3. Introduction
Diabetes Mellitus is a chronic metabolic
disorder characterized by hyperglycemia as
a cardinal symptom, resulting from
deficiency of insulin and results in
abnormal metabolism of carbohydrates,
protein and fat.
It has two types, Type 1 and Type 2.
4. Type 1 DM
Absolute lack of insulin results in non-
utilization of glucose by the peripheral tissues
leading to hyperglycemia.
Most common endocrine disorder of
childhood.
Peak age of presentation in 5-7 years and at
time of puberty.
Incidence is approx. 0.7 in 100,000 per year in
Karachi.
5. Etiology
Lack of insulin due to
• Immune mechanisms: Pancreatic islet β-cell
destruction
• Genetic predisposition: HLA antigens DR3 and
DR4.
• Environmental factors: Cow’s milk, cereals.
• Viral infections: Coxackie B virus, CMV, Mumps,
Rubella.
• Idiopathic: 95% due to hereditary inborn errors
of metabolism.
• Secondary causes: Cushing syndrome,
Hemosiderosis, Hyperpituitarism, surgical
removal of pancreas.
7. Scenario
• A 14-year-old girl presents
with frequent urination,
excessive thirst and hunger.
She has the rapid loss of
weight within few months.
Serum glucose level 250
mg/dl. Urinalysis is positive
for 2+ glucose but is otherwise
normal.
21. Goals
To maintain Fasting blood sugar 80-
120 mg/dl and random ≤200 mg/dl
Adequate nutrition for normal growth
and development
Adequate treatment to avoid clinical
manifestations of disease
Sufficient metabolic control to avoid
long-term complications
22.
23. Diet
Recommended intake is:
Carbohydrates 55%
Fats 30%
Protein 15%
3 fixed meals with 2 snacks in between
Bedtime snacks encouraged if taking NPH
Avoid refined sugar
Add more fiber diet
24. Exercise
Regular exercise of at least
30 minutes a day
During exercise extra calories
or lower insulin diet is
recommended to prevent
hypoglycemia
33. Diabetic
Ketoacidosis
Life threatening acute complication of IDDM
Mortality rate 6-10%
BSR ≥ 250 mg/dl
pH ≤ 7.25
Plasma bicarbonate level ≤ 15 mEq/l
Ketonemia or ketonuria
Severe DKA if pH less than 7.1 and bicarbonate less 10
mEq/l
