Gastrointestinal Symptoms and Diabetes Mellitus in Children and Adolescents

Abstract

Because it may be difficult to evaluate gastrointestinal diseases in children with insulin-dependent diabetes mellitus (IDDM), this report highlights several clinical features unique to diabetes and emphasizes the relationship between gastrointestinal pathology and glycemic control. Two children with IDDM are described whose hyperglycemia, ketosis, and abdominal pain were the presenting features of H. pylori-positive duodenal ulcer disease and acute appendicitis, respectively. A third nondiabetic child developed persistent postprandial hyperglycemia as the initial manifestation of dumping syndrome. These patients illustrate the relationship between glycemic control and gastrointestinal pathology in children with diabetes and the effects of gastrointestinal dysfunction on glucose regulation in nondiabetic children. In children with IDDM, gastrointestinal pathology can be confused with ketoacidosis and complicate diabetes control and management. Early recognition and treatment of the underlying gastrointestinal disease often improves glycemic control. Furthermore, severe gastrointestinal dysfunction in nondiabetic children may deleteriously influence glycemic regulation and may be confused with childhood diabetes.

Pain reports in children and adolescents with type 1 diabetes mellitus

“…Contrary to what has been found in studies of adults with diabetes (Bair et al, 2010; Van Acker et al, 2009; Vogiatzi et al, 1996), this investigation yielded few predictors of pain. Overall, the sample was relatively healthy, with the majority of children and adolescents self-reporting three or more days a week of exercising.…”

“…Other reports of recurrent pain in children and adolescents with T1DM are largely found in the literature as case studies. These reports have suggested that GI symptoms and T1DM are interrelated and, furthermore, that children and adolescents can present with a wide variety of GI symptoms (Schindler and Kowlessar, 1988; Vogiatzi et al, 1996). Contrary to the case study reports, one larger study failed to demonstrate differences in the frequency of GI symptoms between children and adolescents with T1DM versus a control group (Vazeou et al, 2001).…”

“…These hypotheses are based on research involving diabetes-related complications. Such studies highlight factors including rigorous glycemic control (Diabetes Control and Complications Trial Research Group, 1994, 1995; Trotta et al, 2004), hyperglycemia (Vogiatzi et al, 1996), hospitalizations (Burghen et al, 1992), body mass index (BMI; Van Acker et al, 2009), poor health (Bair et al, 2010; Van Acker et al, 2009), and age (Van Acker et al, 2009). It was hypothesized that occurrence of pain would be related to diabetes self-care and indices of health.…”

Autonomic Neuropathy and Gastrointestinal Motility Disorders in Children and Adolescents With Type 1 Diabetes Mellitus

“…An autonomic neuropathy (3,4) and acute hyperglycemia (5,6) have been implicated in the pathogenesis. In children with T1DM, gastrointestinal symptoms are frequently seen, although their pathophysiology and impact on diabetes control are poorly defined (7)(8)(9). The aim of this study was to define the etiological role of autonomic neuropathy and potential motility impairment in children and adolescents with T1DM and gastrointestinal symptoms.…”