Posters Presentations: P3-501–P2-720

2004 Hormone Research in Paediatrics  
In diabetic ketoacidosis (DKA), β hydroxy butyrate (βOHB) is the major ketone body accumulated in blood. During treatment of DKA, βOHB is converted to acetoacetate and acetone which are excreted in the urine. Venous βOHB level is the preferred test for monitoring metabolic status in DKA but cost and unavailability limits its use. Ketone monitoring is usually done semiquantitatively by measuring urinary ketones. However, persistence of ketones in the urine, despite metabolic improvement is seen
more » ... ue to the above mentioned limitations. We aimed to compare the sensitivity of capillary βOHB by electrochemical method with urinary ketone measurement during treatment of DKA Patients with DKA admitted to the hospital were followed with simultaneous measurements of fingerstick capillary βOHBmeasured by electrochemical method (Medisense Optium, Abbott), and urinary ketone by dipstick method. Blood gases were measured in 2-4 hrs intervals. The relationship between simultaneous measurements of urine ketone, blood ketone, blood pH and HCO3 were investigated. 14 patients with DKA (7 M, 7 F, Age: 9.2 ± 4.2 yr) were included with 50 simultaneous measurements of capillary and urinary ketone. Blood gases were assessed 2-4 hourly. No correlation was detected between urine ketone and blood PH (p=0.06) and HCO3 (p=0.79) while a significant negative correlation was found between capillary blood ketone and blood pH (r:-0.41, p <0.05) and HCO3 (r:-0.35, p<0.05). Capillary βOHB and urine ketones did not correlate at the beginning and 3.3 ± 1.4 hrs after treatment, but did correlate in the third samples taken 7.8 ± 2.0 hrs after treatment (p<0.05). We conclude that capillary blood βOHB level shows good correlation with the degree of acidosis (pH and HCO3) during DKA management. Capillary βOHB is more sensitive than urinary ketone measurement in reflecting the patient's metabolic status and improvement during treatment. P3-502 Diabetes and Insulin Introduction: Impaired endothelial function is detectable in patients with diseases associated with vascular complications, such as type 1 diabetes. The aim of our study was to evaluate whether glycemic control could influence vascular endothelial function in girls with type 1 diabetes. Patients/Methods: The study included 18 girls (13.0±3.7 years old) with type 1 diabetes of 62.3± 32.5 months' duration (range 8.0-118 months). All girls underwent to blood sample for determination of fasting glycemia and HbA 1c levels. Vascular function of conduit arteries was assessed by measurement of endothelium-dependent vasodilation of the brachial artery using high-sensibility ultrasound system. Flow-mediated dilation (FMD) was expressed as percentage change of diameter following reactive hyperemia from baseline. Results: The values of glycemia, HbA 1c and FMD were 243±95 mg/dl, 8.7±1.4 % and 7.0±9.0 % respectively. In our patients FMD was significant related to HbA 1c (r = -0.50, p = 0.03; figure) , while no correlation was demonstrated with glycemic levels and the duration of the disease. Conclusions: Our data show that a good glycemic control gets a better vascular function in girls with type 1 diabetes. However, further studies are required to better understand if other factors are involved in functional changes of endothelial dysfunction. Good metabolic control of diabetes decreases the risk of chronic complications. Intensive therapeutic regimens with continuous subcutaneous insulin infusion (CSII) combined with frequent measurements of capillary blood glucose levels are known to be one of the best ways of achieving good metabolic control. The Continuous Glucose Monitoring System (CGMS, Minimed, Sylmar, CA), a Holter-type monitor, gives more information about 24 h glycemic profiles than capillary blood glucose measurements. The purpose of this study was 1) to describe the glucose profile during 24 h in young children with type I diabetes treated with insulin pump therapy; 2) to determine whether the CGMS is representative of the overall metabolic control as assessed by HbA1c. Values are means ± SD. Thirteen young children with type 1 diabetes (age 4.2 ±2.0 years) were monitored for 3 days using the CGMS. One month later, HbA1c was measured by HPLC. Mean 24 h glucose was 162 ± 36 mg/dl, and HbA1C was 8.0 ± 1.0 %. The preprandial glucose (2 h period before meal) was 152 ± 32 mg/dl and the post prandial glucose (2 h period after meal) was 161 ± 28 mg/dl (p<0.05). The nocturnal glucose was 147 ± 47 mg/dl vs. 168 ± 46 mg/dl in the day time (p<0.05). The CGMS detected asymptomatic hypoglycemia (<60 mg/dl) during 10 ± 8 % of the time and hyperglycemia (<180 mg/dl) during 37.5 ± 20 % of the time. The mean 24 h glucose was not correlated with HbA1C. However, the percentage of time in hypoglycemia (<60 mg/dl) was negatively correlated with HbA1C (r=-0.507, p<0.02). The CGMS is useful for detecting unrecognized hypoglycemias in young children with type 1 diabetes. However, metabolic control, as assessed by HbA1c, was better reflected by the percentage of time in hypoglycemia than by the mean 24 h glucose. Purpose: To study prevalence and degree of disorders of central, peripheral and autonomic nervous system in children with diabetes mellitus type I (TIDM). Objects and methods: Examination of nervous system in 100 children -8-15 years with TIDM was provided. The diagnostics of diabetic peripheral neuropathy (DPN) was provided on the basis of quantitative sensory testing (TSS, NSS, NDS) and electromyography. The condition of central nervous system was determined on the basis of cognitive and emotional function tests; cerebral circulation was investigated (rheoencephalography). For evaluation of diabetic autonomic neuropathy (DAN) we used cardiovascular tests. The degree of compensation of carbohydrate metabolism was estimated according to criteria ISPAD Consensus 140 Horm Res 2004;62(suppl 2):1-215 Poster Presentations P3-506 Diabetes and Insulin Children with diabetes should be encouraged to participate in physical activity because exercise can benefit insulin sensitivity and improve known risk factors for atherosclerosis. We investigated physical activity patterns of 119 children and adolescents with stable insulin-dependent diabetes mellitus by 24-hour continuous heart rate monitoring during normal week days. The percentage of heart rate reserve was used to measure the amounts of physical activity at different intensities. The results were compared with normative data (n=200). Diabetic preschool-children accumulated 192.7±78.1, 39.1±24.3 and 21.3±9.4 minutes/day (mean±SD) of light, moderate and vigorous physical activities, respectively. At the same activity levels, diabetic schoolchildren accumulated 168.9±76.7, 35.9±16.9 and 19.0±14.8 minutes/day, and diabetic teenagers accumulated 166.3±67.5, 45.6±26.9 and 25.2±15.3 minutes/day. Diabetic schoolchildren were significantly more active than healthy peers when considering moderate activity (35.9±16.9 vs. 32.1±12.1 minutes/day; p<0.02), diabetic adolescents were significantly more active when considering moderate (45.6±26.9 vs. 32.1±23.5 minutes/day; p<0.02) and vigorous activity (25.2±15.3 vs. 19.1±11.3 minutes/day; p<0.01). Our data showed a significant positive correlation between illness duration and time spent in activity by preschoolchildren (p<0.02). They also showed a significant negative correlation between mean glycosylated hemoglobin for 1 year and time spent in light (p<0.01) and moderate activities (p<0.05) in schoolchildren, but not in adolescents. Our diabetic patients meet the classical pediatric guidelines for physical activity and compare favorably with our healthy population, suggesting that our educational program is effective. Autoimmune hemolytic anemia (AIHA) and diabetes mellitus are not rare diseases in children but their coincidence is very uncommon. A 5-year-old boy, treated for 3 years due to type 1 diabetes mellitus with insulin, was admitted to the pediatric ward in very bad condition, with fever, tachycardia and paleness. There was a history of dark urine. The results of the laboratory evaluation revealed profound anemia (Hb -4.6 g/dl) and a positive direct antiglobulin test (DAT) (++++). Acute autoimmune hemolytic anemia was diagnosed. The disease was caused by warmreactive IgG erythrocyte autoantibodies. The treatment began with erythrocyte transfusion, despite an incompatible crossmatch. Then the treatment with corticosteroids was introduced, first intravenously (methylprednisolone 2mg/kg) and then, orally (prednisone 2 mg/kg). The treatment caused significant problems with the management of the diabetes. Despite the continuous intravenous insulin therapy that was used and the large amounts of insulin given (1-3j/kg/hour), the levels of blood glucose were still very high (200 -435 mg/dl). After 10 days of corticosteroid administration we decided to add azathioprine (2mg/kg) to the treatment, hoping we would be able to finish the treatment with corticosteroids earlier. In the next 4 weeks the tapering of the corticosteroid dose was performed. Reduction of the corticosteroid dose allowed us to finish the continuous intravenous insulin therapy. We started to give the short acting insulin four times a day and then when corticosteroids were finished the same treatment of diabetes as before AIHA was introduced. The patient is now treated by azathioprine and insulin and his condition is very good. The hemoglobin concentration ranges between 11.5 -12.5 g/dl, reticulocyte count 10 -20 promille, but DAT is still positive (++ to +++). The blood glucose levels (100-150 mg/dl) and the insulin demand (0.7-0.8 j /kg/day) are similar to those that had been seen before AIHA began. P3-508 Diabetes and Insulin
doi:10.1159/000081147 fatcat:4zft7gy7d5hdni6poezk7onwhy