Sires J M
Bol Med Hosp Infant Mex. 1979 Nov-Dec;36(6):1153-62.
It is today's general medical opinion that children's diabetes mellitus was uncommon in the past. It was generally admitted at that time the initail stages were so sudden as to make difficut its early diagnosis. It's increased incidence is at present an alarming truth; however, a parallel increase of diabetic coma or of mulminant types has rather dropped. Diabetes may be diagnosed by just considering the main symptoms at the onset which are polydipsia, polyuria and weight loss. If an early diagnosis is not made, acidosis (abdominal pain, nausea, vomiting) may appear within a few days or weeks followed by coma (Kussamul's acidotic respiration and dehydration). Coma may be avoided by an early diagnosis and a life may be saved. It must be stressed that an important percentage of children and adolescents show a slow and gradual evolution (week or months) of their diabetes: gradual weight loss, sometimes with noticeable polyphagia, occasional enuresis, but without other associated symptoms. Asymptomatic, intermittent glucosurias are also frequent; they vary in magnitude an almost always they appear without ketonuria and with fasting normal glycemia. According to our experience they may precede in weeks or months the clinical manifestations of the disease. Postprandial glycemia is a sure diagnostic resource; it is of greater trustworthines than fasting glycemia; therefore we advise it as a routine diagnostic procedure which we recommend widely. In uncertain situations, the oral glucose tolerance test is advisable.
当今医学界普遍认为，儿童糖尿病在过去并不常见。当时人们普遍承认，其初期发病非常突然，以至于早期诊断困难。目前其发病率上升是一个令人担忧的事实；然而，糖尿病昏迷或恶性类型的发病率相应增加的情况反而有所下降。糖尿病可以通过考虑发病时的主要症状来诊断，这些症状是多饮、多尿和体重减轻。如果没有早期诊断，酸中毒（腹痛、恶心、呕吐）可能在几天或几周内出现，随后是昏迷（库斯莫尔氏酸中毒呼吸和脱水）。早期诊断可以避免昏迷，从而挽救生命。必须强调的是，相当一部分儿童和青少年的糖尿病呈现缓慢渐进的发展过程（数周或数月）：体重逐渐减轻，有时伴有明显的多食，偶尔尿床，但无其他相关症状。无症状的间歇性糖尿也很常见；其程度各异，几乎总是在无酮尿且空腹血糖正常的情况下出现。根据我们的经验，它们可能在疾病临床表现出现前数周或数月出现。餐后血糖是一种可靠的诊断依据；它比空腹血糖更可靠；因此我们建议将其作为一种常规诊断程序并广泛推荐。在不确定的情况下，口服葡萄糖耐量试验是可取的。
