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New York, Long Island: Juvenile Diabetes Treatment

A brief introduction to juvenile diabetes and care for children with diabetes. Includes information on causes, treatment, problems with sympton management and specialized problems of children, tweens and teens. In addition, links to various informational websites such as a dictionary of diabetes terms, are available.

Juvenile Diabetes:

Juvenile Diabetes is also known as Type I diabetes or Insulin Dependent Diabetes Mellitus (abbreviated as IDDM and probably the preferred term, as not all Type I diabetics are youngsters). However, classically it is a disease of the young and is due to loss of the cells that secrete insulin in the pancreas, the so-called beta cells. This is in contrast to Type II diabetes (Adult onset diabetes or Non-insulin Dependent Diabetes) where there is abundant insulin and the body is resistant to it. Type II diabetes is usually associated with obesity. The beta cells are abundant in type II diabetes.

As a medical student, Type I Diabetes was one of the first diseases that this editor learned about (in the late 1960s). It involves major disruptions in energy metabolism (glucose not used – and glucose is one of the two fuels that the brain uses), severe acute complications (so-called diabetic ketoacidosis where extremely high levels of glucose are associated with intermediate acidic metabolites {ketone bodies, measured usually in the urine} and severe metabolic complications that may lead to death. There are also chronic complications of diabetes – kidney, eye and accelerated atherosclerosis leading to heart disease, stroke and very tragically, poor circulation to the limbs with poor wound healing and often loss of a foot or a leg.) Another serious complication is low blood sugar or hypoglycemia; it is said that every episode of hypoglycemia with loss of consciousness (hypoglycemic coma) is associated with brain damage.

Much has changed since this editor was a medical student: There is an ever increasing awareness that there are significant psychological issues in Type I diabetes in children – especially as they enter their tween and teen years; the kids learn to use their illness, as do young epileptics, as a mechanism of controlling their parents. Thus Juvenile Diabetes is truly, like epilepsy and mental illness, a family disease. Other changes – and there are many – include diet standardization, new forms of human insulin, including a recently approved insulin that can be taken by nasal inhalation, rather than relatively painful injection. Finally, the biggest advance in medicine is the critical subject of glucose control: It has been learned that MANY if not MOST of the chronic complications of both types of Diabetes are related to poor glucose control – and the royal highway to glucose control has been home monitoring of glucose (many readings throughout the day with microadjustment of insulin dose) and the lab tests such as HA1c (Glycolosated Hemoglobin) that give family, patient and physician an indication of long term glucose control.

As a final quick subject, what causes Juvenile Diabetes? To start, all diseases have both a Genetic and an Environmental Component. And because the patient’s own immune cells are killing the insulin beta producing cells, Juvenile Diabetes is said to be an (archetypical) autoimmune disorder. One set of genes thought to be involved are the HLA genes, involved in transplant rejection. Others are suspected. The trigger for these cells, the environmental component, is unknown but is thought to range from dietary components to infections. This is an area of very, very active study, as prevention of Type I diabetes would be infinitely easier than current treatments.

Below are some informative (to this physician) websites for the general public. Many are also available in Spanish. Please note that is not responsible for the content of external websites. And Diabetes of all types is a significant disorder and any diagnostic or treatment issues MUST be discussed with the Health Care Provider of your choice.
Related Links
1. Medical Care, Long Island, NY
2. Pediatrician, Long Island, NY
3. American Diabetes Assoc.
4. Nat. Diabetes Education Program
5. Diabetes Dictionary by NIH
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