Case of Type 1 Diabetes Mellitus

A 8 year old female brought to the OPD with complaints of weight loss, increased frequency urination day and night from last few weeks Her weight is 23kgs One peculiar thing is her father is diabetic too Investigations HBA1c - 9.5% RBS - 350mg/dl Urine for Glucose +++ Advised for Stimulated C peptide GAD Abs Management Can we put her on basal bolus regimen ? How to proceed with diagnosis and treatment for the same?

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T1DM cases are prone to DKA & frequent hypoglycemia. Hence they need special care, hypoglycemia awareness, training on Carb counting & insulin dose adjustment by themselves. Further required investigations are:- Fasting Sr Insulin, C-Peptide, Ketone bodies in urine, CT Abd especially of Pancreas. Basal-bolus regimen of analogue insulin is ideal and the best way to treat it is to use Insulin Pump.

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Ideal is basal bolus regimen. Only needs close glucose monitoring and titration accordingly, to avoid hypoglycemia. If educated and taken care properly Insuline pump is also a good option.

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Type I diabetes is fragile diabetes, highly prone for hypoglycemia The patient need to be trained and motivated for diagnosis of hypoglycemia and treatment Unless proper training, motivation and support mechanism is established it is wise to keep sugars on higher side around 150 - 200 range, this is different from adult where relatively lower blood sugars are targeted, 90 - 120 mg/dl is desirable in adult but it is strictly avoided in type I children. Children need to be trained for calorie counting if meal and adjustment of dose of insulin according to calorie counting This amount to a huge difference between type I children and type II adult In adults our body takes care of most of the blood sugar management, we need to just give little bit of support to our bodies own insulin secretion In type I children, it is entirely different management, each and every rise in blood sugar level children have to depend on external injection of insulin. We as a doctor has to train children to imitate the nature. We need to give exact amount of insulin as per the calorie content of meal, nothing more and nothing less. It need to be precise. It is difficult to achieve the balance. It can only be achieved after great account of counseling and effort on part of patent, children and doctor. There are peer group of type I diabetes children, where a group of type I children are managed together. Such group gives better motivation and positive interpersonal interaction. Again there are no fixed rule for dose of insulin, it need to be adjusted on response of each child to insulin and based on calorie content of meal. It's a challenging management and require long term support and great amount of dedication from doctors as well! To start - one can start with Glargine insulin 8 units once a day and Glulisine insulin 6 units with each meal The dose needs lot of adjustment!

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Basal bolus regime ideal in this case . Needs close glucose monitoring and titration accordingly to avoid hypoglycemia Constant evaluation required.s r insulin CT Abdo. Regular evaluation and monitoring advised.

Thanks Dr Shivraj Agarwal
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Dear dr Ajeet Pal Singh Yes he is a c/o IDDM Start basal bolus insulin in titrating doses Investigate sr insulin Ct abdomen to study pancreas

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? JUVENILE DIABETES.. NEED'S.. INSULIN TREATMENT.. USG..ABDOMEN.. INSULIN BLOOD TESTS.. ENDOCRINOLOGIST OPINION..

Tnx Dr Ashok Leel sir..
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Further evaluation is required for diagnosis and treatment

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Type 2 diabetes  I AM TREATING THIS TYPE OF CASE BY GOMUTRA SHILAJIT AND SALASARADI KASAYAM AS SUSRUTHA

Congenital Juvenile type 1 DM: yr treatment line is okay. Pt will need life long insulin therapy. USG: upper abdomen, Blood Insulin assay .

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diabetes management tasks, such as insulin injections and blood glucose testing with supervision and support from caring and knowledgeable. remission) period. In the Diabetes Control and Complications Trial (DCCT), a reduction of microvascular complications with improved control was observed, although it should be noted that this trial involved mostly adults with type 1 diabetes. Of note, when the cohort of adolescents included in the DCCT was analyzed separately , the A1C level achieved in the “intensive” group was >1% higher than the current ADA recommendation for patients in general. Advice:-Diabetologists refer to those physicians who treat only diabetic patients,

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