Diabetes mellitus (DM) is one of the most common chronic diseases of the pediatric population accounting for more than 150,000 current US cases. Traditionally, DM in the pediatric patient is generally thought to be diabetes mellitus type 1 (DM1), previously referred to as juvenile onset DM. However, diabetes mellitus type 2 (DM2) is increasingly common among children and adolescents. Previously referred to as adult-onset DM, the disease is becoming increasingly common among children due to dietary and obesity issues.
DM1 accounts for approximately two of every three childhood cases of DM. The presentation of DM1 varies greatly among patients but often falls into two distinct groups: (1) approximately 20–40% of new-onset DM1 present with diabetic ketoacidosis (DKA) and, (2) most of the remainder present with classic signs and symptoms of new-onset DM (Table 42–1). The difference between the two groups is that those presenting with DKA have often progressed to complete or near complete β-cell dysfunction. A third less common group includes children diagnosed early due to historical information such as relatives with DM or via an incidental finding as other concerns are evaluated.
Table Graphic Jump Location Table 42–1.Classic diabetes mellitus presentation. ||Download (.pdf) Table 42–1. Classic diabetes mellitus presentation.
|Weight loss |
Children with hyperglycemia often present with a recent history of polyuria and polydipsia and with clinical dehydration. In younger children, the history may be difficult to elicit but suspicion should be raised by an increasing numbers of wet diapers, especially in the dehydrated child and in child with unexplained weight loss.
Laboratory evaluation may include studies to evaluate for DKA (Table 42–2) and glycated hemoglobin A1c (HbA1c). The test may not be helpful in the emergency department; however, it is an integral part of the hyperglycemia workup and may hasten the patient’s long-term treatment plan.
It is difficult to make a diagnosis of hyperglycemia in children younger than 6 years; therefore, a child presenting with a classic finding (see Table 42–1) or yeast infection in children should have a glucose level obtained.
Table Graphic Jump Location Table 42–2.Common laboratory findings used to make the diagnosis of diabetic ketoacidosis. ||Download (.pdf) Table 42–2. Common laboratory findings used to make the diagnosis of diabetic ketoacidosis.
|aElevated serum β-hydroxybutyrate: > 2.0 mmol/L |
|Hyperglycemia (glucose > 250 mg/dL) |
|Elevated anion gap > 16 |
|Venous pH: < 7.30 |
|Serum HCO3: < 15 mEq/L |