What is neonatal diabetes
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Diabetes is caused by An endocrine-metabolic disorder syndrome caused by multiple causes (heterologous), which is characterized by a relative or absolute lack of insulin secretion in the body and/or insulin resistance leading to a disorder of carbohydrate metabolism and a decrease in tolerance to sugars. Blood sugar is elevated, accompanied by fat, protein metabolism and water and electrolyte balance disorders. Neonatal diabetes is very rare and difficult to treat, and the incidence rate in Europe and America is 1/(400,000 to 450,000).
Medically, diabetes occurring within 6 months after birth is called neonatal diabetes, but the incidence is not high. Type I diabetes is the main cause of this type of child requiring lifelong insulin injections. Another type of neonatal temporary diabetes is rare.
Clinical manifestations of neonatal diabetes
Children with neonatal diabetes lack typical “three more and one less” performance, and about 40% of children are already in ketoacidosis at the time of presentation. status. The symptoms are often heavier than in children with diabetes, and the condition of those who have not been treated with insulin is rapidly developing.
1. More than half of the children are premature, less than the gestational age.
2. Weight loss, fever, decreased subcutaneous fat, slow weight gain, no increase or even decrease, polyuria.
3. Dehydration, hyperglycemia, severe dehydration, symptoms such as cold limbs, weak pulse, fast heart rate, low blood pressure, etc.; polydipsia, eating well, but severe cases are not good.
4. Drowsiness, rarely coma, varying degrees of ketoacidosis, low potassium (early may not be low), pre-renal uremia, prone to infections such as sepsis and urinary tract Infection, etc.
Newborn Diabetes Test
1. Fasting blood glucose>7mmol/L, blood glucose can be increased rapidly without insulin treatment, Up to 100mmol /L or more.
2. There are many mild to moderate ketonuria, a few without; most children have ketoacidosis, which is significantly negatively correlated with blood glucose. The pH of severely ill children can be as low as 7.2 or less.
3. Plasma osmotic pressure increased, serum sodium decreased or normal, serum potassium was normal, and a few increased.
4. Plasma insulin and C-peptide were both reduced or not detected, and islet cell antibodies (ICA) were negative.
5. The immunological tests for both virus and Toxoplasma infection were negative.
Diagnosis of neonatal diabetes
The following three points can be diagnosed.
1. Blood glucose elevation is the main diagnostic basis.
2. Clinical manifestations see the above clinical manifestations.
3. In addition to other causes of neonatal hyperglycemia, urine glucose positive or with ketone body positive.
Diagnostic diagnosis of neonatal diabetes
1. Temporary hyperglycemia
Premature infants are not fully mature due to islet β cell development or the body is suffocated, infected, Hyperglycemia can occur when stress is caused by frostbite or craniocerebral injury, but hyperglycemia disappears after the glucose drip rate is reduced or the primary disease is cured.
2. High anion gap (AG) metabolic acidosis
may occur in metabolic acidosis caused by various causes such as asphyxia, hypoxia, shock, etc., and There is no hyperglycemia in the characteristics of each disease.
Fanconi syndrome may have diabetes, and it has the characteristics of primary disease, and there is no hyperglycemia.