2 research outputs found
Continuous subcutaneous insulin infusion in newly diagnosed diabetic children
In the first century AD Aretaeus of Cappadocia described diabetes
as "a wonderful but not very frequent affection among men
being a melting down of the flesh and limbs into urine .... , life
is short, disgusting and painful, thirst unquenchable, death
inevitable".
The recognition of this disease with its enormous thirst and
massive production of honey sweet urine is very old. Nowadays
diabetes is known as a heterogeneous disorder. Insufficient production
of biologically active insulin is a common denominator in
almost all forms of diabetes. Insulin deficiency results in a
variety of metabolic abnormalities (hyperglycaemia, increased
lipolysis, increased gluconeogenesis at the cost of amino acids).
The NIH National Diabetes Data Group discerns 2 types of diabetes
mellitus: insulin dependent diabetes mellitus (IDDM) and noninsulin
dependent diabetes mellitus (NIDDM) (National Diabetes
Data Group 1979). IDDM frequently starts in childhood. The incidence
in the Netherlands is estimated to be 11.0 subjects per
100.000 inhabitants per year in the age group below 20 years
(Vaandrager 1984). Since NIDDM seldom occurs in childhood it will
be left out of consideration in this study.
Insulin is produced by beta cells in the pancreatic islets of
Langerhans. In due time after clinical onset there is hardly any
beta cell activity evident. An absolute insulin deficiency ensues.
As insulin plays a key role in maintaining normal metabolism,
this implicates a life-long dependency on exogenous insulin administration.
Since insulin is a peptide which can not be administered
orally, administration of injections at least once daily is
necessary. Ten to 15 years after the onset of the disease
severe complications may develop (micro- and macroangiopathy)
resulting in a shorter life expectancy and a reduced quality of
life (Deckert 1978). It is evident that t~is chronic disease and
its consequences also influence life, the psychological wellbeing
and development of patients, especially those of child age.
The cause of this destructive process, which is specifically
directed against the pancreatic beta cells, remains to be
elucidated. Current thought is that a hereditary susceptibility
in combination with an environmental agent can lead to the development
of IDDM (Cahill 1981). Immunological disturbances- cellular
as well as humoral - have also been found at the onset of
the disease (Bottazzo 1981, Buschard 1980, Lernmark 1981, Maron
1983). Their precise role has not yet been clarified.
Multilingual global e-learning pediatric endocrinology and diabetes curriculum for front line health care providers in resource-limited countries: Development study
Background: Electronic learning (e-learning) is a widely accessible, low-cost option for learning remotely in various settings that allows interaction between an instructor and a learner. Objective: We describe the development of a free and globally accessible multilingual e-learning module that provides education material on topics in pediatric endocrinology and diabetes and that is intended for first-line physicians and health workers but also trainees or medical specialists in resource-limited countries. Methods: As complements to concise chapters, interactive vignettes were constructed, exemplifying clinical issues and pitfalls, with specific attention to the 3 levels of medical health care in resource-limited countries. The module is part of a large e-learning portal, ESPE e-learning, which is based on ILIAS (Integriertes Lern-, Informations-und Arbeitskooperations-System), an open-source web-based learning management system. Following a review by global experts, the content was translated by native French, Spanish, Swahili, and Chinese-speaking colleagues into their respective languages using a commercial web-base