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Neonatal Diabetes Medscape

Hyperglycemia In Infants

Hyperglycemia In Infants

What are the other Names for this Condition? (Also known as/Synonyms) High Blood Sugar in Infants Hyperglycemia in Newborns Neonatal Hyperglycemia What is Hyperglycemia in Infants? (Definition/Background Information) Hyperglycemia in Infant is a very common abnormality seen in the metabolism of prematurely born and critically ill newborn children Hyperglycemia is defined as the presence of high levels of glucose (sugar) in blood. The condition occurs due to the lack of sufficient levels of insulin in the body Hyperglycemia in Infants can be the result of gestational diabetes mellitus (a form of type II diabetes) that develops in the mother during pregnancy The signs and symptoms of Neonatal Hyperglycemia may not be apparent during the initial period following birth. The indications of the condition may include frequent urination, dehydration, and increased thirst Undiagnosed and/or untreated hyperglycemia can result in complications such as nerve damage, kidney damage, impaired vision, and greater vulnerability to type II diabetes and heart conditions The mainstay of treatment of Hyperglycemia in Infants is using insulin therapy. With early and adequate treatment of the condition, the prognosis is generally good. In most cases, no long-term effects on the child is noted Who gets Hyperglycemia in Infants? (Age and Sex Distribution) Hyperglycemia in Infants is seen in both term and preterm infants. This form of hyperglycemia (or high blood sugar) is seen in infants shortly after birth; from birth to one month of age Both sexes are equally likely to develop Hyperglycemia. The gender of the baby has no effect on the development of this condition All racial and ethnic groups are generally affected In general, North America has the highest prevalence of diabetes (high blood s Continue reading >>

Neonatal Sepsis (sepsis Neonatorum)

Neonatal Sepsis (sepsis Neonatorum)

Medical Editor: William C. Shiel Jr., MD, FACP, FACR Neonatal sepsis is any infection involving an infant during the first 28 days of life. Neonatal sepsis is also known as "sepsis neonatorum." The infection may involve the infant globally or may be limited to just one organ (such as the lungs with pneumonia ). It may be acquired prior to birth ( intrauterine sepsis) or after birth ( extrauterine sepsis). Viral (such as herpes , rubella [German measles ]), bacterial (such as group B strep ) and more rarely fungal (such as Candida) causes may be implicated. During her pregnancy , a woman's obstetrician is constantly monitoring the health of both of the pregnant woman and her fetus for any signs or symptoms that might indicate sepsis. Prior to birth, many indicators can signal that a potential infection is developing. Women are screened for infectious diseases at their first OB office visit. Some of these include HIV , gonorrhea , syphilis , herpes, Chlamydia , and hepatitis B , as well as immunity to rubella and chickenpox . Between the 35th and 37th week of pregnancy, screening for group B strep is commonly performed. Some symptoms and signs, such as slower than anticipated fetal growth, may be subtle indications of threatened fetal well-being. Measurement of uterine size via the traditional tape measure or ultrasound examination of the uterus, placenta, and fetus will both provide critical information. Throughout the pregnancy, office visits provide the opportunity to monitor fetal heart rate. The obstetrician commonly evaluates both the actual heart rate at rest as well as the infant's cardiac response to a mild stress (for example, uterine contraction). If concerns develop, specialized evaluations can be performed (" stress testing") during which fetal heart rate, f Continue reading >>

Neonatal Hyperglycemia

Neonatal Hyperglycemia

OBJECTIVES After completing this article, readers should be able to: Explain the relationship of the frequency of hyperglycemia with the birthweight and gestational age of the neonate. List factors that may decrease glucose tolerance in the neonate. Describe the major mechanism(s) contributing to altered regulation of neonatal glucose metabolism. List the untoward effects of hyperglycemia in the neonate. Describe the beneficial effects of insulin infusion in selected neonates. Case Study A preterm male infant was born at 26 weeks’ gestation weighing 900 g, with a birthweight percentile below the 3rd percentile and a head circumference at about the 25th percentile. His Apgar scores were 4 and 5 at 1 and 5 minutes, respectively, and he required intubation and ventilation in the delivery room. The infant was given artificial surfactant and maintained on a respirator with“ moderate to high settings.” Several saline boluses were administered for hypotension, and dopamine was started to maintain a mean arterial blood pressure above 30 mm Hg. Initial serum glucose concentrations were in the range of 1.67 to 2.76 mmol/L (30 to 50 mg/dL). The infant was given 10% dextrose at a rate of 100 mL/kg per day. By the second day of life, the serum glucose concentration was in the range of 5.55 to 8.33 mmol/L (100 to 150 mg/dL), and the dextrose infusion, which now contained sodium chloride and potassium acetate, was increased to 150 mL/kg per day because of polyuria of 6 mL/kg per hour. The infant remained NPO. Subsequent glucose concentrations over the next 24 hours increased to more than 13.88 mmol/L (250 mg/dL), and glycosuria was noted. At this time, the intravenous (IV) fluid rate was 225 mL/kg per day (“to maintain hydration”) and the glucose infusion rate was 16 mg/kg p Continue reading >>

Neonatal Diabetes Mellitus Medscape Mineral Deficiency

Neonatal Diabetes Mellitus Medscape Mineral Deficiency

Neonatal Diabetes Mellitus Medscape Mineral Deficiency Diabetic Ketoacidosis Icd 9 What Is grapefruit 3 x a day to avoid this chronic ailment.Goals and Outcomes of Medical Nutrition Therapy for Diabetes.Diabetes Diet Breakfast test for childhood diabetes are symptoms type 2 diabetes diabetes management guidelines 2013Doctors are diagnosing diabetesa condition in which your blood More than one-third of diabetics go for several years without a diagnosis, so it is best to follow these For your own ease and comfort, this test is usually done first thing in the morning, before breakfast.Diabetes Sick Day Rules Treatment Diabetes & Alternative Diabetes Treatment Diabetes Sick Day Rules Diabetic Retinopathy Definition ::The 3 Step Trick thatQuick summary of blood sugar (glucose) testing tips.Thuc gc Insulin - Thuocbietduoc.com.vn.is a skin condition usually found on the lower legs of people with diabetes.Because the symptoms of acute pancreatitis are similar to the symptoms of a number of other conditions, its important to have a doctor perform tests and a physical exam.Step by step, illustrated guide to giving an insulin shot using the Prefilled Humalog KwikPen,A simple kitchen trick may allow you to eat more pasta with less effect on your blood sugars.Prevent complications with your kidneys. Diabetes Type 2 Diabetes Exercise ::The 3 Step Trick that Reverses Diabetes Permanently in As Little as 11 Days.[ Diabetes Symptoms Nhs Article The 11 agencies within the Department work in numerous 1 Key Aspects of Care Patients with type 1 diabetes (T1DM) experience more unpredictable swings in glucose that necessitate more frequent Diabetes Medications In Renal Failure :: Diabetes Symptoms Of The Feet The 3 Step Trick that Reverses Diabetes Permanently in As Little as 11 Days. Neonat Continue reading >>

Neonatal Diabetes Mellitus: Current Perspective

Neonatal Diabetes Mellitus: Current Perspective

Neonatal diabetes mellitus: current perspective Authors Kataria A, Palliyil Gopi R, Mally P, Shah B Published 25 March 2014 Volume 2014:4 Pages 5564 Video abstract presented by Anglina Kataria Anglina Kataria,1 Resmy Palliyil Gopi,2 Pradeep Mally,3 Bina Shah2 1Department of Pediatrics, 2Pediatric Endocrinology, Department of Pediatrics, 3Neonatology, Department of Pediatrics, NYU School of Medicine, New York, NY, USA Abstract: Neonatal diabetes mellitus (NDM) is a rare form of diabetes characterized by hyperglycemia occurring in the first few months of life. It can present as either transient NDM (TNDM), which resolves by a few months, or permanent NDM (PNDM), which continues throughout life. The etiology of this disease remained unclear until recently, when advances in molecular genetic techniques illuminated the mechanisms involved in the pathogenesis of the disease. Having delineated the genes involved in insulin production and secretion and their association with NDM, we currently understand the molecular basis of this disease. While most TNDM cases are caused by the overexpression of chromosome 6q24, the majority of PNDM cases are due to mutations in the adenosine triphosphate-sensitive potassium (KATP) channel. The improved understanding of the etiology of the disease had revolutionized the diagnosis and its management with oral sulfonylureas. The primary objective of this study was to review the current understanding of neonatal diabetes, including its genetic etiologies, clinical presentation, diagnosis, acute treatment, and long-term management. Keywords: hyperglycemia, intrauterine growth retardation, KATP channel mutations, sulfonylurea This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at and inco Continue reading >>

Type 1 Diabetes Mellitus

Type 1 Diabetes Mellitus

Author: Romesh Khardori, MD, PhD, FACP; Chief Editor: George T Griffing, MD more... Type 1 diabetes is a chronic illness characterized by the bodys inability to produce insulin due to the autoimmune destruction of the beta cells in the pancreas. Although onset frequently occurs in childhood, the disease can also develop in adults. [ 1 ] See Clinical Findings in Diabetes Mellitus , a Critical Images slideshow, to help identify various cutaneous, ophthalmologic, vascular, and neurologic manifestations of DM. The classic symptoms of type 1 diabetes are as follows: Other symptoms may include fatigue, nausea, and blurred vision. The onset of symptomatic disease may be sudden. It is not unusual for patients with type 1 diabetes to present with diabetic ketoacidosis (DKA). See Clinical Presentation for more detail. Diagnostic criteria by the American Diabetes Association (ADA) include the following [ 2 ] : A fasting plasma glucose (FPG) level 126 mg/dL (7.0 mmol/L), or A 2-hour plasma glucose level 200 mg/dL (11.1 mmol/L) during a 75-g oral glucose tolerance test (OGTT), or A random plasma glucose 200 mg/dL (11.1 mmol/L) in a patient with classic symptoms of hyperglycemia or hyperglycemic crisis A fingerstick glucose test is appropriate for virtually all patients with diabetes. All fingerstick capillary glucose levels must be confirmed in serum or plasma to make the diagnosis. All other laboratory studies should be selected or omitted on the basis of the individual clinical situation. An international expert committee appointed by the ADA, the European Association for the Study of Diabetes, and the International Diabetes Association recommended the HbA1c assay for diagnosing type 1 diabetes only when the condition is suspected but the classic symptoms are absent. [ 3 ] Screen Continue reading >>

Monogenic Diabetes (neonatal Diabetes Mellitus & Mody)

Monogenic Diabetes (neonatal Diabetes Mellitus & Mody)

The most common forms of diabetes, type 1 and type 2, are polygenic, meaning they are related to a change, or defect, in multiple genes. Environmental factors, such as obesity in the case of type 2 diabetes, also play a part in the development of polygenic forms of diabetes. Polygenic forms of diabetes often run in families. Doctors diagnose polygenic forms of diabetes by testing blood glucose, also known as blood sugar, in individuals with risk factors or symptoms of diabetes. Genes provide the instructions for making proteins within the cell. If a gene has a change or mutation, the protein may not function properly. Genetic mutations that cause diabetes affect proteins that play a role in the ability of the body to produce insulin or in the ability of insulin to lower blood glucose. People typically have two copies of most genes, with one gene inherited from each parent. What are monogenic forms of diabetes? Some rare forms of diabetes result from mutations or changes in a single gene and are called monogenic. In the United States, monogenic forms of diabetes account for about 1 to 4 percent of all cases of diabetes.1,2,3,4 In most cases of monogenic diabetes, the gene mutation is inherited from one or both parents. Sometimes the gene mutation develops spontaneously, meaning that the mutation is not carried by either of the parents. Most mutations that cause monogenic diabetes reduce the body’s ability to produce insulin, a protein produced in the pancreas that helps the body use glucose for energy. Neonatal diabetes mellitus (NDM) and maturity-onset diabetes of the young (MODY) are the two main forms of monogenic diabetes. NDM occurs in newborns and young infants. MODY is much more common than NDM and usually first occurs in adolescence or early adulthood. Most cas Continue reading >>

Treat Neonatal Diabetes Early With Sulfonylureas

Treat Neonatal Diabetes Early With Sulfonylureas

Treat Neonatal Diabetes Early With Sulfonylureas Sulfonylureas improve neurological development in children with neonatal diabetes owing to potassium-channel mutations, supporting prompt diagnosis and early treatment with such agents, shows the first study of its kind. The paper was published online in Diabetes Care October 5 by Jacques Beltrand, MD, PhD, from the Necker University Hospital for Sick Children, Paris, and colleagues and is the follow-up of two previous studies (Lancet Diabetes Endocrinol. 2013;1: 199207 ; N Engl J Med. 2006;355: 467477 ). Senior author Michel Polak, MD, PhD, from the same institution, told Medscape Medical News that "glibenclamide [known as glyburide in the US] allows the definitive discontinuation of insulin and noticeably improves hypotonia, gesture conception, and realization and hyperactivity. "It also leads to an improvement in motor skills and sociability and favors quality of life and school integration," he added. The work is the first to show that one of the sulfonylurea class, used for decades to treat type 2 diabetes in adults, also has a direct effect on children's brains. And there is a "better result when the drug is started before 4 years of age, indicating starting therapy with glibenclamide early in life," highlighted Dr Polak. In the 2006 NEJM paper, the researchers showed the importance of stopping insulin therapy in patients with neonatal diabetes. Sulfonylureas Bind Potassium Channels in the Brain Neonatal diabetes is a rare condition that develops during the first months of life, with an estimated incidence of one in 90,000 newborns, and around 40% of such patients are thought to have mutations in genes that produce proteins involved in functioning of the ATP-sensitive potassium channels (KATP). Around 20% of patien Continue reading >>

Brittle Diabetes (labile Diabetes)

Brittle Diabetes (labile Diabetes)

Tweet Brittle diabetes mellitus (or labile diabetes) is a term used to describe particularly hard to control type 1 diabetes. Those people who have brittle diabetes will experience frequent, extreme swings in blood glucose levels, causing hyperglycemia or hypoglycemia. How does brittle diabetes develop and what is it associated with? Brittle diabetes has a number of potential causes. It can be caused by absorption problems in the intestines. This includes delayed stomach emptying, drug interactions, insulin absorption issues and malfunctioning hormones. Severely low blood sugar levels may also create thyroid and adrenal gland problems. Gastroperesis, delayed stomach emptying, can affect the rate at which food, glucose and insulin is absorbed into the bloodstream. Brittle diabetes is often associated with psychological issues such as stress and depression. Is brittle diabetes different from stable diabetes? All people with diabetes will a certain level of blood glucose level fluctuation. However, when these shifts are not extreme or over-frequent they do not impair the ability to lead a normal life. With brittle diabetes, however, the fluctuations are more serious and tend to result in frequent hospital visits, interruption to employment and can often contribute to psychological issues such as stress. Life expectancy with brittle diabetes The life expectancy for someone with brittle diabetes is no different to someone who has type 1 or type 2 diabetes. In fact, brittle diabetes can also be described poorly controlled type 2 diabetes. Is brittle diabetes common? Brittle diabetes is rare but serious. Around 3 in 1,000 people with type 1 diabetes mellitus will develop brittle diabetes. Will I get brittle diabetes? Those people suffering from psychological problems, includin Continue reading >>

Pediatric Type 1 Diabetes Mellitus

Pediatric Type 1 Diabetes Mellitus

Author: William H Lamb, MD, MBBS, FRCP(Edin), FRCP, FRCPCH; Chief Editor: Sasigarn A Bowden, MD more... Type 1 diabetes is a chronic illness characterized by the bodys inability to produce insulin due to the autoimmune destruction of the beta cells in the pancreas. Most pediatric patients with diabetes have type 1 and a lifetime dependence on exogenous insulin. [ 1 ] The image below depicts the effects of insulin deficiency. Signs and symptoms of type 1 diabetes in children include the following: See Clinical Presentation for more detail. Blood glucose tests using capillary blood samples, reagent sticks, and blood glucose meters are the usual methods for monitoring day-to-day diabetes control. Diagnostic criteria by the American Diabetes Association (ADA) include the following [ 2 ] : A fasting plasma glucose (FPG) level 126 mg/dL (7.0 mmol/L), or A 2-hour plasma glucose level 200 mg/dL (11.1 mmol/L) during a 75-g oral glucose tolerance test (OGTT), or A random plasma glucose 200 mg/dL (11.1 mmol/L) in a patient with classic symptoms of hyperglycemia or hyperglycemic crisis Measurement of HbA1c levels is the best method for medium-term to long-term diabetic control monitoring. An international expert committee composed of appointed representatives of the American Diabetes Association, the European Association for the Study of Diabetes, and others recommended HbA1c assay for diagnosing diabetes mellitus. [ 3 ] The ADA recommends using patient age as one consideration in the establishment of glycemic goals, with different targets for preprandial, bedtime/overnight, and hemoglobin A1c (HbA1c) levels in patients aged 0-6, 6-12, and 13-19 years. [ 4 ] Benefits of tight glycemic control include not only continued reductions in the rates of microvascular complications but als Continue reading >>

Type 1 Diabetes Mellitus Diagnosed Before 6 Months Of Age

Type 1 Diabetes Mellitus Diagnosed Before 6 Months Of Age

Clinical features of the genetic causes of neonatal diabetes mellitus Pihoker, C., Gilliam, L. K., Hampe, C. S. & Lernmark, A. Autoantibodies in diabetes Diabetes 54 (Suppl. 2) S52-S61 (2005) van Deutekom, A. W., Heine, R. J. & Simsek, S. The islet autoantibody titers: their clinical relevance in latent autoimmune diabetes in adults (LADA) and the classification of diabetes mellitus. Diabet. Med. Feb. 25, 117-125 (2008) Edghill, E. L. et al. HLA genotyping supports a nonautoimmune etiology in patients diagnosed with diabetes under the age of 6 months Diabetes 55, 1895-1898 (2006) Iafusco, D. et al. Permanent diabetes mellitus in the first year of life. Diabetologia 45, 798-804 (2002) Stoy, J. et al. Diagnosis and treatment of neonatal diabetes: a United States experience. Pediatr. Diabetes 9, 450-459 (2008) Edghill, E. L. et al. Insulin mutation screening in 1,044 patients with diabetes: mutations in the INS gene are a common cause of neonatal diabetes but a rare cause of diabetes diagnosed in childhood or adulthood. Diabetes 57, 1034-1042 (2008) Flanagan, S. E., Edghill, E. L., Gloyn, A. L., Ellard, S. & Hattersley A. T. Mutations in KCNJ11, which encodes Kir6.2, are a common cause of diabetes diagnosed in the first 6 months of life, with the phenotype determined by genotype. Diabetologia 49, 1190-1197 (2006) Temple, I. K. et al. Transient neonatal diabetes: widening the understanding of the etiopathogenesis of diabetes. Diabetes 49, 1359-1366 (2000) Flanagan, S. E. et al. Mutations in ATP-sensitive K+ channel genes cause transient neonatal diabetes and permanent diabetes in childhood or adulthood. Diabetes 56, 1930-1937 (2007) Gloyn, A. L. et al. Activating mutations in the gene encoding the ATP-sensitive potassium-channel subunit Kir6.2 and permanent neonatal diabet Continue reading >>

Activating Mutations In Kir6.2 And Neonatal Diabetes

Activating Mutations In Kir6.2 And Neonatal Diabetes

Activating Mutations in Kir6.2 and Neonatal Diabetes New Clinical Syndromes, New Scientific Insights, and New Therapy Andrew T. Hattersley; Frances M. Ashcroft Closure of ATP-sensitive K+ channels (KATP channels) in response to metabolically generated ATP or binding of sulfonylurea drugs stimulates insulin release from pancreatic -cells. Heterozygous gain-of-function mutations in the KCJN11 gene encoding the Kir6.2 subunit of this channel are found in ~47% of patients diagnosed with permanent diabetes at <6 months of age. There is a striking genotype-phenotype relationship with specific Kir6.2 mutations being associated with transient neonatal diabetes, permanent neonatal diabetes alone, and a novel syndrome characterized by developmental delay, epilepsy, and neonatal diabetes (DEND) syndrome. All mutations appear to cause neonatal diabetes by reducing KATP channel ATP sensitivity and increasing the KATP current, which inhibits -cell electrical activity and insulin secretion. The severity of the clinical symptoms is reflected in the ATP sensitivity of heterozygous channels in vitro with wild type > transient neonatal diabetes > permanent neonatal diabetes > DEND syndrome channels. Sulfonylureas still close mutated KATP channels, and many patients can discontinue insulin injections and show improved glycemic control when treated with high-dose sulfonylurea tablets. In conclusion, the finding that Kir6.2 mutations can cause neonatal diabetes has enabled a new therapeutic approach and shed new light on the structure and function of the Kir6.2 subunit of the KATP channel. Neonatal diabetes diagnosed within the first 3 months of life is usually a single gene disorder associated with altered -cell number or function. Transient neonatal diabetes resolves by a median of 12 wee Continue reading >>

Maturity Onset Diabetes Of The Young

Maturity Onset Diabetes Of The Young

"Maturity onset diabetes of the young" (MODY)[1] refers to any of several hereditary forms of diabetes mellitus caused by mutations in an autosomal dominant gene[2] disrupting insulin production. MODY is often referred to as "monogenic diabetes"[3][4] to distinguish it from the more common types of diabetes (especially type 1 and type 2), which involve more complex combinations of causes involving multiple genes and environmental factors. MODY 2 and MODY 3 are the most common forms.[5] MODY should not be confused with latent autoimmune diabetes of adults (LADA) — a form of type 1 DM, with slower progression to insulin dependence than child-onset type 1 DM, and which occurs later in life. History of the concept and treatment of MODY[edit] The term MODY dates back to 1964, when diabetes mellitus was considered to have two main forms: juvenile-onset and maturity-onset, which roughly corresponded to what we now call type 1 and type 2. MODY was originally applied to any child or young adult who had persistent, asymptomatic hyperglycemia without progression to diabetic ketosis or ketoacidosis. In retrospect we can now recognize that this category covered a heterogeneous collection of disorders which included cases of dominantly inherited diabetes (the topic of this article, still called MODY today), as well as cases of what we would now call type 2 diabetes occurring in childhood or adolescence, and a few even rarer types of hyperglycemia (e.g., mitochondrial diabetes or mutant insulin). Many of these patients were treated with sulfonylureas with varying degrees of success.[citation needed] The current usage of the term MODY dates from a case report published in 1974.[6][7] Since the 1990s, as the understanding of the pathophysiology of diabetes has improved, the concept an Continue reading >>

Neonatal Diabetes From Gene Discovery Yo Clinical Practice Changes

Neonatal Diabetes From Gene Discovery Yo Clinical Practice Changes

Neonatal Diabetes From Gene Discovery yo Clinical Practice Changes Neonatal Diabetes From Gene Discovery yo Clinical Practice Changes Lotus Medical Center, Bucharest, Romania National Institute of Diabetes, Nutrition and metabolic Diseases Prof. NC Paulescu, Bucharest, Romania Published Online: 2013-09-19 | DOI: Diabetes mellitus is one of the most common chronic diseases but also one of the most heterogeneous. Apart the common phenotypes of type 1 and type 2 diabetes, around 1-2% of all cases arise from a single gene mutation and are known as monogenic diabetes. Diabetes diagnosed within the first 6 months of life is known as neonatal diabetes and has been extensively studied during the last two decades. Unraveling the genetic cause and molecular mechanism of this rare diabetes phenotype led to a dramatic change in the treatment of these children who often can be switched from insulin to sulphonylurea treatment. The aim of this paper is to review the known genetic causes of neonatal diabetes and to highlight the most recent aspects of the disease caused by mutations in the KATP and insulin genes, with a special focus on the individualized treatment of these cases Keywords: neonatal diabetes ; KCJN11 ; ABCC8 ; insulin gene ; sulphonylurea 1. International Diabetes Federation. The global burden. IDF Diabetes Atlas, 5th edn. Brussels, Belgium, 2011. Accessed on 07 January 2013 at: GoogleScholar 2. American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care 36[Suppl 1]:S67-S74, 2013. GoogleScholar 3. Greeley SA, Tucker SE, Naylor RN, Bell GI,Philipson LH. Neonatal diabetes mellitus: a model for personalized medicine. Trends Endocrinol Metab 21: 464-472, 2010 Crossref PubMed GoogleScholar 4. Keidan SE. Transient diabetes in infancy. Arch Continue reading >>

Neonatal Hyperglycemia

Neonatal Hyperglycemia

Hyperglycemia is a serum glucose concentration > 150 mg/dL (> 8.3 mmol/L). The most common cause of neonatal hyperglycemia is Iatrogenic causes usually involve too-rapid IV infusions of dextrose during the first few days of life in very low-birth-weight infants (< 1.5 kg). The other important cause is physiologic stress caused by surgery, hypoxia, respiratory distress syndrome, or sepsis; fungal sepsis poses a special risk. In premature infants, partially defective processing of proinsulin to insulin and relative insulin resistance may cause hyperglycemia. In addition, transient neonatal diabetes mellitus is a rare self-limited cause that usually occurs in small-for-gestational-age infants; corticosteroid therapy may also result in transient hyperglycemia. Hyperglycemia is less common than hypoglycemia, but it is important because it increases morbidity and mortality of the underlying causes. Treatment of iatrogenic hyperglycemia is reduction of the IV dextrose concentration (eg, from 10% to 5%) or of the infusion rate; hyperglycemia persisting at low dextrose infusion rates (eg, 4 mg/kg/min) may indicate relative insulin deficiency or insulin resistance. Treatment of other causes is fast-acting insulin. One approach is to add fast-acting insulin to an IV infusion of 10% dextrose at a uniform rate of 0.01 to 0.1 unit/kg/h, then titrate the rate until the glucose level is normalized. Another approach is to add insulin to a separate IV of 10% D/W given simultaneously with the maintenance IV infusion so that the insulin can be adjusted without changing the total infusion rate. Responses to insulin are unpredictable, and it is extremely important to monitor serum glucose levels and to titrate the insulin infusion rate carefully. In transient neonatal diabetes mellitus, gluc Continue reading >>

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