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Type 1 diabetes mellitus is a condition in which the body has mistaken its own insulin producing cells to be a foreign or enemy germ cells. The body then tries to kill these foreign or enemy cells through the actions of the immune system. When enough Insulin producing cells have been destroyed, the body can no longer make enough insulin to maintain normal glucose levels, and the body gradually develops Type 1 diabetes mellitus.

In Type 2 diabetes mellitus, the main problem is that the body becomes resistant to the actions of insulin. The body tries to make up for this by making more insulin. After some time, the body is no longer able to make enough insulin, and the person develops diabetes. This process can take some time, and the person can go through several stages such as:

  1. Insulin resistant with increased production of insulin and acanthosis nigricans (thickened skin and a dark colour around the neck and other skin fold regions) but normal blood glucose levels.

  2. Insulin resistant with increased production of insulin but insufficient for the body's needs and impaired glucose tolerance or impaired fasting glucose or diabetes mellitus.
    -Impaired glucose tolerance means that the body can no longer achieve normal glucose levels after a test meal of 75g of glucose.
    -Impaired fasting glucose means that the body can no longer achieve normal glucose levels even after the person has fasted overnight.

  3. Insulin resistant with decreased production of insulin, giving rise to Type 2 diabetes mellitus.



Type 1 or Type 2 diabetes mellitus?

Type 1 Diabetes mellitus is still the more common type of diabetes in childhood and the teenage years in many countries. However, all over the world, we are seeing an increasing number of older children and adolescents affected by the spectrum of Type 2 diabetes mellitus related illness, which includes insulin resistance with normal glucose tolerance, impaired glucose tolerance on the oral glucose tolerance test, impaired fasting glucose with or without impaired glucose tolerance, and Type 2 diabetes mellitus.

The use of fasting blood glucose samples alone for case finding in paediatric and adolescent patients is not recommended because patients in this age group with problems of glucose tolerance will often have normal fasting blood glucose values but abnormal 2 hour post glucose tolerance test values (ie blood glucose >7.8 mmol/l and above).

Type 2 diabetes patients often may not notice any symptoms of ill health. However, their bodies will still be affected by high blood glucose values.

It is important to test for this condition if a person is at high risk of Type 2 diabetes, because early treatment and preventive measures can prevent impaired glucose tolerance progressing to type 2 diabetes.

Risk factors include obesity, lack of exercise, a family history of type 2 diabetes mellitus or diabetes in pregnancy, a birth weight above 4kg or a history of having been a premature or IUGR (intra uterine growth retarded) infant.




How do we treat diabetes mellitus in childhood and adolescents?

Not all Type 2 diabetes mellitus patients can be successfully treated with oral medications alone. Some will do better with insulin or a combination of insulin and oral medications, especially in the initial stages of their condition. With individualized therapy and lifestyle changes, some patients are able to improve and then require only oral medications to achieve good diabetes control.

The objective of good diabetes treatment is not to take less medication or fewer injections, but to manage the condition as a whole so that the person with diabetes is able to take part in all normal daily activities with minimal restrictions as a result of the diabetes, to achieve optimum long term health and reduce or delay the onset of diabetes complications. We now have a variety of newer insulin analogues (improved compounds based on natural human insulin) and oral medications which can together help the person with diabetes achieve his or her goals.

At Dr Warren Lee's Paediatrics, Growth and Diabetes Centre, our philosophy is to help each individual with diabetes achieve the best possible control of diabetes with the best possible quality of life in the context of what is available affordable and accepted by the patient and the family.



For more information, please contact clinic at:
Camden Medical Centre
One Orchard Boulevard #02-06
Singapore 248649
Tel: (65) 6235 3678
Fax: (65) 6235 2618
SMS: (65) 9710 7136
General email, appointments and enquiries:


 
Growing Issues
Paediatrics & Endocrinology
Adolescent Medicine
Growth
Diabetes
Insulin Pumps
Glucose Monitoring and CGMS
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