Hypoglycemia in children: causes, diagnostics, treatment. Purchase of hypoglycemia of easy form

For a quote:Інзучі С.Е. Lіkuvannya gіperglіkemiії in the minds of the stationary // RMZ. 2007. No. 23. S. 1693

Until the last hour, hyperglycemia in stationary ailments was seen in the capacity of no more than a manifestation, which was the main disease. However, in some cases of intensive treatment of hyperglycemia can likuvalny effect, I will screw up the respect to the problem of the correction of hyperglycemia in the minds of the stationary.

Vzaєmini mіzh gіperglіkemієyu i hospitality folding. Hyperglycemia is not easy for hospitalized patients in case of stress hormones. The preliminaries in experimental studies showed that hyperglycemia [blood glucose level 250 mg / dL (13.9 mmol / L)] is affected by a negative infusion on the heart immune system(Fig. 1). In some retrospective studies, it has been shown that hyperglycemia is associated with lethal inheritances in stationary ailments. The level of glucose during the operation is an important predictive factor for the development of infectious diseases for the ailments, who have carried out operations on the heart. As a result of the doslіdzhennya, having included the ailments on the diabetic diabetes, they suffered myocardial infarction, adjustments glucose during hospitalization of dressings from death both during hospitalization, as well as stretching the first time to infarction. Similar results have been discarded in patients who have been treated for treatment in intensive therapy (PIT) wards, who have suffered from surgeries, as well as people who have suffered from a heart disease The link between blood glucose and the risk of death of the prodigal will become too reliable to survive the grave problems of illness.
Some people are careful not to get sick with diabetes. According to the tribute of one day, the mortality rate in the period of being known in the hospital in ailments, in some hyperglycemia, has been shown forwards, against a small diagnosis cuckold diabet... For some reason, I would like to say that I do not allow to talk about the manifestation of the causal link. Nutrition about those who є advancing glucose levels will potentially overwhelm the development mechanism, for example, it’s just a symptom, other important illnesses, and we’ll see it too soon. If the adjustment of glucose level is not safe by itself, then intensive correction may be simply necessary. Obviously, insulinotherapy and control over the results will take an hour and a penny. In addition, the development of hypooglycemia, which leads to serious acceleration, is also a matter of course. Would you prove that the strict control of glucose level during the period of time in the hospital will improve the results of the glucose level?
Prove strategies
In decile robots for the effective control of blood glucose levels in the minds of reanimated patients, however, even more advanced groups of sick people (with and without diabetes) took part in these pre-illicit robots. In addition, the design of the dosage has greatly changed, as well as the methods and methods of introducing insulin. As a matter of fact, the results have been rejected and are even worse.
In the robot, which included 1,499 patients, who were on the test in the PIT for cardio-thoracic surgery, the intake of insulin in the form of infusion with the reduction of 150-200 mg / mm of glucose up to 8-11 liters Over a span of 24 years, the recording of critical operations on the heart led to a significant decrease in the frequency of the diagnosis of surgical wounds in cases of ailments such as insulin treatment was performed according to the standard scheme (0.8% vs. 2.0%). The duration of the randomization of the accelerated interpretation of the results in connection with the time, when the control group was formed retrospectively, in an hour, after the moment of the known disease in the hospital, as a matter of fact medical aid could be dyed. Slid, um, it means that analogous results and bullets were eliminated in randomized and nonrandomized dosages of a smaller scale, in which the efficiency of blood glucose level control for cardiological operations was also introduced.
In pre-adolescent Diabetes Insulin-Glucose Infusion in Acute Myocardial Infarction (DIGAMI) 620 patients with diabetes mellitus, who had myocardial infarction, were randomized to undergo intensive and standard glucose prevention during the period During the first 24 years of the hospitalization with the help of lowering the glucose level to 126-196 mg / dL (7.0-10.9 mmol / l) with the onset of glucose concentration for the first 24 years 173 mg / dL (9.6 mmol / L), the difference is in the standard, on the smallest average level of glucose levels 211 mg / dL (11.7 mmol / L) (p<0,001). В группе больных, получавших интенсивное лечение, смертность в течение первого года была на 29% ниже по сравнению с группой, получавшей стандартное лечение (18,6% vs. 26.1%, p=0,03), достоверное различие показателей смертности сохранялось при наблюдении в течение 5 лет . Однако дизайн исследования не позволял сделать определенного вывода о том, какое именно лечение, стационар-ное или амбулаторное, приводило к улучшению выживаемости. Целью исследования DIGAMI-2 являлось разрешение этого вопроса, для чего 1253 пациента с диабетом были рандомизированы на получение трех различных видов лечения после острого инфаркта миокарда: интенсивное стационарное [инфузия инсулина, целевая концентрация глюкозы от 126 до 180 мг/дл (от 7,0 до 10,0 ммоль/л)] и амбулаторное лечение, интенсивное лечение только в условиях стационара и стандартное лечение . Существенных различий в смертности и частоте осложнений между группами не было, однако статистическая достоверность исследования была слабой и различия в средних уровнях глюкозы между группами были небольшими. В связи с этим из результатов данного и еще одного, имевшего те же недостатки исследования, сложно сделать определенные выводы .
Robots, in which the efficiency of glucose infusion, insulin and calcium (IC) was introduced, also yielded superb results. In cich pre-sluggish people, there was not a singing level of blood glucose, but an assessment of the potential positive effects of the very introduction of insulin for an hour, for lack of admiration for myocardial infarction. For the danimi of the most significant amount of money, including 20 yew. Patients, the introduction of DVK did not lead to the completion of the results of the treatment, hoping that it would mean that more glucose in the main group of bullets was less than in the control.
Proof to prove that the strict control of blood glucose levels in the PIT drains will improve the results of testing. So, in the randomized dosage, which included 1548 intubated patients, in which they were transferred to the surgical PIT (13% of the patients diagnosed with diabetes mellitus), 4 to 6, 1 mmol / l)] from standard dosing [internal administration of insulin only, we have a problem, in which glucose levels have changed 215 mg / dl (11.9 mmol / l)]. In the group with the most intensive drinking, the death rate of the bull was 42% lower (4.6% vs. 8.0%, p<0,04). Это снижение имело место прежде всего у больных, находившихся в ПИТ более 5 дней. Кроме того, у больных, получавших интенсивное лечение, отмечена достоверно более низкая частота диализа и септицемии, а также возникновения необходимости в переливании крови или искусственной вентиляции легких.
In the last few days, it included 1200 patients of the foreign PIT, carried out according to the same scheme, the results turned out to be unambiguous. In general, the mortality of the bull was significantly reduced in the ailments, which were treated more intensively, in the case of the standard ones (37.3% vs. 40.0%, p = 0.33). At the same hour, intensive drinking led to a decrease in frequency and an acceleration (including a decrease in the triviality of piece ventilation of legends) and a large amount of early whiskey. In addition, in a group of ailments, as they stayed in PIT for 3 days or more (767 patients), the intensity of abuse led to a decrease in internal mortality (43.0% = 0.009.5%., P. At the same time, it was too early to predict the triviality of moving to PIT, but the mortality of the middle of the sick grew more intensively, as they stayed in PIT for less than 3 days. Dane, if it did not appear to be statistically reliable (the validity interval is 1.09; 95% confidence interval is from 0.89 to 1.32), perhaps a greater value.
In both preliminaries of hypoglycemia [the level of glucose less than 40 mg / dl (2.2 mmol / l) was summed up], it was significantly more frequent in ailments, who were treated with intensive drug addiction, in some% vs. 0.2% of the standard 7% in surgical PIT і 18.7% vs. 3.1% in foreign PIT). If the hypoglycemia did not lead to hemodynamic damage, or in court, the meaning of the important ailments was not to the point of being overwhelmed. Moreover, in the preliminaries held in the foreign PIT, hypoglycemia was an independent predictor of mortality risk.
Possibilities of a greater protective intensive treatment of boule vivcheni in the preliminaries, which included a change in the group of patients with surgical and foreign PIT; Insulin in the form of infusion was injected only when the amount of glucose was replaced with 200 mg / dl. The internal morbidity of the disease was significantly lower than the middle of the ailments, as they were eliminated more intensively, in the context of the control group, formed according to the data of the history of ailments (14.8% vs. 20.9%, p = 0.002). Until the present hour, there is no way of the effectiveness of intensive treatment of hyperglycemia in stationary ailments in the PIT posture.
Factori, scho pour in
on the vibration method of treatment
A number of factors are injected into the insulin resistance and the ability of the sick organism to secrete a whole hormone, including the severity of the illness, the drugs taken (in front of glucocorticoid and fresh agents). In addition, the treatment of ailments at the hospital is not easy to adjust the situation and the operation, as it can also interfere with the regimen of taking medications, as well as adequate control over the level of blood glucose. It is important for the nobility, for a sick person with diabetes, and for the є type (so as for patients with type 1 diabetes, they develop ketoacidosis), as well as those who performed the correction of glucose in the hospital. I will also respect the animals:
- the specialties of the sick person's food, as they begin to add the insulin;
- a very special level of blood glucose, which is important for taking decisions about the intensity of blood glucose and fastness of blood glucose;
- steps to control blood glucose level before hospitalization;
- the level of glucose hemoglobin (you can allow the assessment of the need for more intensive treatment in patients with diabetes, and the sick in the first place in the state of hypertension of the hemoglobin)
In case of high-quality training, intensive therapy requires an assessment of the triviality of moving a sick person to a hospital.
oral drugs
Insulin є we reduce the drug for the treatment of stationary ailments, so that the dose can be higher and faster and more efficient than it should be. Protest in people with ailments (especially with a slight stuntedness and normal capacity) can be continued by taking oral medications with their effectiveness to hospitalization. With especial respect it is put to the sign of metformin, vrahovoyuchi contraindication to the last one (including nirkovo deficiency, heart deficiency and the need for radiological reports for the introduction of contrasting speeches). Acceptance of thiazolidinidion was followed by a symptom of heart or liver failure (if a symptom of an antihyperglycemic drug was taken, it can be taken over a long period of time). For patients who are eating irregularly, drugs that fail to see insulin (for example, from a group of sulfonyls) are especially not safe, and ingibitories of alpha-glucosidase are ineffective. In addition to the decrease in the dosage of the drug, it can be used by the patients who use the stationary treatment and find the day with the same calorie content, so as to be more useful in the case of changes. If the glucose level is significant when it is properly controlled, or if the control over it is lost before the hour of being transferred to the cell, it will often be used as an insulin.
insulin
In the minds of PIT Insulin, you are encouraged to introduce a trivial internal infusion by the way. Є okremі norms-yattya kіlka zalnoprinyatnyh protocols introduced. The most effective ones, in which a dynamic scale is stagnated, will prevent the dose change in the fallowness from the level of glucose. Often, vimir level of glucose (change the skin for a period of time) is very important for minimizing the risk of hypoglycemia. In the world of polіpshennya, the patient can go to the hypodermic insulin; At the same time, for the development of the microorganism, the reduction of the infusion rate, multiplied by the progression between the injections, should be used for the basic dose, which is tied to the same part (Fig. 2). On the other hand, it is necessary to unify great interruptions between internal and pediatric introductions, especially among children with type 1 diabetes. Patients with type 2 diabetes, which require less than 2 units of insulin for a year, can reduce the need for less intensive treatment; for children with ailments, you can add oral medications.
Beyond the intervals of intensive therapy, the scale for determining the dosage of insulin in the fallowness of hyperglycemia is becoming increasingly widespread. The stagnation of such tactics, as a rule, is not effective enough, especially in patients with type 1 diabetes, as they require continuous, reliable insulin for suppression of ketogenesis. The short control can be achieved when the tactics are introduced. The method of introduction, which includes basal insulin (medium or trivial) and insulin of a short period, which is introduced before the beginning of a decrease in the incidence of postprandial hyperglycemia, allowing for the most benign results Shvidkodyuchі analogs іnsulіnu (lispro, aspart and glulіzіn) should be introduced immediately before іzheya. The standard human insulin slid should be introduced 30 minutes before the day, which is often easy in the minds of the stationary to call the staff. Besides, shvidkodiyuchі drugs more effectively control postprandial hyperglycemia. For patients, children of which are unassigned, follow conservative tactics. Alternatively, the introduction of a fast-moving insulin at once, the dose will start to fall asleep.
Additional corrective doses can be introduced at the same time with a prandial insulin to compensate for a diabetic diabetes, a win in front of a child. Sensitive to insulinu patients (a large number of patients with 1 type of diabetes, thin patients, who accept altogether small doses of insulin (less than 30-40 units per dose), and also a poor diet for cinnamon 150 mg / dL (8.3 mmol / L), 2 units for 200 mg / dL (11.1 mmol / L), etc.). The majority of patients with type 2 diabetes mellitus (may take a vagu or take an additional dose of insulin - from 40 to 100 units per day) will require smaller doses of crimson (for example, 2 units of glucose for a shortcut dl etc.). For children with type 2 diabetes and with increased resistance to insulin (with overweight patients who take insulin at high doses (more than 100 units per day), or take blood glucose levels of blood glucose dl, 8 units at 200 mg / dl, etc.). In the world of polіpshennya zagalniy camp of the sick one can move sensitiveness to insulin.
As a rule, as the patient's age is stable, the ratio of doses of the main and prandial insulin should be 1: 1. The dose of the main insulin is taken in the presence of the backward dynamics of the change in glucose concentration. Yakshko zastosovutsya glargine or detemir, viznachennya dosage viroblyayut at the presentation of rank glucose concentrations. In case of stasis of the NPH, the dose is taken out of the rank glucose concentration or the value before the evening reception of the glucose. At the time of the selection of the dose, it is also possible to include the correct dose in the main one, adding 50% of the correct dose, which was taken on the previous day before the main one. The dose of prandial insulin should be started at the presentation of the post-prandial hyperglycemia. Correctional dosage of the insulin can be taken on the basis of the effectiveness of the dosage used earlier. To ensure the safety of the sickly need in the insulin, it is guilty but re-evaluated immediately for any changes in the day.
Deyakim ailments on type 2 diabetes can be completed with a less aggressive drug, zokrem, the introduction of only the main insulin (for example, glargine once a day, detemir one or two times a day or NPH twice a day) any Insulin middle and short or even shorter than short diy (for example, "70/30"). A similar pidhid can be validated for patients with a different hyperglycem, especially if a vip is planned in an hour for the preparation of a dose of insulin.
If a patient, who will take off insulin, is not, then enter the main dose in the form of a standard insulin for the skin for 6 years. It is absolutely necessary for patients with type 1 diabetes and for children with type 2 diabetes. In some cases, it is also possible to diagnose an infusion to an insulin, especially if a patient is aware of the adequacy of an ab-sorption from a child's tissues.
Patients who are self-conscious and accept insulin, the regimen of administration of the drug, which is stagnant before hospitalization, can be saved with its efficiency. As in the case of oral medications, in the presence of a clinical situation, it is possible to reduce the dose of insulin in case of a decrease in caloric intake. This is especially true for people with diabetes type 2 diabetes. If the concentration of glucose for an hour I enter visoka (at 200 mg / dl), the dose of insulin slid zbilshiti. Slide to see the possibility of transition to coriguval doses. If hyperglycemia is affected [the level of glucose from 300 to 400 mg / dL (from 16.7 to 22.2 mmol / L)] can be taken for longer than 24 years and not to get good doses of healthy It means that, in conjunction with a short period, the insulin was given with an internal injection (5-9 hvili), with the development of the hypoglycemia, it can be shydko usunen. Z mirkuvan is safe in case of stagnation of infusion insulin in the back wards (in the case of PIT), it goes to higher concentrations of blood glucose.
Control over the concentration of glucose in patients who receive a continuous enteral feeding through a probe can be most easily reached when the main insulin is consumed, given corigal doses for the required skin 6 years. As soon as it was interrupted, it was necessary to introduce internally the very amount of carbohydrates (for example, glucose), which is guilty to be administered enterally to prevent hypoglycemia. If a patient is found to be on parenteral harshness, insulin can be added without the need for a bottle. The dose is titrated with a crock of 5-10 units per liter for optimal control.
For good control, a frequent assessment of the blood glucose concentration is necessary, at the end of the skin 1-2 days after the correction of the insulin dose. Whilst, the first time to dose the drug, then to assess the possible causes of hyperglycemia (for example, missed doses, infection, infection) and usunuti їkh. The unfortunate control of glucose concentration, feeding and the introduction of prandial insulin are also common reasons for the amount of glucose in the brain. For the proper control of glucose level, coordination of nurses and sportsmen is required, so as to prevent sickness. In the ideal of blood loss from the finger, it is necessary to check the skin once before sleep and before going to bed. Early adolescence of post-prandial glycemia (lasting for 2-3 years) can lead to an overwhelmingly intensive treatment of insulin, which is uncommon behind the wine of special situations (for example)
Before the vipiska, the scheme of the introduction of the guilty insulin was simplified in the fallowness of the ailments' abilities. For children with ailments of type 2 diabetes, it is possible to have a prolonged insulin once a day. For those ailments who, during the period of being in the hospital, require small doses of insulin during the period of their experience, but if the blood glucose level is monitored, if a minimum of 25-30 one day is administered, there may be sufficient preparations. If there is a sign of an antihyperglycemic drug or a change in dosage in the hospital during the current period, it is necessary to re-look at the patients after 1-2 days of writing.
Let's take the rank to lead stationary ailments from the previously developed hyperglycemia, if some of the patients do not need to continue their treatment, which is aimed at reducing the level of glucose compensation, which is the main problem. In such ailments, the concentration of glucose in the blood (and, as much as possible, glycated to hemoglobin) is guilty of control after 1-2 months of drinking whiskey.
recommendations
Two robots presented recommendations for monitoring blood glucose levels in hospitalized patients (Table 1). The data are ambiguous, only a small number of randomized reports have been carried out. It is generally accepted that the insulin slide is introduced internally in the minds of the PIT and the other methods of introducing the insulin guilty as close as possible to the physiological minds, especially in patients with a child of 1 type. In connection with the visibility of the awareness of the effectiveness of the pedagogical introduction of the insulin in the minds of the stationary, the recommendation is based on the clinical information.
unclear areas
Little evidence has been accumulated on the role of strict control of blood glucose levels in hospitalized patients. If I want to show more, that the decrease in glucose levels in important patients is not suitable for the poor visibility, the exact target concentration, the optimal method of introducing and introducing a group of patients at home, for some of the most Oskilki Intensive insulin therapy reduces mortality, even for the middle of the sick, as they spend a trivial hour in PIT, it is possible to get rid of them, but not all important patients have the same blood glucose control. Trivial continued intensity of treatment with insulin in PIT add new information to this nutrition.
Optimal response to correction of hyperglycemia in patients who have suffered myocardial infarction, nevidomy. In particular, the meritorious tribute to the two recent reports, who demonstrated the interconnection between the development of hyperglycemia during the period of the hospitalization with the drive of myocardial infarction and the increasing risk of death. I want, in case of coronary coronary syndromes, insulin volodyn not only for hypoglycemic diyu (even more anti-lipolytic, supineoplastic, anti-fatigue and professional), which is of great importance.
It is unclear whether it is possible to see the results of a further increase in PIT for non-important patients. Slidelly appraisal of spіvіdnoshennya mіzh vigodoy vigodoy and nezpekami (first for all the development of hypocriticalism).
Visnovok and recommendations
In surgical and out-of-the-box PIT, blood glucose concentration should be taken at a level of less than 140 mg / dl, and it is possible to take less than 110 mg / dl. Optimal indicators of glucose concentration in ailments in those with cardio-reanimation and large spirits: generally, but very high values ​​(up to 180 mg / dl). Internally, the introduction of insulin allows a higher dose to be taken in seriously ill patients, but not in children. In surgical and therapeutic ailments, who do not overwhelm an important patient, the assistant needs to increase the glucose concentration before the dose of 90 to 150 mg / dL (from 5.0 to 8.3 mmol / l), not only because of the decrease in energy at Z metoyu unique hypoglycemia. It is important to note that strict control over the concentration of glucose is responsible for the responsibility of the qualified personnel.
I would like the exact goals of glucose concentration in stationary ailments to become unimportant, it is important to think that before the hour of the hospitalization of the insulin, we are active, with frequent corrections of the internal dose, in the formalized form. When vipisci of ailments need, clarify the scheme of treatment in outpatient minds.

Abstract of preparations by V.V. Iremashes for materials of statti Inzucchi S.E. Management of Hyperglycemia in the Hospital Setting. New England Journal of Medicine 2006; No.355: pp. 1903-1911.

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45. Chaudhuri A, Janicke D, Wilson MF, et al. Anti-inflammatory and profibrinolytic effect of insulin in acute ST-segmentelevation myocardial infarction. Circulation 2004; 109: 849-54.
46. ​​Cryer PE. Hypoglycaemia: the limiting factor in the glycaemic management of the critically ill? Diabetologia 2006; 49: 1722-5.
47. Inpatient diabetes and glycemic control: management: a call to action conference, January 2006. AACE-ADA Consensus Development Conference position statement. (Accessed October 6, 2006, at http://www.aace.com/meetings/consensus/IIDC/.)

Hyperglycemia in a large variety of vines is not as an independent affliction, but as a heritage of childhood changes in the life of an organism. The main reason, which may be hyperglycemia in children, is a child with diabetes.

With such a state in the body of the child, there is no sufficient amount of insulin. It’s not a good transport to go from їzhey tsukor to kіtin. Glucose accumulates in the blood, which is the main manifestation of hyperglycemia.

However, diabetes is not the only reason for this symptom. Hyperglycemia can cause damage to the child's robotic organism:

• wrong food: there are high-calorie products in the warehouse, so there are a lot of carbohydrates in the warehouse;
• frequent perejdannya, nedotrimannya regime eating;
• severe stress and emotional problems;
• injuries;
• transfer of infectious diseases.

The peculiarities of the fact, as the diagnosis and manifestation of hyperglycemia in the organism of the child, zoom in on the manifestation of decile options in the classification of the pathological camp.

Behind the turn of the hyperglycemia boom:

• lung step (with glucose in the blood 6-10 mmol / l);
• average variation (the level of glucose becomes 10-16 mmol / l);
• important form (indicators of the level of zukru in the blood translate into a mark of 16 mmol / l).

Hyperglikemia can also be developed in many ways:

• pidvishennya rivnya tsukru after 8 years of hunger,
• Improvement of indicators in place of glucose for consumption.

symptoms

Hyperglycemia in a child is not often supervised with characteristic symptoms. Ditya can be used to show signs of a pathological camp:

• Seeing strong sprague and dryness in the mouth,
• parts of the affair until the next day,
• no difficulty in dikhannya,
• acceleration pulse,
• ill feeling in the stomach,
• tediousness with the onset of blues,
• pogirshennya zoru,
• zagalny camp nezduzhannya i vtomi.

Independently, the identification of such symptoms as signs of hyperglycemia can be easily achieved. But the reason and the nature of the manifestation is guilty of the fahivets.

Diagnosis of hyperglycemia in a child

Iakshcho the child has a strong spraga to repent for no apparent reason, the fathers should be brutalized by such a snake. A quick walk before the doctor can help to diagnose hyperglycemia in the early stages.

Diagnostics of the country is possible for additional help:

• vypadkovogo doslіdzhennya blood in the Danish moment for vnnachennya rіvnya zukru in blood;
• an analysis of blood for a sucker for 8 years of hunger (natsche);
• complex bagatorazovogo blood dosage (test for tolerance to glucose).

Diagnostics is necessary for the maintenance of glucose levels in the blood. It is possible to help determine the primary diagnosis, which provoked hyperglycemia, and to indicate a course of treatment.

accelerating

Decrease in hyperglycemia develops in case of trivial manifestations of a pathological stance and in a day-to-day treatment. Hercules, which may not be an unbeatable hyperglycemia for a child, are:

• development of sickness of the heart і heart-vascular system;
• the destruction of robots nirok, which can lead to the development of nirk's lack;
• zahvoryuvannya organ_v zoru;
• diseases in the robots of the central nervous system;
• ketoacidosis (with sugar diabetes).

Accelerate the development more quickly and help me respect you until you become a child and promptly see the doctor.

lykuvannya

You can zrobiti vi

Likuvati hyperglycemia is necessary in the presence of the disease, as the disease was the cause of such changes in the body. So, if the promotion of tsukru in the blood of a child born to a tl_ tsukrovy diabetus, you need:

• turn to the fahivtsya for the correction of the sign,
• regularly vimіryuvati rіven zukru in the blood of the child for the sake of all the wines,
• forgetting to eat correctly from low-carb children,
• zdіysnuvati іnsulіnovі ін'єкції for the education of important biological processes in a child's body.

However, not all daddies know how they are going to be affected by hyperglycemia on the other, non-diabetic problems. Add more help:

• catching the right food with a profit in the great number of fruits and vegetables,
• hitting the nutritional regimen,
• attraction of the child to the singing regimen of reception,
• control of the visitor by the little patient of all fahivts' orders.

How to rob a license

Yakshcho hyperglycemia was provoked by non-diabetic reasons, it’s quite possible. Lykar signifies drug therapy, tailored to the achievement of three main goals:

• normalization of the ryvnya zukru in the organism of the child;
• lіkuvannya main zhvoryuvannya, scho wicked snakes in indicators instead of glucose;
• replenishment of additional changes in the future.

Likuvannya transferring like medication therapy, as well as changing the way of life, feeding a child.

prophylaxis

Iakshcho a child with an ailment for diabetics, prevent hyperglycemia in addition to helping the singular regime of life. For many fathers it is necessary:

• good control and maintenance of changes in blood glucose,
• stitches for the child's child's eye-catching,
• to privatize awkward physical rights to the vison,
• to work in a timely manner to the insulin.

Yaksho є risik development of hyperglycemia for non-diabetic patients, unique inheritance in addition to:

• respecting the regime and the quality of food,
• besides physical activity,
• timelessly gostrykh of infectious and chronic ailments,
• unique stress situations and emotional drops.

Nowadays, the brutalization of the doctor will help you to cleanse the young member of all the possible problems for health.

You also see how it is possible that it is not uncommonly possible for children to get rid of the ailments of hyperglycemia in children, and for which it is so important to identify the inheritance. All about those who will overcome hyperglycemia in children and will not allow acceleration.

And even if the daddy know on the sides of the service, I will give more information about the symptoms of hyperglycemia in children. What are the signs of ailments in children in the 1st, 2nd and 3rd births? What is more beautiful than lіkuvati zvoryuvannya hіperglіkemiya in children?

Protect the health of loved ones and be in good shape!

describe:

Hіpoglіkemіya - tse stan, which is characterized by a low level of zukru in the blood.
The human body and especially the brain for normal functioning require a constant level of glucose in the blood. & Nbsp & nbsp To that, hypooglicemia is a camp, scho vimag of non-intrusive visits. With the development of hypoglycemia, one is more likely to see it more clearly, to feel hunger, to see the lips and fingers puckered, blit, heartache, shivering, and also faintness and weakness in the stomach. When the central nervous system becomes obstructed, there may be clouding and double vision, spastic, rapid muscularity, or frequent posturing. Sometimes I see and psychic symptoms in vigilance and drudgery, I will become sleepy during the day and sleepless at night. We are averse to giving pardons to diagnoses or depression at the connection with the cymbal bagatom.

Reasons for the determination:

Decrease in the place of zukr in blood can be developed both among healthy people and sick people because of the loss of carbohydrate exchange.
The reasons for producing hypooglycemics before development.
- znevodnennya;
- inadequate consumption of malignant refined carbohydrates, with a sharp increase in deficiency of corticosteroids, vitamins, mineral salts;
- lіkuvannya іnsulinom, oral sucroznіzhuvalny drugs in case of overdose;
- ominous alcohol;
- non-private physical navantazhennya;
- somatic ailments;
- menstruation in women;
- lack of abnormalities in the reception of їzhі;
- the lack of an organ is critical: nirkova, pechinkova abo, visnazhennya;
- hormonal deficiency: cortisol, hormone growth or the stench of offense, glucagon + adrenaline;
- not r-klinna puhlina;
- pukhlin (insulinoma) or congenital anomalies - 5-cell hypersecretion, autoimmune hypotension, 7-cell hypersecretion;
- hypoglycemia in newborns and children;
- vnutr_shnyovenna introduction of fizrozchinu with a drip tray.

symptoms:

For the clinical picture of hypoglycemia, characteristic developmental symptoms.
vegetative:
- adrenergic: anxiety, increased aggression, restlessness, fear
- Blіst shkіrnyh curves
- (tachycardia)
- (myazove tremtinnya), myazovy hypertonicity
- (expanded zinitsi)
- Adjusted for food
- Hypertension (adduction of arterial vise)

parasympathetic:

With such a state, as a hypoglycemia, a liking is required at any stage.

The emergency of hypoglycemic control needs to be carried out in that case, if the symptomatic picture is important.

Without a smart and correct supply of help, people can fall into the camp of the hypocritical Komi and reject the serious organic damage to the brain.

It is important for carrying out the treatment.

In medicine, there are two types of hypoglycemia:

• toshchakova, tobto vinikaє on the heart;
• gipoglikemia pislyattya yzhi.

Hypoglycemia for the better to get involved in the better to give in to love. With a few days of trap an attack of hypochondria, it is necessary to provide a shrewd dolikarsky and lykarskoy additional help.

When carrying out differential diagnostics and establishing the reasons for the diagnosis of hypoglycemic syndrome, a complex treatment is recognized.

Toshchakova's hypoglycemia is based on analyzes for a sucker for an eight-year hunger, as well as for 3 days of a special day. So, if you go to bed, it will also be called insulinova hypoglycemia.

The second type of hypoglycemia is often found in women of asthenic statues, after 2-3 years after the birth. The number of tsukru for a short-hour fall is known to come to the end of the day. Destroyed to take blood on tsukor before the hour of attack.

Skin types of hypoglycemia can be contracted in a light and important form.

Purchase of hypoglycemia of easy form

For easy formation of ailments, as a rule, it is easy to consume in carbohydrates:

• products that take revenge on fructose or sucrose;
• chocolate bars;
• honey, food products;
• bili hlib.

In case of a progressive outbreak of ailments, the terminovo requires diagnostics, to ensure the dynamics and stagnation of signs of lykarsk problems.

Correction of severe form hypoglycemia

The symptomatology of an important form of seizure manifests itself in a boisterous and well-advised manner:

• the interlocking of information, communication and coordination;
• shipbuilding, fast music;
• uncomfortable camp, right up to comatose.

First lykarskoyu help є drink 50 ml of 40% glucose, which should be introduced sooner.

Another option for providing additional help is the use of the drug Glucagon, which is against the insulin.

When the patient is turned up to them, it is necessary to pump him with a lot of carbohydrates, small portions with small interruptions between priyomas.

Reconstruction of the ryvnya zukru in the blood to carry out the skin for 5-7 years before the reversal of the hypoglycemic camp.

How robots are in extreme weather?

How can I get a gipoglycemia, why don't people come to see you?

At the end of the day, the doctor has started the intensive therapy of hypoglycemia with the onset of rehabilitation:

1. With a sweep of decilcoh dib, continue to introduce p'yatvidstkovy glucose levels with additional doses of pre-nizolone.
2. Administer the drug cocarboxylase.
3. Introductions of 5% ascorbic acid razchin and increases the level of glucose.
4. The introduction of adrenal adrenaline prior to cutaneous infusion of glucose.

If there is an increase in the amount of sugar in the blood of 12 mmol / l, then add a dose of insulin in a small amount.

Yakshcho lyudin not come until a trivial hour, demanding to carry out prophylaxis to build up the brain.

For the preparation of the following preparations:

• rozchin manitol;
• drug lasixom;
• rozchin sulphate magnesium;
• rozchin Prednizolone;
• Ingestion of food

Pislya prinennya, vikoristovuyu to improve metabolism in cells of the central nervous system:

• glutamic acid;
• stugeron;
• aminalon;
• cerebrolizin;
• Cavinton.

The therapy should be carried out once a month.

Likarsky preparations: tablets and gels

For a quick and effective suppression of hypoglycemia in the household, such tablets and gels are used:

1. Blister with tablets Girofri, in the skin of which there are 4 gr. glucose (glucose).
2. Bistrose in the form of tablets, 4 g each. Myak_ tablets, which are easy to rozzhovuvati, take for relish.
3. Dextro 4 tablets and a gel, which are stored with pure D-glucose, by a quick process, moistened without the need for the first time in the mouth.

Gel-shaped cushions for the purchase are widely used to provide additional help to people who have lost their testimony.

Lightly rub this form of lykarskiy zasoba into a clear or vyvlyuvati in the gap between your teeth. The gel is kindly distributed in the mouth.

Gel Dextro 4 permissions before being stashed by new people. In such a rank, you can get more brain damage from young people.

Pathologies and decreases instead of glucose

Differential diagnostics of hypoglycemic polyagus in an advanced pathological camp of the most common pathologies of the endocrine system.

From the correct setting of the main diagnosis, it is not possible to determine the speed of the acceleration and the forecast for the day.

Razr_znyayut such changes of mind, as to produce to the hypoglycemic camp:

• puffs of the islands of Langerhans;
• pathology of the liver, congenital and nabuty;
• at vagitnykh;
• nirkova lack of;
• early stages of sugar diabetes;
• alcoholic abo kharchova іntoksikatsіya;
• operatively involved in the area of ​​organs in the shlunkovo-intestinal tract.

By the method of collecting information about the patient, it is possible to also add factors to the hypoglycemic index:

• stress;
• neurosis;
• psychotic food.

For differential diagnostics, it is necessary to know the data of ultrasound diagnostics of internal organs, as well as extensions of the biochemical analysis of the patient's blood.

Based on the results of the analyzes, it is possible to determine the adequacy of the main ailment, which can lead to the production of suckers in the blood until the end of the day.

Features of the therapy of hypoglycemia

I’ll get to the heart of the hypoglycemic person, as I’m going to get ready for the reception of the child, and then I’ll spend some extra time and other food. The head of such tactics is to change the number of carbohydrates in the race.

Lіkuvannya toshchakova hіpoglіkemії

This type of ailment is corrected for the increase in carbohydrates in the ratsioni of food. , Such yak Dilatin and Anaprilin, kindly cope with all the staff.

Alle the stink of depriving you of tidying up the deyakі of a reduced amount of glucose in the blood, for that reason it is necessary to take care of usunenny reasons.

Likuvannya of the reduced number of tsukru among the new people

Primary help to new people with the establishment of hypoglycemic polygases at the internally introduced dose of glucose.

If you see a relapse in the syndrome of low blood sugar, then you can probably get vikoristovuvati hydrocortisone, the dose of which will be recovered for the vagina. Yogo stasis through the skin chotiri godini.

With the correct implementation of medical maneuvers, as not an important camp of the new generation will increase for 1 month, so that the insular apparatus is normalized until the end of an hour.

What analysis is required?

To carry out accurate diagnostics, it is necessary to reveal the results in the decile types of analyzes:

• test with insulin hypotension;
• biochemical analysis of blood;
• analysis of the section.

The main thing for the identification of the severity of the ailment is the analysis of the test with insulin hypotension. This is a special test, which is the transfer of a blood test for cortisol when the hypoglycemic threshold is reached at 2.2 mmol / l.

If the amount of cortisol is less than 540 nmol / l, then the hypoglycemia reference will be confirmed.

Carrying out a test of special respect from a medical practitioner, all day long before the patient is tested, the patient is in the stationary under the control of the doctor.

Complex pidhіd to hіpoglіkemії

The patient with the diagnosis of hypoglycemia is guilty of the following methods of treatment:

• zagalnozm_tsnyucha therapy with medications;
• gymnastics;
• dyeta, stuffed with white hedgehog and carbohydrates;
• phytotherapy.

Dobre tincture of levzei, lemongrass leaves. Nastya shipshini is not only a tsukor, but a supply of necessary things to the body's vitamins S and K.

In case of hypoglycemic stanі, black currants and lemon should be used. There is a great number of zucru in these products, as well as special words that normalize the metabolic process.

How can you find a hypoglycemic event? Mild forms of sugar in the blood can be rapidly increased and trimmed under the control of glucose and glucose preparations.

Important forms are subject to continuous control. Їх usunennya spriyє success in catching up with the main ailment, as the cause of the hypoglycemic camp.

The level of glucose in the blood of practically healthy people increases in the range of 3.3 to 5.5 mmol / l when indicated by the glucose oxidase method. By stretching, add glucose in the blood plasma in the normal range from 2.8 to 8.8 mmol / l. Instead of glucose in the blood lower than 2.7 mmol / l, it was taken for hypoglycemia.

The main reason for the hypoglycemic symptom complex is hyperinsulinism.

Hyperinsulinism is a pathological state of organism, overwhelmed by an absolute or tolerable excess of insulin, which means a decrease in the amount of blood in the blood; as a history of glucose deficiency and a sour brain hunger, which leads to destruction in the first place of great nervous activity.

Absolute hyperinsulinism is a process of dressing with pathological insular apparatus (primary organic hyperinsulinism). Most common causes of organic hyperinsulinism є insulinoma - pukhlina b-clitin of Langerhans' spines, secreting an overwhelming amount of insulin (in adults and older children); Another common cause of hyperinsulinism in young children is functional hyperinsulinism in newborns from mothers with diabetes.

Good for the adenoma of the islands of Langerhans for the first time having appeared in 1902 when Roztin Nicholls was born. In 1904, L. V. Sobolov wrote about the "Strum of Langerhans Islands". In 1924, Rots of Garris and Vichyznyaniy hirurg VA Opel just one of one described the symptom complex of hyperinsulinism. In general, GF Lang has spared multiple adenomatosis of pancreatic islands. In Russia, a successful operation was made by the Insulinoma Bula Viconan in 1949 by A.D. Ochkin, and in 1950 by O. V. Nikolaevim. Insulin-secreting poohlina has been described in all groups of women, from the new generation to the people of the kidnapped age, however, more often than not, the enemies of the first generation are from 30 to 55 years. In the middle of the overwhelming number of sick children, they are close to 5%. 90% insulinom is good. Closely 80% of them are solitaries. In 10% of vipads, the hypoglicemia was filled with multiple puffs, 5% of them were malignant, and 5% became nezidioblastosis (Antonov A.V. Klinichna endocrinology, 1991).

The term nezidioblastosis was introduced by G. Leidlo in 1938. Nezidioblastosis is a total transformation of the ductal epithelium of the b-cells into b-cells, which produce insulin. In children of the first fate of life, the most common cause of organic hyperinsulinism (deprived of 30% of hyperinsulinism in children is insulinoma, 70% - nezidioblastosis). Tse is genetically obumovlene zhvoryuvannya.

The diagnosis is established only morphologically after the vignette of insulinomy. Clinically, it is important to show important, it is important to allow for the correction of hypoglycemia, however, when there is a positive effect in the form of conservative addiction, it will be brought to a change in tissue mass. The initial reception of the operation is 80 - 95% of the resection of the surgery.

Insulinomas in children develop in and out of the wild, either in the tail, or in the middle of the grass. Їх diameter can be varied from 0.5 to 3 cm. Small dimensions are insulated for folding for diagnostics (information content of the ultrasound method is not more than 30%). For identification of localization of insulinomas, selective angiography, CT and MRI or scanning with an isotope of octreotide (analogue of somatostatin) are used. Most informative angiography with selective sampling of blood from the veins of the underflow zone (60 - 90%).

Insulinoma manifests itself in a greater-lesser extent to the sharp drop in blood sugar, which is enlarged by the increased secretion of insulin in the roof. By the radical method of treatment of insulinomy and surgical (insulinomectomy), the prognosis in a large number of cases of hospitable (88 - 90%) with prompt operative involvement.

Organ hyperinsulinism (insulinoma, nezidioblastosis) is the cause of important pancreatic hypoglycemias with a decrease in blood flow up to 1.67 mmol / l and lower (before an hour is attacked). The process of hypoglycemia is not ketotic (acetone in the negative for the smothering of the processes of lipolysis).

Most often, in clinical practice, ketotic hypoglycemia (with acetonuria) is developed. Ketotic hypoglycemia є extra-pancreatic and can be endocrine and non-endocrine-dependent. The stench of supernatural hyperinsulinism, so that we do not tie it to the pathological apparatus of an insulinous cavity (secondary, functional, symptomatic hyperinsulinism). Intravenous hyperinsulinism of the sensitivities of the body to normal visibility by the b-cells of the pancreatic islands of the insulin or of the impaired compensatory mechanisms, so that they take part in the regulatory endeavors

Endokrіnnozavіsіmie ketotіcheskіe gіpoglіkemії (without pіdvischennya rіvnya іnsulіnu in krovі) viyavlyayutsya at nedostatnostі kontrіnsulіnovih gormonіv have ailments of gіpofunktsієyu perednoї dolі gіpofіza (cerebro-gіpofіzarny nanіzm, іzolovany defіtsit STH, hypopituitarism) schitovidnoї zalozi (gіpotireoz), measles nadnirkovih zaloz (hvoroba Addіsona).

Without admission, insulin may be against extra-pancreatic hypochondria, which can develop in case of extrapancreatic fluff (breast tissue, chronically empty, retroperitoneal, chronic diseases), etc. In children of the first fate of life, the cause of ketotic non-endocrine-dependent hypoglycemia (without hyperinsulinism) є congenital enzymopathy (glycogenosis).

Clinical practitioners often develop reactive hypoglycemia - functional hyperinsulinism with vegetative dystonia. The stench is promoted in individuals with obesity, in neurotic children of preschool age on aphids of acetone bleeding through impaired gluconeogenesis processes, etc.

Neither hypooglycemics of exogenous nature (against the introduction of insulin, sucrose diseases, salicylates, sulfanilamids, and other lykars).

In case of functional hyperinsulinism, the hypoglycemia clinically decreases the turn, instead of blood flow it does not fall below 2.2 mmol / l.

Evidence of hypoglycemia is possible for the key signs, often for the decrease in the level of zukru in the blood є laboratory knowledge. Victims of hypochondria are affected in the early ranks of the year or even the heart before a child in capillary blood is not less than 2 - 3 times (if there are clear clients). Indicated for improvement in hospitals є classic class of hyperinsulinism of the level of hyperinsulinism of three types of hypoglycemia (without clinical manifestations) lower than high indicators (decrease in the level of hyperinsulinism for the new period of 1.67 mm) , older than 18 years - less than 2.7 mmol / l).

For hypoglycemic ailment pathognomonic є Whipple's test:

• the diagnosis of attacks against hypoglycemia due to tricky hunger or physical overthrowing;
• a decrease in the amount of sugar in the blood before an hour of attack is below 1.7 mmol / l in children up to 2 years, below 2.2 mmol / l - older than 2 years;
• kupiruvannya hypoglycemic attack by intravenous injections of glucose or oral administration of glucose products.

The greater number of symptoms of hypoglycemia is accompanied by insufficient supplies of the central nervous system and glucose. With a decrease in the level of glucose to hypoglycemia, mechanisms are switched on, which are correlated to glucogenolysis, gluconeogenesis, mobilization of fatty acids, ketogenesis. In cich processes, they take part in the main 4 hormones: norepinephrine, glucagon, cortisol, growth hormone. The first group of symptoms is associated with the development of catecholamines in the blood, as well as weakness, tremor, tachycardia, fatigue, restlessness, feeling hungry, losing the children. Symptoms on the side of the central nervous system (symptoms of neuroglycopenia) include headache, double vision, impaired behavior (mental disturbance, aggressiveness, negativity), insistence on loss of testimony, dyspnoea yazovoy atonієyu. Gliboka coma ved before death or non-edentulous ears of the central nervous system. Part of the attack of hypoglycemia is produced to the detriment of specialness in older adults, and a decrease in intelligence in children. The incidence of symptoms in hypoglycemia from reference neurological conditions is a positive effect on receiving a patient, there is a large number of symptoms that do not contribute to the clinical picture.

Evidence of circulating neuropsychic breakdowns and lack of information about diagnostics about hypoglycemic patients often leads to the fact that diagnoses of diagnoses of ailments are often caused by organic hyperactivity problems. Pomegranate diagnoses in 3/4 of the ailments with insulinoma (epilepsy is diagnosed in 34% of cases, cerebral swelling - in 15%, vegetative-vascular dystonia - in 11%, diencephalic syndrome - in 9%, psychosis, 3% A. M., 1999).

The period of the state of hypoglycemia is the result of the visibility of counterinsular factors and adaptive powers of the central nervous system.

The most frequent attacks develop in the early rankings of the year, which is tied to a trivial interruption in the early years. Call ailments you can’t "throw yourself" through the rosy genus of disabilities. May be a blasphemy, apathy vrance. Sparing in cich ailments epileptiform seizures occur as more trivial, choriform convulsive smiles, hyperkinesias, clear neurovegetative symptoms. Recognition of a history of illness and respectful care for ailments. It is especially important for the diagnosis of organic hyperinsulinism as the cause of hypoglycemia in children.

In children of the first fate of life, it is clinically possible to develop hypoglycemia in a foldable manner, as the symptoms are unclear and atypical. There may be cyanosis, blistering curvatures, lowering myaz tonus, zupinka dikhannya (apnea), tremor, sudomi, "zakochuvannya" apple apples (nistagmus), unconsciousness. With a congenital form (nezidioblastosis), there is a great mass of tila (great fruit), swelling, round discoloration.

In children of preschool and school age with organic hyperinsulism, good insulinoma is often rebuilt. These children are characterized by rank unpredictability, difficult to rank awakening, loss of concentration of respect, turning towards hunger, craving for liquor, negativity, and heartbreak. Hyperinsulinism can lead to increased appetite and obesity. Chim is a young child, Tim is more intelligent to a low blood pressure in people who are more trivial to interrupt with the help of a family.

Among laboratory indicators in case of adolescence for organic hyperinsulinism (insulin or nezidioblastosis), it is especially easy to obtain immunoreactive insulin (IPI). Ale, as practice has shown, do not expect it when the insulinoma is brought forward. The ІРІ was taken otsinuvati one hour from the level of glukemia. It is important to note the і index of change in insulin to glucose - ІРІ μED / ml / glucose venous mmol / l. In healthy people and on aphids without hyperinsulinism, the index does not change 5.4.

Between functional tests, such as vicorisation for the diagnosis of organic hyperinsulinism, the test for hunger is expanded.

The sample is based on the development of hypoglycemia in people with hyperfunctional insular apparatus in the presence of hypoglycemic conditions in case of an adequate intake of carbohydrates. For an hour after the test, the sick person is allowed to drink only water or tea without sugar. Chim a young child and more often than not attack hypooglicemias, tim the trial is shorter.

Probe triviality:
children up to 3 years - 8 years;
2-10 years - 12-16 years;
10 - 18 years - 20 years;
over 18 years old - 72 years old.
(Recommendations of the Department of Children's Endocrinology, Russian Medical Academy of Postgraduate Education, Moscow).

For children of 2 years and older, they are guilty of being guilty beforehand in the evening; For children up to 2 years, the test is repaired in the early rankings of the year.

The cool people are nich, and also more trivial after an hour of hunger, the level of glucose is reduced, and it is characteristic that it changes instead of insulin in the blood. With the appearance of puffiness, gradually producing an overwhelming amount of insulin, in the minds of hunger, there are changes in mind for the development of hypoglycemia, some of the necessary glucose from the intestine is not malignant, and the hepatoclinic blocks of glucose

Before the ear, try to start glucose change in blood plasma. Distant glycemia in the capillary blood (with a glucometer) is reached in children up to 2 years 1 time per year, in children of 2 years and older - 1 time in 2 years. With a decrease in blood sugar up to 3.3 mmol / l and less than the interval, it is possible to speed up 2-3 times. The threshold of permissible glucose, in case of starvation, it is necessary to carry out the dosage, is 1.7 mmol / l in a child up to 2 years, 2.2 mmol / l in children older than 2 years. Pіslya reєstratsії glucometer porogovoї gіpoglіkemії doslіdzhuєtsya sirovatka krovі on vmіst ІRІ i kontrіnsulіnovih gormonіv, glucose krovі doslіdzhuєtsya bіohіmіchnim method (oskіlki pіslya znizhennya rіvnya glucose to 3.3 mmol / L i nizhche meter daє inaccurate result) doslіdzhuєtsya rіven lіpіdіv krovі.

To stop the attack of hypoglycemia introduced in / in strumenevo 40% glucose; immediately after the introduction of glucose, and after 3 years or after the end of the test, the test will continue to be cut on the substitute of ketone substances.

Interpretation of test results

• Even though acetone is not detected in the section, it means that the hypoglycemia of the reaction is hyperinsulinism (changes in insulin induces the process of fatty acid decay - lipolysis). The presence of acetone, depending on the intensity of the establishment of ketone salts, came from the fat depots of fatty acids. In case of hypoglycemia, not related to hyperproduct insulin, lipolysis is included as a dzherelo energy, which leads to the establishment of ketone levels and the establishment of a positive acetone in the section.
• In case of hyperinsulinism, in the place of lіpіdіv in the blood it is not changed but rather diminished, in case of ketotic hypoglycemia rіven lіpіdіv is increased.
• A decrease in the level of counterinsuline hormones is indicated for endocrine-fallow ketotic hypoglycemia; with organic hyperinsulinism, the indicators do not change.
• Index ІРІ / venous glycemia in healthy children and on aphids without hyperinsulinism became less than 5.4, while in case of organic hyperinsulinism it was an indicator of significant growth.

If there is an onset of hyperinsulinism as a cause of hypoglycemia, it is necessary to provide additional protection and treatment in a special endocrinological assessment.

In all cases, insulin has shown a surgical treatment. With nesidioblastosis, therapy can be conservative and radical. Naybіlshe viznannya in Danish hour by removing the drug diazoxide (proglіkem, zaroxolin). Hyperglycemic effect of non-urethic benzothiazide of deposits on galvanized secretion of insulin from chubby cells. The recommended dose for children is 10 - 12 mg per kg of mass for dobu in 2 - 3 doses. With the presence of a rotated positive dynamics, it is shown operatively - subtotal or total resection of the dermal zone (with a possible transition to diabetic diabetes).

S. A. Stolyarova, T. N. Dubova, R. G. Garipov
S. A. Malmberg, Doctor of Medical Sciences
V. I. Shirokova, Candidate of Medical Sciences
DKB No. 38 FU "Medbioekstrem" under the Ministry of Health of the Russian Federation, Moscow

Khvory Zakhar Z., 3 months. Having entered the psychoneurology report of the Children's Clinical Hospital No. 38 of the FU "Medbioekstrem" of Moscow on 01.11.02 with a direct diagnosis of epilepsy.

Ditin will have a perinatal history. Vaginism in the mother of Persha, was diagnosed with toxicosis in the Persian half, anemia. The slopes at the 40th tizhnі, the great plodding (wagat at the populace of 4050 g, the dovzhina 54 cm). Rating on the Apgar scale - 8/9 points. From the period of neonatal up to 2 ms. periodically there was a tremor of pidboridya, from the 2nd month of the year I appeared to attack like a stand at the viglyadi look, decrease the activity of the man, smack the right half of the face, the right hand (behind) the focal point of the judge Lіkuvavas outpatient with a neuropathologist, otrimuvav protisudomnu therapy without a pronounced positive effect. Before one of the hospitals, a choreiform posmikuvannya appeared at a rank hour on the smallest deteriorated svidomosty. Hospitalizations for the assessment of neuropsychiatry from which they are directly diagnosed with epilepsy.

With the proper camp of a child of average gravity. In the somatic status - shkirny pokrivi with manifestations of atopic dermatitis, pure scent, in the legends wheezing nemaє, tone of the heart sound, tachycardia up to 140 - 160 beats. in hv. Lives meaky, pepynka +2 cm, spleen +1 cm. At the neurological status - blasphemy, look fiksuє, I will wipe my head rotten. CHN - intact, muscular tone of lowering, more in the hands, symmetrical. Tendon reflexes are not high, D = C, insane reflexes n / r - behind the nose. Vaga - 7 kg, height - 61 cm (the excess of vagi on the average growth rate is indicated).

In the hospital, with a pre-existing biochemical analysis of the blood, a decrease in blood sugar to 1.6 mmol / l was revealed for the first time with a daily rate of ketone levels in the section.

Results of laboratory and instrumental provision:

1. Oculist - no pathology was revealed on the day.
2. EKG - heart rate 140, sinus rhythm, vertical position of EOS.
3. Allergologist - atopic dermatitis, the form is broadened, slight overload.
4. Ultrasonic inspection of organs in a worm-emptying - pidshlunkov zloza in a typical microscope does not readily appear. Ultrasonic examination of supra-nirkovy zalozov - without changes. Ultrasound imaging of nirok - reactive changes in PCS, Frehley's syndrome, it is not possible to turn on pyelectasis of malignancy. Selezinka is like splenomegaly.
5. Zagalny blood analysis - Нb 129 g / l, ep - 5.08 million, L - 8.7 yew, SHOE-3 mm / year.
6. Zagalny analysis of the section - billok, zukor, acetone - neg., L - 2 - 3 in the field of view, Ep - 0 - 1 in the field of view.
7. Biochemistry of blood (at entry) - block zag. - 60.5 g / l, ALT - 20.2 g / l, AST - 66.9 g / l, bilirubin zag. - 3.61 mmol / l, glucose - 1.6 mmol / l, creatinine-36.8 mmol / l, sechovina - 1.88 mmol / l, cholesterol zag. - 4.44 mmol / l, zalizo zag. - 31.92 μmol / L, calium - 4.9 mmol / L, sodium - 140.0 mmol / L.

Dynamical control of glucose level allowing the development of hypoglycemia in the capillary and venous blood. The heart rate and after 2 years, when the breast milk was taken with a stretch of breast milk, the blood glucose ranged from 0.96 to 3.2 mmol / l. Clinically, hypoglycemia was caused by an increase in appetite, malaise, tachycardia, epizodes of "zakochuvannya" of the right full-time apple, generalized epileptiform courts. In the period between attacks, self-respect is good. Hypoglycemic patients were stopped by taking glucose in the middle, as well as by intravenous injections of 10% glucose.

With a diagnostic method for the diagnosis of hyperinsulinism of the child, a test was carried out for starvation: the last year I have a 6-year-old wound, before the age of glycemia - 2.8 mmol / l, after 3.5 years, after a year, the blood glucose meter was determined to be 1.5 mm (below the permissible threshold value). A blood sample for hormonal dosage (IPI, c-peptide. Cortisol, STH) was taken from the hypoglycemia. Broken parkan of venous blood for biochemical dosage of glucose and lipids. For the reduction of hypoglycemia in / in the injection of glucose, the trigonine portion of the cut is taken on the substitute of ketone liquids.

Test results: acetoneuria is mute. The level of counterinsulin hormones does not decrease (cortisol - 363.6 with a norm of 171 - 536 nmol / l, STH - 2.2 with a norm of 2.6 - 24.9 MCU / ml). C-peptide - 0.53 at normі - 0.36 - 1.7 pmol / l. ІРІ - 19.64 at normі - 2.6 - 24.9 mEu / ml. Venous glucose - 0.96 mmol / l. The level of lipid in the blood at the lower boundary of the norm (triglyceride - 0.4 mmol / l, cholesterol zag. - 2.91 mmol / l, cholesterol lipopr. Vis. Density - 1.06 mmol / l, cholest. Lipopr. Low. Density . - 1.67 mmol / L. Index ІРІ / glucose (19.64 / 0.96) to 20.45 with a norm of less than 5.4.

Given the anamnesis, dynamic warning, clinical and laboratory situation, they allowed us to diagnose: non-ketotic hypoglycemia. Hyperinsulinism. Nesidioblastosis?

To clarify the genesis of the disease and the tactics of dealing with the child's transfers to the endocrinology department of the Russian Children's Clinical Hospital of Moscow, the boy was diagnosed with insulinoma. Confirmed diagnosis of nezidioblastosis. A trial of conservative treatment with proglycem at a dose of 10 mg per kg of body weight was assigned. Based on the tendency to normalization of indicators in carbohydrate metabolism. To plan further dynamically caution for the correction of tactics of lіkuvannya.

Clinical diagnosis dictates the need for advanced indicators of carbohydrate metabolism in all early-onset children with convulsive syndrome, in view of the absence of key symptoms in early childhood illnesses for such infants.