Diabetes Mellitus in Juveniles Diabetes Mellitus (IDDM) in Juveniles

A complex disorder, diabetes mellitus afflicts people of every race, sex, age, and cultural background. The form most prevalent in juveniles is insulindependent diabetes mellitus (IDDM). Although the etiology of IDDM is not yet completely understood, the disease is probably caused by some type of autoimmune response. The diagnosis of this disease has important implications, particularly for the very young. Juvenile IDDM patients may be at risk for neuropsychological problems. In addition, over the longterm, IDDM patients may also suffer from numerous other complications. Fortunately though, advances in technology continue to provide these patients with effective tools for managing their condition. With the introduction of new therapeutic modalities, as well as the improvement of existing ones, the adverse health consequences of IDDM may be minimized.

Type I or insulindependent diabetes mellitus is a severe, chronic metabolic disease. In North America, it affects approximately 3 in every 1,000 children (Grey & Thurber, 1991, p. 302). Thus, IDDM ranks as the most common metabolic disorder of childhood. Worldwide, however, IDDM incidence is somewhat variable. For example, there are 14 new cases per year for every 100,000 children at risk in the United States; in Japan, that same number is less that 1 (Santiago et al., 1992, p. 1025). Although it is known that in people of European extraction IDDM tends to be genetically transmit

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Slidingscale adjustments generally require some adjustment, themselves, for each patient's individual characteristics. Lastly, pattern therapies employ the algorithm approach, but over an extended time frame. Typically, blood glucose levels are monitored for a couple of days before insulin adjustments are made. This technique provides for a more gradual change of blood biochemistry (Spollet, 1993, pp. 3336). Intensive insulin therapy takes a lot of time and energy. Patients must perform BGSM repetitively, determine premeal bolus dosages, and make the necessary insulin adjustments. While such attentiveness to diabetes management can potentially improve glycemic results, the required patience and perseverance can often be too demanding for some juvenile IDDM patients. Another therapeutic option, the insulin pump, was developed to imitate pancreatic insulin secretion. These systems, however, do lack builtin blood glucose sensors. Patients must therefore perform their own blood glucose monitoring, and then program the pump to administer the right amount of insulin (Clark & Plotnick, 1990, p. 4). Advanced external insulin pumps are about the size of a pocket calculator. Typically, they deliver shortacting insulin thr

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