Polycystic ovary syndrome (PCOS) usually arises during puberty and is marked by insulin resistance, hyperinsulinemia, and hyperandrogenism. The principle is that the diagnosis of PCOS must be based on the presence of at least two of the following three criteria: chronic anovulation, hyperandrogenism (clinical or biological), and polycystic ovaries. The diagnosis of PCOS in adolescents is particularly difficult due to developmental problems in this group. Many symptoms of PCOS, including acne, menstrual irregularities, and hyperinsulinemia, are common in normal puberty. Adolescents with PCOS are at an increased risk of developing health problems later on in life, such as diabetes, cardiovascular disease, and infertility. One should reckon with the frequent occurrence of the PCOS in type 1 diabetes, when the ovaries and the adrenals are exposed to excessive insulin concentrations. Ovarian hyperandrogenism is common in adolescent girls with type 1 diabetes. Methods of treatment for an adolescent with PCOS include diet and exercise. Metformin is commonly used in young girls and adolescents with PCOS as first-line monotherapy or in combination with anti-androgen medications. StreszczenieZespół policystycznych jajników (PCOS) zwykle pojawia się w okresie dojrzewania i charakteryzuje się występowaniem insulinooporności, hiperinsulinemii i hiperandrogenizmu. Przyjęta jest zasada, że diagnoza PCOS musi opierać się na obecności co najmniej dwóch z trzech następujących kryteriów: przewlekłego braku owulacji, hiperandrogenizmu (klinicznego lub biologicznego) i policystycznych jajników. Rozpoznanie PCOS u nastolatek jest szczególnie trudne. Wiele objawów PCOS, w tym trądzik, zaburzenia miesiączkowania i hiperinsulinemia, są częste w okresie dojrzewania. U nastolatek z PCOS istnieje zwiększone ryzyko wystąpienia problemów zdrowotnych w późniejszym życiu, takich jak cukrzyca, choroby sercowo-naczyniowe i niepłodność. Należy liczyć się z częstym występowaniem PCOS w cukrzycy typu 1, gdy jajniki i nadnercza są narażone na nadmierne stężenia insuliny. Hiperandrogenizm pochodzenia jajnikowego występuje często u nastolatek z cukrzycą typu 1. Leczenie młodzieży z PCOS obejmuje dietę i ćwiczenia fizyczne. Metformina jest powszechnie stosowana u młodych dziewcząt z PCOS w monoterapii pierwszego rzutu lub w połączeniu z lekami przeciwandrogenowymi. Słowa kluczowe hiperandrogenizm, zespół policystycznych jajników, insulinooporność, cukrzyca

The basis of treatment in autoimmune diabetes is insulin therapy; however, many clinical cases have proven that this method does not solve all problems. Trials of causal treatment including blocking the autoimmune processes and insulin-producing cells transplants were carried out. Those methods require more research to be concerned as efficient and safe ways of treatment in type 1 diabetes. The use of non-insulin adjunct treatment is a new trend. It has been successfully used in laboratories as well as clinical trials. Metformin is the most widely used drug, together with sodium-glucose co-transporters 2 (SGLT2) inhibitors, amylin analogues, glucagon-like peptide 1 (GLP-1) receptor agonists, and dipeptidyl peptidase-4 (DPP-4) inhibitors. The results of administration of these medicaments give good outcomes in patients with diabetes mellitus type 1. Most likely, in the near future, they will progressively be used in both adult and adolescent patients with type 1 diabetes. Further multicenter, randomized studies are required to evaluate the efficacy of treatment and long term safety of these drugs.

ABSTRACT

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The amount of glucose in the circulation depends on its absorption from the intestine, uptake and release from the liver, and uptake by peripheral tissues. Insulin and glucagon together control the rate of metabolism required by peripheral tissues, and both are involved in maintaining glucose homeostasis. Insulin is considered to be an anabolic hormone that promotes the synthesis of protein, lipid, and glycogen. The key target tissues of insulin are: liver, muscle, and adipose tissue. Glucagon notably affects catabolic processes. Glucose is essential for cerebral metabolism. Unsurprisingly therefore, hypoglycaemia may result in encephalopathy. Knowledge of the homeostatic mechanisms that maintain blood glucose concentrations within a tight range is the key for diagnosis and appropriate management of hypoglycaemia. Young age, fasting, and severe infectious diseases are considered as important risk factors. Failure in investigating a neonate, infant, or a child with suspicion of hypoglycaemia, increases the risk of delaying a definitive diagnosis and instituting effective treatment. Expeditious identifying the specific cause of hypoglycaemia, as outlined above, will enable accurate institution of appropriate treatment and decrease the risk of permanent brain injury from persistent and recurrent severe hypoglycaemia. Prompt diagnosis with aggressive early intervention remains the mainstay of treatment to avert irreversible brain damage.

Diabetes mellitus is a group of diseases characterized by chronic increase of glucose level. Recent years brought much progress in understanding its complex pathogenesis. The classification that has been valid since 1999 which divided diabetes mellitus to type 1, type 2, gestational, and a group of "other specific syndromes." has become inadequate to current knowledge.The differential diagnostics of types of the diseases is playing an increasing role in diabetology, as it enables selection of optimal treatment methods, as well as, the assessment of prognosis referring to the diabetes course and complications occurrence. One of the indicators enabling such an assessment is the determination of the titres of autoantibodies, among them anti-GAD. Increasing the titre of these autoantibodies indicates an autoimmune basis for the development of diabetes and the need for insulin therapy in its treatment.Materials and methods: This paper presents a retrospective analysis of 7 patients with diabetes diagnosed initially as type 2 diabetes.The determination of the level of C-peptide and the titres of autoantibodies carried out in subsequent years allowed us to verify the diagnosis of type diabetes. Conclusion:This analysis indicates the importance of determining the level of C-peptide and the titres of autoantibodies for the early diagnosis of autoimmune diabetes mellitus.

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