Zaburzenia metabolizmu glukozy w populacji wieku rozwojowego – co nowego w diagnostyce i leczeniu? Część II

© Borgis - Medycyna Rodzinna 1, p. 19-23
*Ewa Otto-Buczkowska, Przemysława Jarosz-Chobot
Zaburzenia metabolizmu glukozy w populacji wieku rozwojowego – co nowego w diagnostyce i leczeniu? Część II
Alterations of blood glucose homeostasis in children and adolescents – what news in diagnostics and therapy? Part II
Górnośląskie Centrum Zdrowia Dziecka i Matki, Poradnia Diabetologiczna, Katowice
Secondary diabetes may occur in association with endocrine or nonendocrine disorders. The most common endocrine diseases associated with glucose intolerance are those involving overproduction of counterregulatory hormones. Diabetes frequently coexists with altered function of the pituitary, adrenal and thyroid glands and gonads.
Corticosteroids induce a state of insulin resistance characterized by decreased binding of insulin to insulin receptors and decreased utilization of glucose. These agents also increase hepatic gluconeogenesis by enhancing the activity of gluconeogenic enzymes and by increasing the availability of gluconeogenic substracts.
Diabetes mellitus not infrequently coexists with hypo- and hyperthyroidism. Thyroid hormone causes a decrease in glucose-induced insulin secretion. Abnormal glucose metabolism with impaired glucose tolerance has been documented in patients with thyrotoxicosis Thyrotoxicosis causes dramatic increase of glycogen degradation and/or gluconeogenesis.
Nonendocrine conditions associated with glucose intolerance or diabetes fall into three general categories: pancreatic diseases, drug-induced diabetes and genetic syndromes.
The therapy for secondary diabetes centers on the correction of underlying disturbance. Patients with fasting hyperglycemia should be treated with an understanding of the pathophisiologic basis of their diabetes.
Stress that follows critical states may lead to a profound impairment of that homeostasis, including occurrence of hyperglycemia.
Hyperglycemia is a common feature of the critically ill patient and has been associated with increased mortality. It does not appear to be associated with a particular diagnostic category but is significantly associated with severity of illness. Severe hyperglycemia may be associated with complications, this in turn could result in end-organ dysfunction. Prevention of glucose toxicity by strict glycemic control but also other metabolic and non-metabolic effects of insulin contribute to these clinical benefits. Continuous insulin infusion can rapidly and safely improve intravenous glucose tolerance.
Key words: glucose homeostasis, impaired glucose tolerance, hyperglycemia, decreased peripheral glucose utilization, secondary diabetes, endocrine disorders, overproduction of counterregulatory hormones, genetic syndromes, pancreatic diseases, drug-induced diabetes
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otrzymano/received: 2007-12-14
zaakceptowano/accepted: 2007-12-27

*Ewa Otto-Buczkowska
Jasnogorska 16/21, 44-100 Gliwice
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