Obsah fóra poradna o diabetes (= cukrovka) poradna o diabetes (= cukrovka)
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DM nešpecifický

 
Přidat nové téma   Zaslat odpověď    Obsah fóra poradna o diabetes (= cukrovka) -> DIABETES U DĚTÍ A DOSPÍVAJÍCÍCH
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anna rákayová



Založen: 16.3.2008
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PříspěvekZaslal: ne březen 16, 2008 6:30 pm    Předmět: DM nešpecifický Citovat

5r. synčekovi pred rokom sa náhodne zistil diabetes.Vtedy mal protilátky negat,glykovaný hemoglobin 8,2, C peptid pod dolnou hranicou normy.rok sa držal na diete,počas kontroly koncom leta glykovaný hemoglobin 5,4, protilátky negat, C peptid na rovnakej úrovni.pri poslednej kontrole v januári protilátky negat, C peptid ako predtým, glykovaný hemoglobin 6,8.teraz posledné 2 mesiace sa mu stav zhoršil,posledný týždeň už po jedle máva glykémiu 15, nalačno 8-10,bez ketoacidózy, bez typických klinických príznakov /do pitia tekutín ho treba skôr nútiť, denne v pohode prebicykluje 5-6km, váhu si drží/ .Diagnózu máme susp. DM nešpecifický. maxim. do niekolkých týždňov sa určite budeme musieť hlásiť na zahájenie inzulinoterapie.Moja otázka znie: pri nega. protilátkach, neklesajúcom C peptide a zvyšujúcom sa glykovanom hemoglobíne o aký typ cukrovky by sa mohlo jednať? má význam skúsiť najprv terapiu perorálnymi antidiabetikami typu napr. sulfonylurey? vedeli by mi určiť príčinu na nejakom odbornom pracovisku ?máme aj genet. vyš. na MODY 3, kt. je negat.Dakujeme za odpoveď a každú dobrú radu!
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MUDr. Radomil Pluschke



Založen: 3.7.2008
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PříspěvekZaslal: út březen 18, 2008 1:26 pm    Předmět: Citovat

Vážená paní Rákayová,
problém je velmi složitý, jsou oblasti v medicíně, které zatím nelze 100% zmapovat, touto oblastí je např. genetika. Je velmi složité se i k tomuto problému vyjadřovat pouze písemně, bez klinického vyšetření a sledování výe zmiňovaného pacienta. Protilátky typu anti GAD nemusí býti vždy zachytitelné. Snížení sekrece C-peptidu ale jasně hovoří o tom, že produkce insulínu klesá, že došlo k destrukci tkáně zodpovědné za produkci insulínu. Zatím ale zřejmě dílem k zachovalé sekreci Váš syn nemá tendenci ke ketoacidose. Myslím si ale , že jde zcela jasně o problém, který bude muset být léčen insulínem. DM typu MODY jste vyloučili. Insulínoterapie bude nevyhnutelná, protože glykovaný hemoglobin je v takové úrovni, že lze hovořit až o glukotoxicitě. Perorální antidiabetika /tablety/ jsou nevhodná, navíc by problém neřešila, navíc se nepodařilo vyloučit na 100% teratogenní vliv perorálních antidiabetik. .
Samozřejmě by měl být syn hlídán dětským diabetologem, a definitivní rozbor situace a řešení nabízí u nás v Česku snad šestnáct diabetologických center. Jakýsi prim udává Diabetologické centrum nemocnice IKEM v Praze, kde podobné situace řeší tým lékařů a sester. (prof. MUDr. Bartoš, prof. MUDr. Pelikánová atd.) Na Slovensku situaci takto podrobně neznám, ale dětský diabetolog by Vám měl dát komplexní odpověď i v tomto slova smyslu.

S pozdravem

MUDr. Radomil Pluschke
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