3. clinical presentation
•
There are usually no any specific symptoms
associated with neonatal hyperglycemia, but the
major
•
•
clinical problems associated with hyperglycemia
are hyperosmolarity and osmotic diuresis
.
4. •
Although rarely seen in the first months of life,
diabetes mellitus can present
•
•
with severe clinical symptoms, including polyuria,
dehydration, and ketoacidosis
.
•
reduced subcutaneous fat
,
•
•
and failure to thrive
5. Etiology
•
1
.
Exogenous parenteral glucose administration
•
2
.
Drugs.The most common association is with
steroids.theophylline, phenytoin, and diazoxide
.
•
3.
Extremely low birth weight (ELBW) infants
4.Sepsis
,
•
5.
“
Stressed
”
premature infant .surgical
procedures .hypoxia
6. •
6.
.
Neonatal diabetes mellitus. In this rare disorder
,
•
infants present with significant hyperglycemia
•
that requires insulin treatment in the first months of
•
•
life. They characteristically are SGA term infants
,
•
with no gender predilection, and a third have a
•
family history of diabetes mellitus
.
7. •
7.Diabetes due to pancreatic lesions such as
pancreatic aplasia, or hypoplastic
•
or absent pancreatic beta cells
8. Treatment
.
•
The primary goal is prevention and early detection
of hyperglycemia
•
and frequent monitoring of blood glucose levels
and urine for glycosuria
.
•
correct dehydration
•
Feed if condition allows; feeding can promote the
secretion of hormones that
•
promote insulin secretion.
•
•
9. • Exogenous insulin therapy has been used when
glucose values exceed 250mg/ dL
• Bolus insulin infusion
•
• a) Dose 0.05 to 0.1 unit/kg every 4 to 6 hours
•
• b) Infuse over 15 minutes via syringe pump
•
• c) Monitor glucose every 30 minutes to 1 hour
10. • If glucose remains 200 mg/dL after three doses ,
•
consider continuous infusion of insulin
• Rate of infusion is 0.01 to 0.2 unit/kg per hour
•
Monitor potassium level
.
11. • b. Subcutaneous insulin lispro
•
• i. This is rarely used except in neonatal diabetes. A typical
dose is 0.03 unit/kg as needed for glucose 200 mg/dL.
• ii. Do not administer more frequently than every 3 hours to
avoid hypo-glycemia.
• Insulin lispro has a rapid onset of action ( 15
–
30 minutes)
and peak effect is 30 minutes to 2
sruoh ½
.
•
•
