Nutritional Management of Type 1 Diabetes

This chapter focuses on medical nutrition therapy (MNT) in type 1 diabetes mellitus (T1DM), which is vital to achieve metabolic control in patients suffering from this disease. The nutritional goals for people with T1DM are reviewed, which aim at maintaining near-normal blood glucose levels by coordinating insulin therapy, diet, and physical activity patterns. A nutrition prescription is given, and recommendations for appropriate MNT in type 1 diabetes are deduced. Glycemic targets in people with T1DM are highlighted; moreover, the principle of carbohydrate consistency and insulin adjustments with food intake are stressed upon. Meal planning approaches to achieve carbohydrate consistency, including carbohydrate counting, exchange system, and sample meal plans, are explained. Weight management, energy requirements, macronutrients and micronutrients needs, as well as nutritional management during exercise and supports take special attention in this chapter

Categorization of differences of sex development among Egyptian children and the role of antimullerian hormone and inhibin B

BackgroundDifferences of sex development (DSD) are congenital conditions linked to atypical development of chromosomal, gonadal, or anatomical sex.ObjectiveThe aim of this study was to demonstrate our experiences at the Diabetes Endocrine and Metabolism Pediatric Unit (DEMPU), Faculty of Medicine, Cairo University in the field of DSD by focusing on the clinical presentation, laboratory profile, classification, and etiological diagnosis of these conditions. In addition, the present study intended to delineate the importance of serum anti-Müllerian hormone (AMH) and inhibin B in detecting the presence of functioning testicular tissue.MethodsThis cohort study included 451 infants and children with various clinical presentations of DSD. The study performed a retrospective analysis on medical records of established DSD cases to evaluate the clinical importance of AMH and inhibin B. In addition, newly diagnosed patients were prospectively analyzed.ResultsThree hundred thirty-six (74.5%) patients were 46,XY DSD, 98 (21.7%) were 46,XX DSD, 14 patients had other karyotypes and 3 had missing karyotypes. Among the 46XY DSD patients, the most common cause was partial androgen insensitivity. In contrast, congenital adrenal hyperplasia constituted the most common diagnosis in 46,XX DSD cases. The cut off value of serum AMH was 14.5 ng/ml with 100% sensitivity and 55.1% specificity.ConclusionPartial androgen insensitivity was the most important cause of 46,XY DSD in Egyptian children, and congenital adrenal hyperplasia was the most common cause of 46,XX DSD. AMH was valuable in detecting functioning testicular tissue

Red blood transfusion in preterm infants: changes in glucose, electrolytes and acid base balance

Background: Preterm neonates comprise the most heavily transfused group of patients, and about 85% of extremely low birth weight newborns receive a transfusion by the end of their hospital stay. The aim of this study was to assess the possible metabolic effects of RBC transfusion on preterm infants, especially during the first 2 weeks of life, and its relation to blood volume. Materials and Methods: This study was conducted on 40 preterm neonates with gestational age of less than or equal to 34 weeks. They received RBCs transfusion during first 2 weeks of life. Venous blood samples of infants were collected 2 to 4 hours before and 1 hour after the end of transfusion to evaluate hemoglobin (Hb) level, hematocrit, acid-base, electrolytes, and glucose status. Then, infants were classified into two main groups: those who received RBCs volume less than or 20 ml/kg and those who received RBCs volume more than 20 ml/kg. Results: Infants received a mean volume of 20.38 ± 3.2 ml/kg RBCs (range, 10.9 - 26.6 ml/kg) at a median age of 9.8 ± 3.6 days. After transfusion, a significant increase of mean Hb (P<0.001), mean Hct (P<0.001), pH (P<0.001), pO 2 (P<0.05), and a significant decrease of the pCO2 (41.46 ± 8.8torr vs 35.4 ± 9.34 torr; P<0.001) were observed. In addition, there was a significant increase of serum K + (P<0.001), and a significant decrease of Ca +2 (P<0.001). A positive correlation was found between the K + intake and the changes of kalemia (r = 0.99; P = 0.00). Furthermore, we observed an inverse correlation between the patients′ calcium intake and the changes of calcemia (r = -0.35; P = 0.02). On comparing the changes in clinical and biochemical variables between two groups after transfusion, we observed a significant increase in mean Hb and Hct associated with a significant decrease in mean serum Ca +2 (P<0.001) in the group receiving the larger blood volume. Conclusion: RBC transfusion was effective in improving anemia, oxygenation, increasing pH, and decreasing CO 2 and Ca +2 . However, from a more clinically relevant point of view, we demonstrated the development of hyperkalemia, especially in infants with a previously borderline hyperkalemia