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Dx Diabetes Treatment in Children (Type II) Treatment: Read More...


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Observation:
Diabetes in Children (Type II)

 The Merck Manual states:
"Recently, the number of children, especially adolescents, with type 2 diabetes has been steadily increasing. Today, 10 to 50% of children newly diagnosed with diabetes have type 2 diabetes. The increase in childhood type 2 diabetes has been particularly prominent among Native Americans, blacks, and Hispanics. Obesity and a family history of type 2 diabetes are major factors in the development of type 2 diabetes (but not type1)."

Medscape explains Diagnostic Testing for type 2 diabetes should be considered when a patient is overweight and has any 2 of the following:
*Family history of type 2 diabetes in first-degree or second-degree relative
*Minority race or ethnicity (eg, American Indian, black, Hispanic, Asian or Pacific Islander)
*Signs of insulin resistance or conditions associated with insulin resistance (eg, acanthosis nigricans, hypertension dyslipidemia, PCOS)

Recommendations for screening are as follows:
*Initial screening may begin at age 10 years or at onset of puberty if puberty occurs at a young age

*Screening should be performed every 2 years A fasting plasma glucose test is the preferred screening study; if clinical suspicion is high but fasting blood glucose is normal (< 100 mg/dL), an oral glucose tolerance test should be considered

Glucose values may be interpreted as follows:
*A random plasma glucose concentration of 200 mg/dL or greater in association with polyuria, polydipsia, or unexplained weight loss is diagnostic of diabetes
*In an asymptomatic patient, a fasting plasma glucose value of 126 mg/dL or greater or a 2-hour plasma glucose value of 200 mg/dL or greater during an oral glucose tolerance test is also diagnostic of diabetes

Other laboratory results that usually suggest type 2 diabetes are as follows:
*Elevated fasting C-peptide level
*Elevated fasting insulin level greater than 10miu/L
*Absence of autoimmune markers (glutamic acid decarboxylase [GAD] and islet cell antibodies."

Medications Used in Treatment:
1. Biguanides: metformin
2. Insulins: Humalog
3. Anabolic steroids for select males over age 18d>

*[Editor]PODCAST focus on  Children with Adult Onset Diabetes

Suggested Links
*Merck Manual
*Medscape

*[Editor]: See Breakthrough in Diabetes: Lecture Series

*[Editor]: With the fasting insulin, fasting glucose and hemoglobin A1c blood laboratory tests costing less than $20 (twenty dollars), every obese child and those of obese or diabetic parents should be screened for diabetes.

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