Complicated life of teenagers

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Complicated life of teenagers

In Brief Included in this comprehensive discussion of type 2 diabetes in teens is a brief review of definitions of type 1 and forms of non-type 1 diabetes, the epidemiology of type 2 diabetes in teens, and the scope of related problems.

Management considerations including pharmaceutical interventions for teens with type 2 diabetes are described.

The end of the 20th century witnessed a dramatic rise in the incidence of type 2 diabetes in children. Although considered uncommon a few decades ago, type 2 diabetes in adolescents now represents one of the most rapidly growing forms of diabetes in the United States and perhaps worldwide.

Not surprisingly, the incidence of type 2 diabetes in adolescents has paralleled the epidemic of childhood obesity now occurring in Westernized societies.

Complicated life of teenagers

This article provides an overview of this problem, plus provides direction for clinicians caring for these children. It is reasonable to speculate that, as more is learned from studies of the molecular genetics of type 1, type 2, and GDM, better defined clinical subtypes will emerge.

Although the ADA diagnostic criteria were developed primarily from data obtained from adults, they are to be applied equally to children and adolescents. The categories of type 1 and type 2 diabetes are clinically defined. While this allows flexibility in assigning type to a given patient Complicated life of teenagers on clinical presentation, it sometimes requires revision as the clinical course may alter the assignment and perhaps the choice of therapeutic options over time.

For example, some overweight adolescents initially presenting with classic signs and symptoms of type 1 diabetes may actually have type 2 diabetes. Medical management with oral agents after an initial period of stabilization with insulin is often possible.

If type 2 diabetes is suspected, clinicians are cautioned to not make hasty statements regarding the long-term need for insulin therapy. For now, the designation of type 1 diabetes suggests a chronic, immune-mediated destruction of functional -cell mass with characteristic laboratory measures in serum of -cell autoimmunity anti-glutamic acid decarboxylase [GAD], anti-insulin, and antibodies to tyrosine phosphatases IA-2 and IA-2 found in the majority of cases.

In type 1 diabetes, insulin therapy is always indicated and is the only appropriate pharmacological option. Oral agents are contraindicated, although the presence of residual insulin secretory capacity at time of diagnosis i. Nonimmune forms of diabetes in children and adolescents include "idiopathic" type 1 diabetes, type 2 diabetes with insulin resistance, atypical diabetes mellitus, maturity onset diabetes of youth MODYgenetic defects in insulin action, and secondary diabetes e.

Idiopathic Type 1 Diabetes This form is clinically indistinguishable from type 1 diabetes due to autoimmune-mediated -cell destruction.

In fact, it can only be diagnosed by the failure to demonstrate evidence of serum markers of -cell-directed autoimmunity e. The cause s are unknown.

The management is the same as with any patient with type 1 diabetes. The expression of this syndrome may be seen as early as 2 years of age with the appropriate genetic background and environmental milieu.

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The hallmark of type 2 diabetes in adolescents, as in most adults, is insulin resistance. The development of overt glucose intolerance ultimately arises on this "foundation" of insulin resistance.

For years, reduced hepatic and skeletal muscle insulin sensitivity is compensated for by increased pancreatic insulin secretion, resulting in normal glucose tolerance.

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In a typical adolescent with type 2 diabetes, steady increases in insulin resistance accompany the normal progression through puberty secondary to increased growth hormone secretion.

This contributes to the development of postprandial hyperglycemia. Many children of predominantly non-European origin e. Abnormal sustained elevations in plasma glucose contribute to an erosion of insulin secretory capacity due to the phenomenon of glucose toxicity.

Ultimately, fasting, as well as postprandial, hyperglycemia occurs.

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In contrast to many adults who develop type 2 diabetes in middle life or later, adolescents are more likely to demonstrate early recovery of -cell function following resolution of the glucose toxic state.

This has significant implications for long-term pharmacological management. The explanation for this finding may be that, in some cases, adults with type 2 diabetes may have gone undiagnosed for years, accruing irreversible -cell damage from years of insulin resistance preceding the development of overt glucose intolerance.

The prevalence of insulin resistance is high in the Hispanic community of South Texas. However, well before glucose intolerance occurs, many adolescents have already experienced years of co-morbidity due to underrecognized insulin resistance-related problems e. As a late event in the progression of the insulin resistance syndrome, type 2 diabetes truly represents the "tip of the iceberg" in regards to a much more insidious process.

Atypical Diabetes Mellitus A form of diabetes that disproportionately affects African Americans and Asian Indians has been described as atypical diabetes mellitus.

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Following initial stabilization, patients may be managed similar to children with type 2 diabetes. In these cases, family history is strong for diabetes. However, obesity does not appear to be a regular feature of this condition, and insulin sensitivity is normal.Pandiculation is something you've done many times in your life, and it's contagious.

It's the act of yawning, or more specifically, of stretching one's self. Pandiculation derives from the Latin word pandiculari, which means to stretch one's self, from pandere, which means to stretch.

Complicated bereavement in children Complicated Bereavement (also known as complicated mourning, complicated bereavement, prolonged grief) is the concept used when a bereaved person appears to be “stuck” in their grief process or their grief has become a way of life.

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Teens and pre-teens especially seem to have an “I don’t care,” or “Why bother?” attitude about school, homework and their other responsibilities, whether it be chores around the house or a part-time job. He didn't understand the pain of having girls hug him every sigle day, squeezing the very life out of him, then having to apply some rash lotion because his mother was to lazy to get the actual cream.

Relationship Problem: Conflict. Occasional conflict is a part of life, according to New York-based psychologist Susan Silverman.

It's Complicated: The Social Lives of Networked Teens by Danah Boyd