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Chapter 15. Diabetes Mellitus

Manmohan K. Kamboj; Martin B. Draznin

Athough the incidence of type 2 diabetes mellitus (type 2 DM) in chidren and adolescents has increased in recent years, type 1 diabetes mellitus (type 1 DM) is the most prevalent type seen in this age group and is reviewed in more detail here. Within the context of sport participation, most patients seen by pediatricians are adolescents and although the following discussion mostly refers to adolescents, it is equally applicable to children unless otherwise specified.

Definitions

The diagnostic criteria for diabetes mellitus are shown in Table 15-1.

Table 15-1. American Diabetic Association Diagnostic Criteria for Diabetes Mellitus
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Table 15-1. American Diabetic Association Diagnostic Criteria for Diabetes Mellitus

Normoglycemia

IFG or IGT

Diabetes*

FPG ≤100 mg/dL

FPG≥ 100 and ≤126 mg/dL (IFG)

FPG ≥126 mg/dL

2-h PG†≤140 mg/dL

2-h PG†≥140 and ≤200 mg/dL (IGT)

2-h PG†≥200 mg/dL

Symptoms of diabetes and casual plasma glucose concentration ≥200 mg/dL

*In the absence of unequivocal hyperglycemia, a diagnosis of diabetes must be confirmed, on a subsequent day, by measurement of FPG, 2-h PG, or random plasma glucose (if symptoms are present). The FPG test is greatly preferred because of ease of administration, convenience, acceptability to patients, and lower cost. Fasting is defined as no caloric intake for at least 8 h.

†This test requires the use of a glucose load containing the equivalent of 75 g anhydrous glucose dissolved in water. 2-h PG, 2-h postload glucose.

Source: American Diabetes Association Position Statement. Diagnosis and Classification of Diabetes Mellitus. Diabetes Care. 2004;27:S5-S10.

Epidemiology

There are 20.8 million individuals in the United States with diabetes mellitus, comprising 7% of the total population; 176,500 of them are children and adolescents younger than 20 years of age. One in 400 to 600 children and adolescents have insulin-dependent diabetes, also called type 1 DM.1

Pathogenesis

A brief summary of the pathophysiology of diabetes mellitus as it relates to sports participation is essential to better understand the principles of management of diabetes in children and adolescents.

The availability of carbohydrates is important for use by the exercising muscles. Nondiabetic children and adolescents have full muscle and liver glycogen stores at rest. During exercise, muscle glycogen is used first to release lactic acid for the Cori cycle, followed quickly by liver glycogenolysis. As insulin levels decrease, liver glycogenolysis is continued; at the same time, with increased blood flow, binding of insulin to receptors in skeletal muscles is increased causing increased glucose uptake and metabolism during exercise. The glycogen stores in muscles and liver are then replenished from blood glucose following completion of physical activity.2–4

It is believed that hepatic glucose production is the same in children and adolescents with diabetes and those without diabetes. However, there ...

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