الفهرس 
Epidemiology, Pathophysiology and Types of Pediatric DMOnly 14 pages are availabe for public view
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Abstract
Diabetes is one of the most common endocrine abnormalities in childhood. Despite the frequency of this condition, little is written on the perioperative management of diabetic children.
There are three main types of diabetes affecting children; type 1 diabetes, type 2 diabetes and Maturity onset diabetes.
Diabetes mellitus is responsible for lots of complications as regard paediatric age group; it can be classified to micro or macro vascular, micro vascular disease is responsible for retinopathy, nephropathy, and neuropathy. Macro vascular complications affecting coronary, carotid, and other major vessels are increasingly recognized as beginning during childhood. Of particular interest in children have been skeletal, joint, and skin complications, and the effects of diabetes on growth and development.
Also Hyperglycaemia and its sequel on tissue healing or leading to diabetic ketoacidosis and hyperglycaemic Hyperosmolar state.
Paediatric patients with diabetes mellitus are managed during the perioperative period by paediatric anaesthesiologist who carefully monitors glycaemia levels, in addition to the type of surgery and the Pathophysiology of the disease. This essay represents a practical guide, an algorithm for managing paediatric diabetic patients undergoing surgery, whether under general or regional anaesthesia.
The management must be classified to preoperative care that includes careful assessment and management according to the different insulin regimens or oral hypoglycaemic drugs.
The current management of diabetes in childhood has undergone significant recent changes as new preparations of insulin and new delivery technologies come into broader use. Euglycemia and the avoidance of long-term complications of diabetes remain the key goal.
Exogenous insulin preparations classified according to their pharmacodynamic profiles into rapid acting (Insulin
lispro – Humalog®, Insulin aspart - Novolog®), short acting (soluble or regular insulin), intermediate acting (NPH – Isophane) and long acting (Insulin glargine - Lantus® and Insulin Detemir -Levemir®).
This essay is going to explain the several regimens for managing the diabetic paediatric patients as regard different insulin regimens (basal-bolus insulin therapy using insulin Glargine (Lantus®) or insulin Detemir (Levemir®) once daily, insulin pump, I.V. insulin infusion and using the oral hypoglycaemic agents).
Intraoperative care that includes; managing of fasting, choice of anaesthesia whether GA or RA, fluid therapy and intraoperative monitoring.
Finally postoperative care that includes; following up the level of blood sugar and when to resume feeding and medications (Insulin or oral hypoglycaemic), anti emetic therapy, analgesia and discharge criteria.