Surgery
Treatment of Comorbidities
Hypertension
Dyslipidemia
Nonalcoholic Fatty Liver Disease
Screening for Comorbidities
Complications of Type 2 Diabetes in Children
Vascular Complications
PREDICTORS OF TYPE 2 DIABETES
PREVENTION OF TYPE 2 DIABETES
Lifestyle Modification
Preventive Pharmacotherapy
CONCLUSION
CHAPTER 4:
Maturity Onset Diabetes in the Young
INTRODUCTION
MATURITY ONSET DIABETES IN THE YOUNG 1
MATURITY ONSET DIABETES IN THE YOUNG 2
MATURITY ONSET DIABETES IN THE YOUNG 3
MATURITY ONSET DIABETES IN THE YOUNG 4
MATURITY ONSET DIABETES IN THE YOUNG 5
OTHER TYPES OF MATURITY ONSET DIABETES IN THE YOUNG
MOLECULAR GENETIC TESTING FOR MATURITY ONSET DIABETES IN THE YOUNG
CONCLUSION
CHAPTER 5:
Neonatal Diabetes
INTRODUCTION AND EPIDEMIOLOGY
TRANSIENT NEONATAL DIABETES
Defect Due to Immaturity of Islets
Chromosome 6q24 Abnormalities
Hepatocyte Nuclear Factor-1β
KCNJ11 and ABCC8 Mutations
PERMANENT NEONATAL DIABETES
Pancreatic Transcription Factor
Pancreas Duodenum Homeobox-1/Insulin Promoter Factor-1
GLI Similar 3
Wolcott-Rallison Syndrome
Insulin Gene Mutations
Immunodysregulation Polyendocrinopathy Enteropathy X-linked Syndrome
Glucokinase Mutations
KCNJ11 and ABCC8 Mutation-related K+ Channel Dysfunction
CONCLUSION
CHAPTER 6:
Rare Forms of Childhood Diabetes
INTRODUCTION
WOLFRAM (DIDMOAD) SYNDROME
MITOCHONDRIAL DIABETES
THIAMINE RESPONSIVE MEGALOBLASTIC ANEMIA (ROGERS SYNDROME)
DIABETES OCCURRING AS PART OF RARE SYNDROMES
CONCLUSION
CHAPTER 7:
Glycemic Monitoring and Assessment
INTRODUCTION
LABORATORY TESTING OF BLOOD GLUCOSE LEVELS
SELF-MONITORING OF BLOOD GLUCOSE
GLYCOSYLATED HEMOGLOBIN
CONTINUOUS GLUCOSE MONITORING
OTHER ASPECTS OF GLYCEMIC MONITORING IN TYPE 1 DIABETES MELLITUS
CONCLUSION
CHAPTER 8:
Insulin Therapy in Children with Diabetes Mellitus
INTRODUCTION
RATIONALE AND GOAL OF INSULIN THERAPY
BARRIERS FOR GLYCEMIC CONTROL IN CHILDREN WITH DIABETES MELLITUS
PHYSIOLOGICAL BASIS OF INSULIN THERAPY
TYPES OF INSULIN
Rapid and Short-acting Insulins
Intermediate-acting Insulin
Long-acting Insulins
INSULIN REGIMENS
INSULIN ADMINISTRATION
Split-mixed Regimen
Adjustment of Insulin Dose Based on Premeal Blood Glucose
Basal Bolus Regimen
Exercise and Insulin
Home Monitoring of Blood Glucose
WHICH REGIMEN TO CHOOSE?
NEWER INSULIN DELIVERY SYSTEMS
Continuous Subcutaneous Insulin Infusion
ALTERNATIVE INSULIN DELIVERY SYSTEMS
Artificial Pancreas
Patient Education and Support
Sick Day Management
CONCLUSION
CHAPTER 9:
Hyperglycemic Emergencies in Children
INTRODUCTION
DIABETIC KETOACIDOSIS
Definition
Epidemiology and Precipitating Factors
Pathophysiology
Clinical Features
Investigations
Management
Rehydration
Insulin
Electrolytes
Morbidity and Mortality
HYPERGLYCEMIC HYPEROSMOLAR SYNDROME
Complications of Hyperglycemic Emergencies in Children
Cerebral Edema
Other Intracerebral Complications
Rhabdomyolysis
Mucormycosis
Pancreatitis
Peripheral Venous Thrombosis
Follow-up
CONCLUSION
CHAPTER 10:
Hypoglycemia in Diabetic Children
INTRODUCTION
DEFINITION
COUNTER-REGULATORY MECHANISMS
CLINICAL FEATURES
ROLE OF EXERCISE
RISK FACTORS FOR HYPOGLYCEMIA
SEVERITY OF HYPOGLYCEMIA
Mild-to-moderate Hypoglycemia
Severe Hypoglycemia
TREATMENT OF HYPOGLYCEMIA
Prevention of Hypoglycemia
Nocturnal Hypoglycemia
Dietary Management During Exercise in Type 1 Diabetes Mellitus
CONCLUSION
CHAPTER 11:
Hypoglycemia in Nondiabetic Children and Newborn
INTRODUCTION
SPECIAL PROBLEMS IN GLUCOSE HOMEOSTASIS IN THE NEWBORN AND INFANCY
NORMAL BLOOD GLUCOSE HOMEOSTASIS
HORMONAL INTERPLAY IN GLUCOSE HOMEOSTASIS
CHANGES IN BLOOD GLUCOSE HOMEOSTASIS AT BIRTH
BLOOD GLUCOSE LEVELS AND OCCURRENCE OF HYPOGLYCEMIA
SYMPTOMS OF HYPOGLYCEMIA
CAUSES OF HYPOGLYCEMIA
Galactosemia
Hereditary Fructose Intolerance
Ketotic Hypoglycemia
Persistent Hyperinsulinemic Hypoglycemia of Infancy
EVALUATION
MANAGEMENT
CONCLUSION
CHAPTER 12:
Chronic Complications in Children with Diabetes
INTRODUCTION
BURDEN OF THE PROBLEM AND ITS SIGNIFICANCE
COMMON CHRONIC COMPLICATIONS
MICROVASCULAR COMPLICATIONS OF DIABETES IN CHILDREN
Pathogenesis
Diabetic Retinopathy
Epidemiology
Classification and Grading of Diabetic Retinopathy11
Pathology
Prevention and Screening Guidelines
Management
Diabetic Nephropathy
Epidemiology
Stages and Classification
Pathology
Prevention and Screening Guidelines
Diabetic Neuropathy
Epidemiology
Types of Diabetic Neuropathy
Significance
Prevention and Screening Guidelines
MACROVASCULAR COMPLICATIONS
Epidemiology
Pathogenesis
TARGETS TO REDUCE DIABETIC VASCULAR COMPLICATIONS
RISK FACTORS
Modifiable Risk Factors
Glycemic Control
Hypertension
Environmental Factors
Genetic Factors
Nonmodifiable Risk Factors
Gender
Puberty
Duration and Onset of Diabetes
PREVENTIVE AND TREATMENT STRATEGY
SCREENING FOR MICROVASCULAR AND MACROVASCULAR COMPLICATIONS
Recommended Care
Limited Care
Comprehensive Care
RECOMMENDATIONS OF INTERNATIONAL DIABETES FEDERATION/INTERNATIONAL SOCIETY FOR PEDIATRIC AND ADOLESCENT DIABETES (2011) FOR ASSOCIATED COMPLICATIONS
Recommended Care
Limited Care
Comprehensive Care
OTHER COMPLICATIONS
Impaired Growth and Development45
Necrobiosis Lipoidica Diabeticorum
Limited Joint Mobility
Edema
FUTURE TRENDS
CONCLUSION
CHAPTER 13:
Autoimmune Associations of Type 1 Diabetes Mellitus
INTRODUCTION
AUTOIMMUNE THYROID DISEASE
CELIAC DISEASE
ADDISON’S DISEASE
OTHER DISEASES
The Autoimmune Polyglandular Syndromes
Atrophic Gastritis
CONCLUSION
CHAPTER 14:
Management of Diabetes in Children Undergoing Surgical Procedures
INTRODUCTION
PROTOCOL FOR MANAGEMENT7–10
Major Surgery
Minor Surgery
Emergency Surgery
Type 2 Diabetes Mellitus
CONCLUSION
CHAPTER 15:
Diabetes Education in Children with Type 1 and Type 2 Diabetes
INTRODUCTION
DIABETES EDUCATION PROGRAM IN CHILDREN
Primary or Level 1 Education
At the Diagnosis: Survival Skills1
Second or Level 2 Education: Continuing Educational Curriculum
Education for Different Age Groups
Infants and Toddlers
Schoolgoing Children
Adolescents
Diabetes Education for Children with Type 2 Diabetes
Screening for Complications Specific to Type 2 Diabetes in Children
Continuing Education
CONCLUSION
CHAPTER 16:
Exercise in Children with Diabetes
INTRODUCTION
EXERCISE
Normal Physiology
Influence of Exercise in Patients with Type 1 Diabetes Mellitus
Hypoglycemia
Hyperglycemia
Exercise and Diabetic Complications
Insulin and Exercise
Preventive Measures for Maintaining Euglycemia
Monitoring
Supplemental Nutrition
Insulin Dose Modification
Glycemic Control and Exercise in Type 1 Diabetics
Exercise in Type 2 Diabetics
CONCLUSION
CHAPTER 17:
Nutritional Principles in the Management of Diabetes in Children
INTRODUCTION
GENERAL PRINCIPLES AND AIMS OF MANAGEMENT
Basic Nutritional Management
Carbohydrates in Diabetes
Carbohydrate Counting
Exchange System
Glycemic Index
Proteins
Fats
NUTRITION IN SPECIAL CIRCUMSTANCES
Different Requirements in Different Age Groups
Different Regimens of Insulin
Exercise and Special Activities
Celiac Disease
Diabetes in Adolescents
CONCLUSION
CHAPTER 18:
Continuous Subcutaneous Insulin Infusion in Children with Diabetes
INTRODUCTION
HOW DOES INSULIN PUMP WORK?
ADVANTAGES OF PUMP THERAPY
PRACTICAL CONSIDERATIONS
DISADVANTAGES
ADVANCES IN PUMP THERAPY
CONCLUSION
CHAPTER 19:
Transplantation and Emerging Treatment Modalities in Type 1 Diabetes
INTRODUCTION
APPROACHES TO TRANSPLANTATION
POST-TRANSPLANT PANCREAS AND ISLET CELL FUNCTION
EFFECT OF TRANSPLANTATION ON DIABETES COMPLICATIONS
COMPLICATIONS OF TRANSPLANTATION AND PATIENT SURVIVAL RATES
PROBLEMS WITH IMMUNOSUPPRESSIVE DRUGS
Issues with Transplantation Sites
EMERGING THERAPIES FOR TYPE 1 DIABETES MELLITUS
CONCLUSION
CHAPTER 20:
Prevention of Diabetes in Children
DIABETES IN CHILDREN: EPIDEMIOLOGY
PATHOPHYSIOLOGY AND NATURAL HISTORY OF TYPE 1 DIABETES
INTERVENTION: WHEN AND HOW?
Primary Prevention of Type 1 Diabetes
Primary Prevention Trials
Secondary Prevention of Type 1 Diabetes
Tertiary Prevention of Type 1 Diabetes
TYPE 2 DIABETES IN CHILDREN AND ADOLESCENCE: THE EPIDEMIC IN INFANCY
ROLE OF EXERCISE IN THE PREVENTION OF DIABETES IN CHILDREN
CONCLUSION
INDEX
TOC
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