Diabetes
mellitus is a chronic disease in which the body does
not produce or properly use insulin. The body requires
insulin, a hormone manufactured by the beta cells of
the pancreas, to maximally use glucose from digested
food as an energy source. Diabetes mellitus is characterized
by elevated glucose in the blood and sometimes urine.
The goal of treatment is to manage the factors that
affect blood glucose levels (e.g., insulin, food, physical
activity)
to promote near-normal levels. Although the exact cause
of diabetes is not known, a genetic component to the
disease is recognized, and environmental and immunologic
factors may also play roles.
There
are two types of diabetes mellitus. In type 1 diabetes
mellitus, the body does not produce any insulin, and
daily insulin injections are required. Type 1 occurs
in infants, children, adolescents, and young adults and
accounts for 5 to 10 percent of all cases of diabetes
mellitus.1 In
contrast, persons with type 2 diabetes mellitus produce
insulin, but the body is unable to make enough or properly
use what is made.
Type
2 diabetes mellitus is typically diagnosed after the
age of 40 and accounts for 90 to 95 percent of all cases;
however, because of the increasing prevalence of obesity,
the number of children, adolescents, and young adults
with type 2 is increasing. Treatment of type 2 diabetes
mellitus includes lifestyle changes to promote a healthy
weight and regular physical activity, as well as oral
medications or supplemental insulin if needed. Prevention
of type 2 also involves the promotion of a healthy weight
and regular physical activity to improve carbohydrate
metabolism and insulin sensitivity. (See
the Obesity chapter.)
Nearly
16 million people in the United States have diabetes
mellitus; it affects 123,000 children and adolescents
under age 20.2 The
quality of care that children and adolescents receive
may affect their long-term health. Control of diabetes
mellitus aims to prevent acute complications (e.g., diabetic
ketoacidosis and severe hypoglycemia, both of which can
be life threatening) and chronic microvascular and macrovascular
complications, which can lead to blindness, kidney disease,
nerve damage, amputation, heart disease, and stroke.
No
screening recommendations for the diagnosis of diabetes
mellitus in children or adolescents with type 1 have
been established. During the early course of type 1 diabetes
mellitus, children and adolescents may present with symptoms
of polyuria (excessive urination), polydipsia (excessive
thirst), polyphagia (excessive appetite), and weight
loss. At this time, a random blood glucose level greater
than or equal to 200 mg/dL (11.1 mmol/L) or a fasting
plasma glucose greater than or equal to 126 mg/dL (7.0
mmol/L) is sufficient to make the diagnosis.3 Early
diagnosis reduces the risk of more dangerous conditions
(e.g., increased weight loss, dehydration, diabetic ketoacidosis).
