Clinical Corner
Prevelance
of Diabetes - USVI 1999-2001 |
Diabetes in USVI Children age (0-19) Diabetes mellitus occurs among children
in two major forms, Type 1 and Type 2 as it does among adults.
The onset of Type 1 is usually severe and often requires hospitalization
at the time of diagnosis. Children with Type 1 diabetes will
need insulin injections to manage their blood sugar and avoid
going into diabetic coma. The onset of Type 2 diabetes may
be less severe, and children with Type 2 diabetes may go undiagnosed
for months to years. Because of this possibility, it is important
that children who are obese and have a family history of diabetes
be carefully monitored for the signs of diabetes. There is no available information on the frequency of Type 2 diabetes for USVI children. However the trend among USVI children towards an increase in overweight and obesity may indicate that childhood Type 2 diabetes will become a significant health problem in the USVI as it is on the mainland United States. Lifestyle factors such as fast food eating and physical inactivity contribute to higher obesity rates in children. Careful monitoring by parents of their children’s diets and physical activity levels will be an important aspect of the effort to prevent childhood Type 2 diabetes in the USVI. References: 2. Tull ES, Jordan O, Simon L, Laws M,
Smith DO, Vanterpool H, Buttler C. Incidence of childhood-onset
IDDM in black African-heritage populations in the Caribbean.
The Caribbean African Heritage IDDM Study (CAHIS) Group. Diabetes
Care;20(3):309-310, 1997 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5227a3.htm Diabetes Mellitus or diabetes or “sugar” as commonly called in many Caribbean cultures is a metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action or both. Blood glucose levels are regulated by the hormone insulin, which is produced by the pancreas gland. The primary purpose of insulin is to help open the cells of the body to receive glucose as a source of energy. Diabetes occurs when the body either lacks the ability to produce insulin, or lacks the ability to use insulin properly (insulin resistance), or both. Without insulin to “unlock” the entry into cells, glucose builds up in the blood, and at high levels is passed out in the urine. Some symptoms of high blood glucose include excessive urination (polyuria), excessive thirst (polydipsia), weight loss, excessive hunger (polyphagia), and blurred vision. Diabetes is frequently not diagnosed until complications appear, and approximately one third of all persons with diabetes may be undiagnosed. There are three major types of diabetes. Type 1 diabetes (formerly known as insulin dependent diabetes or juvenile onset diabetes) typically occurs in persons younger than 30 years of age and accounts for approximately 5-10% of all cases of diabetes. Type 1 diabetes is the result of genetic and environmental factors, as well as an autoimmune response where the defense system of the body inappropriately “attack” the pancreas, destroying its insulin-producing capacity. Persons with Type 1 diabetes require insulin from an outside source (needle injections or an insulin pump) to survive. Type 2 diabetes (formerly known as non-insulin dependent diabetes or adult onset diabetes) is the form of diabetes that typically occurs in persons older than 30 years of age, although a growing number of children and adolescents are being diagnosed with Type 2 diabetes. Type 2 diabetes is more common among older adults, persons who are obese and physically inactive, persons with a family history of diabetes, and persons of African American, Hispanic, and Native American ancestry, and some Pacific Island racial/ethnic groups. Type 2 diabetes accounts for about 90-95% of all cases of diabetes. Gestational Diabetes: About 1-14% of all pregnancies in the US result in the development
of gestational diabetes (GDM) and complicates approximately
4% of all pregnancies. This form of diabetes is usually temporary,
but is believed to increase the risk of developing in later
years.6 Note that many individuals with IGT are euglycemic in their daily lives and may have normal or near normal glycated hemoglobin levels. Individuals with IGT often manifest hyperglycemia only when challenged with the oral glucose load use in the standardized oral glucose tolerance test (OGTT). In the absence of pregnancy IFG and IGT are not clinical entities but risk factors for future diabetes and cardiovascular disease. IFG and IGT are associated with the insulin resistance syndrome also known as syndrome X or the metabolic syndrome, which is directly involved in the development of Type 2 diabetes.6 Diagnostic
Criteria: The American Diabetes Association recently
revised their criteria for the diagnosis of diabetes mellitus.
The criteria
used to diagnose diabetes includes:
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