Neonatal diabetes is defined as the appearance of hyperglycemia in need of insulin treatment for at least two weeks and that occurs in the first month of life, most commonly in the first two weeks, although several authors extend this period until the third month. The author Luzuriaga and her collaborators outline, Classically two clinical forms of presentation of the disease have been described: Transient, with resolution in the first 18 months of life and predisposition to later diabetes in the juvenile age or even with a silent interval of more than 30 years and permanent. A third “relapsing” form could be considered, which after a clinical period of normality in glycemic control, 5-20 years later, hyperglycemia appears again with ketosis that requires insulin and evolves towards permanent diabetes3. It is believed that they are forms of evolution that express a different severity of the same disease. By the form of presentation it is difficult to define what will be the subsequent evolution? perhaps patients who have a later onset are the ones who will last and need lifelong insulin treatment. (1)
The NICE 2015 guides expose, the most commonly described form of presentation is the transitory one. The signs and symptoms of both forms are identical, it is common to start early, before the second week of life. Glucose levels may be quite high, often above 500 mg / dl, but presentation with ketoacidosis is infrequent and is not even related to the duration of the disease; it may appear with other associated boxes. A history of poor intrauterine growth and low birth weight is also common, probably related to insulin deficiency during intrauterine life. Intrauterine delay preferentially affects weight, but also the size and cranial perimeter, suggesting chronic fetal distress, even at term. This indicates an insufficient intrauterine insulin secretion (2).
Concomitantly, other disorders have been associated, such as anemia, macroglossia, hypothyroidism, celiac disease, intractable diarrhea, defects of the ventricular septum, intracranial hemorrhage; some of them may be pathology associated with low weight and / or preterm.
Martis and collaborators in a systematic review of literature delimit, not only the evolution is variable but also the initial response to the treatment. Although it is a diabetes that is exclusively shown with hyperglycemia, the treatment must be insulin, since oral hypoglycaemic therapy is not indicated. The use of continuous intravenous insulin has been standardized initially, without a doubt it is the easiest way to manage these patients to avoid hypoglycemia and hyperglycemia. The complication regarding the therapeutic management of these patients is later because infants make a greater number of intakes, with great richness in carbohydrates, and there is a high sensitivity to insulin. Therefore, specialized personnel in the care of these patients is required, as well as the use of dilutions for precise insulin therapy (3).
(1) Luzuriaga C., Cantero P., Llorca J., Martínez-Chamorro M.J. y Pérez de Nanclares G. (2001). Diabetes Neonatal. Anales Españoles de Pediatría. 54, Suplemento 1, 2001
(2) Bhatia M et al. (2018). Clinical Implications of the NICE 2015 Criteria for Gestational Diabetes Mellitus. J Clin Med. Oct 22;7(10).
(3) Martis et al. (2018). Treatments for women with gestational diabetes mellitus: an overview of Cochrane systematic reviews. Cochrane Database Syst Rev. Aug 14;8
Dr. Tortolero is a surgeon specializing in Clinical Angiology (ASCARDIO). Fellow in comprehensive and interventional ultrasonography (UNEFM) and biomedical researcher. Member of the Venezuelan Association for the Advancement of Science, Venezuelan Society of General Medicine, former member of Junior Chamber Internationational. Considered the researcher of the year 2007 by UNEXPO Venezuela, lecturer and collaborator of several ONGs for the development of medicine and society such as Médicos Unidos and the Venezuelan Red Cross. He is currently a medical writer for SB Medical.