Reference no: EM133930282

A 6-year-old boy was seen at the EMR with presentations of weight loss, extreme weakness, ketone breadth, and osmotic features. The fasting blood sugar level was 300 mg/dL, the postprandial glucose level was 467 mg/dL and the hemoglobin A1c (HbA1c) was 7.2%. He was administered with standard intravenous insulin and fluid, which finally brought down the fasting blood glucose level to around 120 mg/dL. He was administered basal-bolus therapy and was discharged. The patient had two episodes of severe hypoglycemia. His parents were worried due to frequent checking of blood glucose levels many times in a day. The challenge was also to avoid urination in bed at night by the child. Otherwise, he would get a common cold. The patient remained unconscious in the middle of the night and was fed up with the frequent monitoring of blood sugar. The patient and the parents had severe anxiety, depression, frustration, and disgust. The parents considered diabetes as a curse on their family. He was informed about degludec/injection tresiba, which is not yet approved in children because of lack of experience. The physician explained to them that there was nothing wrong in administering it and is not contra-indicated in T1DM. The parents were also explained that insulin degludec may even help the child to convert from four injections to one injection a day, and from very frequent monitoring to once in a day. After reviewing the literature about insulin degludec, the parents were finally convinced about it. The patient was then put from basal-bolus to 2 boluses plus 1 basal and finally degludec at 16 U. Over the period of time, blood sugar level came to normal at around 110 mg/dL-pre meal. The patient was trained very well that if he wanted to reduce the frequency of monitoring of blood sugar level, then he had to follow small frequent meals. This made him feel happy because once the sugar was controlled then a small amount of sweets was also given. The techniques resulted in good compliance from the patient. The patient did not report any hypoglycemic events over a period of 3 months. This was a big relief for the patient and his parents. Later parents were told that the child may require basal-bolus therapy.

Questions

What is diabetes mellitus (DM), What are the different types of DM and possible risk factors?

What are the symptoms and signs of DM? What is the working diagnosis of the patient at EMR in this case? Outline the treatment modalities in this patient.