CHILDHOOD INSULIN-DEPENDENT DIABETES-MELLITUS - INITIAL PRESENTATION AND MANAGEMENT IN THE 90S

Diabetes mellitus with onset during childhood usually presents as over t ketoacidemia. Pediatricians now inquire specifically about diabetes mellitus in children with nonspecific signs of illness and perform uri nary dipstick testing. The present study was therefore performed to as sess the possible in fluence of this strategy on the initial presentat ion and management of diabetes mellitus. The charts of 61 consecutive children with newly diagnosed diabetes mellitus (positive glucosuria a nd ketonuria and capillary glucose >14 mmol/l), who had been admitted between 1991 and 1996 at the Department of Pediatrics, University of B ern, Switzerland, were therefore reviewed. Twenty-six out of the 61 pa tients were nonacidemic (blood pH 7.36 or more). Children with and wit hout acidemia did not differ with respect to age, history of polydipsi a and polyuria, plasma glucose and circulating glycated hemoglobin AI, . The degree of dehydration and the amount of fluid required for its c orrection and the total insulin dosage were more prominent in the grou p of patients with acidemia. The study demonstrates that childhood dia betes mellitus is nowadays often recognized as nonacidemic hyperglycem ia and that in these patients a reduced initial fluid repair and total insulin dosage is recommended.