Transcripts
DR. MAUSETH:
Now the usual onset of most of
the diabetes that occurs is right at the acute
phase. Now when I mean acute phase I mean the
hospitalization phase. And what happens is
usually around the time of dialysis, again that's
a period that's most stress, that's a period of
where you have most of the -- the blood vessel
problems that are occurring, and dialysis is
stress that can make the insulin not work as
well. So you have this injury.
That's also about the time when
the pancreatitis is at its worst. Not
only do you have an increased need for insulin
because of the stress, but you also have
decreased ability to increase your insulin
release because your pancreas is already
inflamed.
This can sometimes be transient.
And so what you see with the transientness of
this it could be just during that stress and
then it could be gone, several days later or
even weeks later, when you're over the acute
illness.
I would warn people that if you
have had significant problems during the
hospitalization, in particular with blood sugar,
and it looks like the diabetes or transient
diabetes was there just don't forget that your
children grow.
And what happens with that is
that as children grow, they need more insulin.
Their bodies need more insulin because their
bodies are bigger. And if they've lost a
certain percentage of their islet cell function
in the early period then as they grow and get
bigger they may not be able to increase that
insulin production as they go through puberty.
Puberty also causes you to
release -- we know this from our diabetic
patients, that we have to increase their insulin
doses by 50 percent just because they're going
through puberty.
So the sex hormones stimulate
growth hormone release. And the growth hormone
makes the body require more insulin. So puberty
would be another time to be very careful about
looking at children and watching for signs of
diabetes.
Now, if you are in a
circumstance where you get going on and the
child is actually going on to have a transplant
and some of the immunosuppressants and the stress
of the transplantation also might precipitate
diabetes. And weight gain, again, would be a
major concern.
Again, the weight gain makes the
insulin not work as well with a damaged pancreas
and decreases insulin reserves. You might see
that with a period of extreme weight again, and
the same is true of illness.
So when we look at this and
we're looking at when would you really monitor
the child or when you
should be looking, the acute onset is usually
the hospitalization, but then you want to be
aware of the possibility of diabetes with rapid
growth, puberty and during illness, in
particular.
