Neonatal diabetes is treated with pills
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The onset of diabetes in the first months after birth is often associated with life-threatening hyperglycemia. The diabetic ketoacidosis often accompanies this hyperglycemia. Unfortunately, it is also challenging to treat in such a small child.
The diagnosis of type 1 diabetes is incorrectly attributed to these forms of diabetes. Type 1 diabetes is the correct diagnosis for most kinds of pediatric diabetes, but only starting after the age of six months.
The correct diagnosis in the first six months of life is neonatal diabetes. Neonatal diabetes falls into the category of rare diseases. The incidence is about one case per 100,000 inhabitants per year.
In this form of diabetes, pancreatic beta cells are still present. However, they are not functional for various reasons. The situation is radically different from type 1 diabetes. In type 1 diabetes, the immune system destroys the pancreatic beta cells. Therefore, detailed knowledge of the classification of diabetes is essential in children.
Insulin secretion in neonatal diabetes
Insulin secretion deficiency is generally similar in type 1 and neonatal diabetes. Neonatal diabetes often begins with ketoacidosis. Ketoacidosis from the onset of neonatal diabetes is treated the same as for type 1 diabetes. Insulin therapy should be initiated promptly and will save the child’s life.
A therapeutic option other than insulin is the correct subsequent treatment for neonatal diabetes mellitus. You can almost always switch medication to some special pills that try to restart the non-functional beta cells. This is possible because they are present in a normal number in the pancreas.
The consequence can be spectacular, with complete cessation of insulin treatment and perfect metabolic control using only oral antidiabetics (pills).
Classification of neonatal diabetes
Neonatal diabetes classifies according to severity into three subcategories:
- Transient neonatal diabetes
- Permanent neonatal diabetes
- DEND syndrome
Transient neonatal diabetes resolves spontaneously after one year of age. However, hyperglycemia can sometimes recur after the age of 20 years. Permanent neonatal diabetes involves hyperglycemia that persists from the onset for the rest of the life. DEND syndrome is the association of neonatal diabetes with nerve development deficiency and epilepsy.
Causes of neonatal diabetes
Neonatal diabetes occurs as a consequence of a genetic mutation that affects one of the essential components of the pancreatic beta-cell. In this way, it becomes completely dysfunctional, although it is still present in the pancreas (in the Langerhans islands). In more than two-thirds of cases, the mutation affects a very special relay. This relay connects the blood glucose measuring system to the insulin delivery system.
This relay is known as the ATP potassium channel. The closed position leads to the release of insulin. When opened, it stops the secretion of insulin. Usually, the potassium ATP channel (K / ATP channel) is in the open position.
The hyperglycemia detection system is responsible for switching it to the closed position, which will automatically lead to the release of insulin. There are almost 100 genetic mutations that can affect this vital relay (potassium ATP channel). Most involve two genes, with very technical names, KCNJ11 and ABCC8.
Genetic analysis is free
Genetic analysis for neonatal diabetes is available free of charge at Elias Hospital, Bucharest, Romania, for any patient with diabetes that begins in the first 6-9 months of life. The highest chances of confirming a neonatal diabetes are for those with an onset in the first six months of life. You can apply for a free genetic analysis regardless of the patient’s current age. The oral medication is effective even at an advanced age (e.g. over 40 years).
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