Dr.Azad A. Haleem Almezori
Assistant Professor Of Pediatric Endocrinologist, Iran
Title: Challenging cases of Neonatal Diabetes ; simply approached
Biography
Biography: Dr.Azad A. Haleem Almezori
Abstract
Case 1- A three-day-old boy with hyperglycemia:
Presentation: This boy was born at 32 weeks of gestation with a birth weight of 1.4 kg. He was in the neonatal intensive care unit on intravenous fluids. Blood sugar was high on routine monitoring (220 mg/dL, 12.2 mmol/L).Plan: Hyperglycemia in the neonatal period is usually due to high dextrose infusion. Neonatal diabetes should be considered only with persistent insulin-requiring hyperglycemia. Details regarding dextrose infusion rate, infection, and vasopressors should be obtained. Assessment: The child had no dehydration. He was on high dextrose infusion (9 mg/kg/minute). Sugar levels normalized after a reduction in dextrose infusion. Diagnosis: Transient hyperglycemia due to high dextrose infusion. Messages
Case 2- A 14-day-old girl with respiratory distress and hyperglycemia:
Presentation: This girl was admitted to the intensive care unit with respiratory distress. She had high blood glucose levels (270 mg/dL, 15 mmol/L).
Plan: An important consideration in a neonate with hyperglycemia includes the effect of stress and steroids.
Assessment: She girl was on steroids and beta-agonists. Glucose levels normalized with a decrease in steroid dose.
Diagnosis: Steroid-induced transient diabetes
Case 3- A 15-day-old girl with hyperglycemia and normal HbA1c:
Presentation: This girl presented with failure to thrive and dehydration. She had high blood glucose (320 mg/dL, 18.2 mmol/L) with normal HbA1C (5.6%).
Plan: High blood glucose, dehydration, and failure to thrive suggest neonatal diabetes; HbA1C may be falsely low in the period due to high fetal hemoglobin. Insulin should be considered in view of the clinical presentation.
Case 4- A five-day-old girl with diabetes and omphalocele:
Presentation: This girl presented with failure to thrive (current weight of 1600 qm as against a birth weight of 1800 qm) and dehydration. Investigations showed high blood glucose (425 mg/dL, 23.4 mmol/L) with no ketosis.
Plan: Early-onset hyperglycemia, low birth weight, and no ketosis suggest transient neonatal diabetes. Careful examination for pointers of TNDM (omphalocele and ear creases) should be done. Assessment The girl had omphalocele and ear creases suggesting TNDM1 due to a DMR defect.
Plan: Hypoglycemia after resolution of transient diabetes suggests increased beta-cell activity due to removal of the suppressive effect of ZAC 1 and HYMA1 genes. She should be started on diazoxide.