Joos, Thaddeus H.

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Henry Ford Hospital Medical Journal Volume 1 Number 3 Article 5 9-1953 Late Complications in Juvenile Diabetes Thaddeus H. Joos Follow this and additional works at: https://scholarlycommons.henryford.com/hfhmedjournal  Part of the Life Sciences Commons, Medical Specialties Commons, and the Public Health Commons Recommended Citation Joos, Thaddeus H. (1953) "Late Complications in Juvenile Diabetes," Henry Ford Hospital Medical Bulletin : Vol. 1 : No. 3 , 18-20. Available at: https://scholarlycommons.henryford.com/hfhmedjournal/vol1/iss3/5 This Article is brought to you for free and open access by Henry Ford Health System Scholarly Commons. It has been accepted for inclusion in Henry Ford Hospital Medical Journal by an authorized editor of Henry Ford Health System Scholarly Commons. LATE COl\lPLT CATJO S I J U\ 'ENJLE DI ABETES THADDEUS H. Joos, M.D.• Smee the introduction of Insulin in 1922, some 120 children with diabetes mellit IS have been treated in the Pediatric Department at the Henry Ford Hospital. T l is paper deals with our experience in thirty-one of these patients followed ten or mc,-c years. In general, our results are in agreement with those published by \\'alker ( ), Po. t and tickle (2), and Root, inden and Zanca (3) . That is, the better t 1e control, the fewer the complication, the most common of these being retinal hen-orrhage_ and albuminuria, which were found in a sizable number of these patient . CO\IPLICATIO:S:S FOUND IN JUl'EN ILF. DIABETES IN FOUR SERIES Table No. l HFH W alker Post & Stickle Root Rcuno1,athr 30 percent 46 . 6 percent S4 percent 56 percent Catarac1 3 percent 14 .6 percent H ll'<ttcn.,icm 3 percent 4.0 percen t 36 percent Albuminuria 30 percent 4 .0 percent '26 percent K.S.11 .D. 7 percent ' l"phruis 9 pcrccnt , ·cun>1nuhy 2 percent Of the thirty-one patients followed ten or more years, twenty exhibite<l nt leac-.t one or a combination of several of the following changes: ( I) Retinitis, P) .\)huminuria, (J) Cataracts, (4) 'euroP.athy, (5) Hypertension, and (6) Kimmel-M1d-\\ ilson dic,eac.e. Table t\l.O outlines the frequency. Tl P~S m CO\IPLICffJO'\S A'\D XU~IBFR OF LESIONS IN PATIENTS FOJ.JOIUD TEN OR ~JORE YE.~RS Table '.'\o. 2 ~ ~IJ.uminuna Catuacts '-curopoth,· Hrpemn ion K \\'D 10 JO The degree of each varied as to severity and physical disability, but one per~on died of l\.irnmcl,tiel-\\'il,on di,ease and another with bilater.1.I cataracts hnd ,uch cxten\lve retinal hemorrhagec, that c.1.taract removal was thought unwise. \\·hen cla,,1fying control we u,ed the number of times in coma and the positi,·c Bcnt<.lict\i rco1ction of urines te,tcd at home, as criteria. Table three illustr:i.te~ rh1,. •h,nncrh K iJcnt in Pc,u,uri \t rrnr~t uh the l !"I ' Jin \I, dical Corps. 18 I•' --G<MI Fair F.i.ir to Poor Poe, CLASSIFICATION OF CONTROL OF DIABETES T able No. 3 Coma 2 or 3 4 or more Positive Benedicts Test on Urine '2 daily or less 2 daily or less 2 or J dai ly 4 or more dai ly n Table four the relationship between control and complications in the group can be seen . Control p..,, Fair to Poor Fair Good CONTROL AND CO~IPLICATIONS Patients with Complications Patients without Complic:ations No. Patients No. Patients There were six deaths recorded in the patients, five of whom died in our hospital and one in another institution. Coma claimed the lives of four, while pulmonary tuberculosis and Kimmelstiel-\\'ilson disease accounted for the other two. D!SCL\SION The conrrovers)r between "free" and "controlled'' diets we believe is swinging in favor of the controlled type of regime because of the increa1;,ing number of reports that control and complications are directly related<' •1. Lichtenstein•, when writing on the "free diet" in childhood diabetes gives his results on the bash, of IO years experience. He states that the number of complications en-countered were few. \\'e must, however, remember that seldom do any of the vascular changes make themselves evident until the child has had the di\ea,e .it lea,;;t ten years 7• Our average time for the development of any of thec.,e changes was eleven years and eight months after the initial diagnosis of diabete, w.is established. \Ye believe our management where a moderate amount o f carbohydrate i, given and two positive Benedicts tests dai ly are allowed to guard agaim;t inc..lilin re-action,;;, affords a good middle ground to follow. A:, pointed out by J ohn '\ when a per,on runs a positive Benedicts once a day we can assume that he is hyperglycemic about six hours out of 24. He goes on to say that a normal person with hi1, po,t prandial hyperglycemia has high blood sugar level s approximately ~5c, of the time also. 19 I I I I I \\ 1th a diet in which rhe toral calories are based on basal calories times 1.4 and with roral calories from Protein 15 '1c, Fat SO<"c-, and Carbohydrates 35'1, rhe child ha, a well balanced diet which is easily followed. Despite its relativelv high fat content thi s diet had no ill effect on the blood cholesterol as determined 1n a limited number of our pat ien ts having the disease ten or more years. Thi diet provides the needed protein for sound continued growth, and on such a pre,. gram all bur a ,;;mall number of our patients grew no rmally and remained well w1rhin the normals as given by \\'et1el.1 CO.\'Cl.t.:SION.I': In the regulatio n o f diabete, mellitus in children, con t rol is of the utmost im. portance, ,ince there j,_ a stead)' accumulation of infor111;1tion showing that good control will lead to a lowered incidence of complication,;;, e,;;pecially retinopath \·, hn>erten\lon, and albuminuria. To obra111 th is control, a diet allowing a moderate amount of carbohydrate can be u,ed with , ucces,. Such a diet has been uc.;ed in the reported patients and may ca,ily be prescribed a, 15 percent of total calories from protein, 50 percent from fat and :u percent from carbohydrate. Doctor ~ichola, G. Douvas kindly did the eye examinations and was of major ,lv .. i,tance in thi., cla ... sification. Ill lltlOG RAPI-IY I. \\ ,1ll..cr, (; I .: l>1ahet1c r.:~iino1,:Hh) 1n )Oung persons, Tr. Am. Ophth. Soc. 48:677, 1950. 2. 1'0,1, I T., .1nd Stickle, .\ . W., Jr.: Fumlus chan'(es in juvenile diabetics, Tr .. .\m. Ophth Sor. .f :191, l'J'O. J. Rum, 11 I•., Sinden, R. 1-1. , :1ml /.anca, R.: F.tctors in 1he r:uc of Je\'Clopment of ,•ascular Je,11•!1t m th( l..1,ln1·~,. rttlnae .1nd pcnpher-al n~h, of the youthful diabetic, Am. J . Digest. Dis. 17: 179, 1950. 4 \\ il•on, J. I .. , Root, 11. F., and \l.1rhlc, A.: Con 1rolled ,·ersus free diet management of lli,1hctc 1 I \ \I \ 14',1526, 195 1. S. John, II ,J .: Liberal regimen ol trc;llrncnt of diabetes, Arn . J . ~led. 5:537, 1948. t,. l.1lhtcn,tem, .\ .: Treatment of c.:hiMren· lhabe tcs; ten ,ears' experience without dietetic rc\tric-uon,, .\ tta P.aC",1i,1t J2:556, 19+-J...45. - Jm.hn, .. P., anJ \\ 1h,.on, J I.. 1...e,"°n' for future treatmen t from 4-2 fa,aliri~ in diabern: l'hil-Jn-n, Rm. \I J. 2:1:?9J, 19.50. II. \\ cud, , . C 1•h, ,1cal fitnc,, 1n term, of physique, <le,·dopment .tml basal met:tbolism: Yi 1th a w:u tic to 1n.ll\1 u.al l'~rc. tfom inf.1nn m m:11um,: .-\ new meth01.I for e,•a luation, J. A. :'\I . -\ , llfi: II ;, 1q41. 20 

Late Complications in Juvenile Diabetes

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Late Complications in Juvenile Diabetes

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