At present, the prediction of type 1 diabetes is not a major clinical issue outside of trials for diabetes prevention. Patients, especially children, usually present acutely with diabetes with a dramatic history of polyuria, polydipsia, and weight loss. Despite what in retrospect is almost always a clear-cut clinical history of diabetes, a significant number of children have a delay in diagnosis, which increases the risk of severe metabolic decompensation with diabetic ketoacidosis (DKA), cerebral edema, and death. In Colorado for instance, with a population of four million, approx 1 child dies at the onset of type 1 diabetes every 2 yr. Overall in the United States, DKA occurs in 25-50% of children with new-onset diabetes, and symptomatic cerebral edema occurs in approx 1% of DKA episodes. Of those patients with clinically apparent cerebral edema, between 40% and 90% die (1).
in an attempt to identify risk factors for cerebral edema, a multicenter study evaluated several laboratory value parameters on hospital admission and different therapeutic regimens. it revealed that hypocarbia and treatment with bicarbonate were the two independent variables that placed patients at highest risk for cerebral edema (1). Perhaps the greatest risk factor for poor outcomes, however, is the misdiagnosis or delay in diagnosis once the child is seen by a health care provider. Therefore, for acutely ill children, one should have a very low threshold for obtaining a urine and finger-stick glucose, two simple rapid tests that can rule out diabetes.
From: Contemporary Endocrinology: Type 1 Diabetes: Etiology and Treatment Edited by: M. A. Sperling © Humana Press Inc., Totowa, NJ
Despite the usual acute dramatic presentation of diabetes, there is now considerable evidence that type 1 diabetes (particularly the common immune form of type 1 diabetes termed type 1A diabetes) is a chronic autoimmune disorder (2,3). In studies of relatives of patients with type 1A diabetes and recent studies of children from the general population, anti-islet autoantibodies usually precede the development of diabetes by years (4-9). There may be some children with acute development of autoimmunity and rapid progression to diabetes, but discovering such children in prospective studies will require considerable effort, as it appears that they are rare. There are a number of reports of acute development of type 1 diabetes ascribed to acute viral infections (10). It is likely that these reports may represent viral infections occurring in individuals who expressed anti-islet autoantibodies years prior to the acute infection. A recent report from Japan described several individuals with likely a form of type 1B diabetes, who, despite marked hyperglycemia, had normal HbA1c levels, suggesting a truly acute development of diabetes (11). These individuals also had elevated pancreatic serum enzymes and pancreatitis but not islet inflammation. In the United States, with a much higher incidence of type 1 diabetes compared to Japan, it is rare to find individuals presenting with diabetes with normal HbA1c and it is likely that the great majority have had hyperglycemia for months prior to diagnosis.
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Diabetes is a disease that affects the way your body uses food. Normally, your body converts sugars, starches and other foods into a form of sugar called glucose. Your body uses glucose for fuel. The cells receive the glucose through the bloodstream. They then use insulin a hormone made by the pancreas to absorb the glucose, convert it into energy, and either use it or store it for later use. Learn more...