[The treatment of ketoacidosis in children and adolescents with diabetes (simultaneous major ketosis and severe hypoglycemia)]. / Traitement de l'acido-cétose de l'enfant et de l'adolescent diabétiques (ainsi que des cétoses importantes et des hypoglycémies sévères).

Ketoacidosis in pediatric diabetes mellitus remains an active problem. Although the authors have recorded no deaths among their own patients, fatal cases still occur in France and other countries, usually as a result of inappropriate therapy, sometimes based on mistaken immediate pathophysiologic interpretations of laboratory test results. A very simple protocol based on the author's extensive experience is proposed. Rehydration solutions (optimal sodium bicarbonate, isotonic saline for the first two hours, then 10% glucose solution with electrolytes infused at a fixed rate of 3 l/m2 body surface area) are given at the same time as insulin (22 units per liter in each infusion flask). This protocol is remarkably effective and gives rise to no complications. In extreme conditions, reagent strip assays of blood glucose levels and evaluation of acidosis by respiratory rate measurements would suffice to ensure appropriate monitoring. A simple method for treating hypoglycemia is also described.

[Permanent malabsorption of rifampicin in a diabetic with celiac disease]. / Malabsorption permanente de la rifampicine chez un diabétique atteint d'une maladie coeliaque.

A 14 year-old boy with coeliac disease and poorly treated diabetes mellitus and pulmonary tuberculosis due to INH resistant BK presented with a permanent malabsorption of rifampicin. Pharmacokinetics of rifampicin was studied after oral administration and intravenous injection. Treatment of diabetes and coeliac disease did not improve the situation. Tuberculosis was cured by pyrazinamide and ethambutol.

[Glomerular filtration and tubular reabsorption of glucose in insulin-dependent diabetes in children]. / Filtration glomérulaire et réabsorption tubulaire du glucose dans le diabète insulinodépendant de l'enfant.

Although glycosuria is important in the control of diabetes in children, few studies clearly show its significance as compared to glycemia. The aim of the present study was therefore to determine the two parameters that control glucose presence in urine, i.e. glucose glomerular filtration rate (GFR) and tubular reabsorption (JrG). GFR was measured by using a 110 min polyfructosan perfusion in 96 diabetic children and adolescents. The results are as follows: 1) In this population there is a significant correlation (p less than 0.01) between the quantity of glucose in urine and mean glycemia during the test; 2) polyfructosan clearance that reflects GFR in diabetic children without renal complication is 2.11 +/- 0.04 ml/s 1.73 m2, or 126 +/- 2.4 ml/min 1.73 m2 (mean +/- SEM); it is higher than in the reference values already published; 3) JrG is correlated with glucose filtered load (p less than 0.01), GFR (p less than 0.01) and sodium reabsorption (p less than 0.01). The ratio JrG/GFR could be substituted for the classical concept of "renal threshold", as it can be easily measured and may help in interpreting glycosuria in some diabetic children. To conclude, in IDD children, the parameters controlling glycosuria may be studied by a simple method. The clinical value of such renal exploration has still to be determined.

[Renal diabetes. Apropos of 103 cases]. / Le diabète rénal. A propos de 103 observations.

Three main concepts came out of this prospective study of 103 cases (51 girls and 52 boys) of renal diabetes followed up from 1955 to 1975 and reviewed in 1984: contrary to what is still sometimes written, renal diabetes does not evolve to diabetes mellitus; renal diabetes does not seem to progress over the years; the mode of genetic transmission, when present, which is rare, is obscure but it seems to occur in a recessive rather than a dominant fashion.

[Treatment of severe diabetic ketoacidosis in children. A comparative study of two methods (author's transl)]. / Traitement de l'acidocétose diabétique sévère de l'enfant. Etude comparative de deux méthodes.

Fifteen children with severe diabetic ketoacidosis (pH less than 7,10) were treated according to two protocols. Protocol I used in 7 patients, consisted in a low dose insulin therapy by intravenous and intramuscular injections. Protocol II consisted in a low dose continuous intravenous insulin therapy, with insulin added to the rehydration solution at constant concentration (22 U/l). Rehydration and potassium supplementation were similar in both methods. The fall of glucose concentration, rise in venous pH, fall of diuresis, glycosuria, ketonuria were similar in the two groups. With protocol I three hypoglycemias (greater than 4 mM) and three hypokalemias (greater than 3 mEq/l) did occur. With protocol II no hypoglycemia and only one moderate hypokalemia was observed. Thus, continuous infusion of insulin added to the rehydration solution, including isotonic bicarbonate, isotonic saline, glucose and electrolytes is as effective as discontinuous insulin infusion, but with a lower incidence of complications. In addition, this method has the advantage of being easy and applicable everywhere.

[Plasma insulin, C-peptide and glucose concentrations in type I diabetic children after a morning injection of insulin (author's transl)]. / Taux plasmatiques d'insuline, de C peptide et de glucose chez l'enfant diabétique après injection matinale d'un mélange d'insulin.

Plasma levels of insulin, C-peptide and glucose were monitored for 24 hours after a single injection of a mixture of regular and protamine zinc insulin in 22 diabetic children. Results were compared with those in 7 control children. They indicate that plasma insulin in diabetic children is similar or higher than that in controls over the entire time of survey. Plasma insulin is usually high in the first part of the day. However, important variations were observed from one patient to another and, in the same patient, from one day to another. These results stress the necessity of a daily individual adaptation of the doses in diabetic children and adolescents treated with one or several daily injections of insulin.

[Measurement of insulin sensitivity in obese or diabetic children in vivo. A comparison of three methods (author's transl)]. / Mesure de la sensibilité à l'insuline in vivo chez l'enfant obèse, ou diabétique. Comparaison entre trois méthodes.

Three groups of ten similar obese children were infused with one of three protocols. Protocol I glucose only (1.15 mM/min/m2). protocol II, glucose, insulin (42 mM/min/m2). Protocol III, glucose insulin, propanolol (0.04 mg/min/m2) adrenalin (3 micrograms/min/m2). Eighteen newly diagnosed diabetic children without acidosis received glucose according to protocol II. Thirteen normal adults (controls) received glucose infusion according to protocol I. Protocols I and II were well tolerated and gave consistent results but Protocol III was not well tolerated and did not give interpretable results. In obese children steady state blood glucose levels are significantly higher than in controls but this difference was only moderate (8.8 + 0.7 mM, against 6.6 +/- 0.4 mM for protocol I). There was no difference in insulin levels. In diabetic children the steady state was more rarely obtained after a 120 min infusion and blood glucose levels were higher than in the controls or in obese children.