Neonatal Diabetes Mellitus: Symptoms, Causes, And Treatment Insights

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Diabetes is indeed a bane of our age; according to the International Diabetes Federation, 540 million people across the globe suffer from diabetes. Once considered the disease of adults, diabetes mellitus is now known to affect individuals of all ages, even neonates.

When it occurs in a newborn, it’s termed neonatal diabetes mellitus. It’s a rare genetic disorder that affects neonates and infants aged up to six months. One in a hundred thousand newborns suffer from neonatal diabetes mellitus.

It’s likely linked to a mutation in protein present in the member of insulin cells. It prevents insulin from leaving the cells, preventing the body from maintaining optimal blood glucose levels. Read along to understand the cause, symptoms, treatment, etc. of diabetes mellitus.

Transient or Permanent Diabetes in Neonates

Diabest in newborns manifests in two forms. one is temporary (TNDM), which resolves over time and the other is permanent (PNDM) which needs lifelong medications.

causes of neonatal Diabetes mellitus

Transient Neonatal Diabetes Mellitus (TNDM)

  • Onset – typically manifest within six months from birth.
  • Duration – Resolves in a short interval, usually within 18 months from birth.
  • Cause – In most cases, it’s due to abnormalities in chromosome 6, around the 6q24 region.
  • Treatment – In the active phase, the child will require insulin therapy. As the condition resolves the need for insulin diminishes.

Permanent Neonatal Diabetes Mellitus (PNDM)

  • Onset – typically manifest within six months from birth.
  • Duration – Currently no cure to eliminate it permanently, therefore persists lifelong.
  • Cause – Genetic mutations that affect the production and regulation of insulin in the body.
  • Treatment – Lifelong insulin therapy or sulfonylurea therapy is necessary to maintain optimal blood glucose levels.

What are the causes of neonatal Diabetes mellitus?

Earlier, neonates suffering from hyperglycemia were considered type 1 diabetic. However, our understanding has changed now – the most likely culprit of neonatal disease is a single genetic defect heterozygous that impairs insulin regulation.

The mutation can occur in the pancreatic beta cells or the subunit of the ATP-sensitive potassium channel. That’s why neonatal diabetes mellitus is also known as monogenic diabetes. Today, monogenic diabetes accounts for 85% of all cases in children below six months of age.

In addition, 4% of all cases of diabetes in children can be attributed to a single gene mutation. Even after the neonatal period, MD should be considered if type 1 diabetes autoantibodies are negative

What are the symptoms of neonatal Diabetes mellitus?

Unlike children and adults, symptoms of diabetes are subtle and easily missed. Proper monitoring is the surest way to detect diabetes mellitus in newborns, especially for those who have a strong family history of diabetes.

Symptoms include:

  • Frequent urination can be recognized by the number of times you have to change the baby’s diaper.
  • If the baby appears to be breathing rapidly, it needs to be checked by the doctor.
  • If the baby appears dehydrated, it can be due to neonatal diabetes mellitus.
  • Infections (sepsis) and the Liver problem can also lead to diabetes in neonates.
  • NDM also causes low gestational growth, a situation known as intrauterine growth restriction. Therefore, newborns suffering from NDM are much smaller than normal children of the same age.
  • Newborns suffering from diabetes often fail to gain weight and grow at a normal pace.

How is Neonatal Diabetes Mellitus (NDM) diagnosed?

If NDM is suspected in your newborn, the doctor will instruct the following test to confirm the diagnosis and find out the cause:

  • Blood Glucose Monitoring – It’s often the first course of action. Blood glucose levels are monitored continually to detect hyperglycemia and understand how well the body is regulating blood glucose levels.
  • Genetics testing – Neonatal Diabetes has over 20 known genetic causes. Therefore a detailed genetic examination is almost always required to identify the specific gene mutation that is behind the condition.
  • Additional testing – A doctor may also go for imaging studies like ultrasound or MRI to evaluate the structure of the pancreas and detect abnormalities.

What are the treatment options for NDM?

  • The initial treatment of diabetes in neonates involves lowering blood glucose levels in the blood and treating the underlying cause such as sepsis.
  • Once the glucose levels are stable, newborns are then put on insulin therapy to maintain blood sugar at optimal levels.
  • Most patients with MD, especially with a mutation in the MLM and KCNJ11 genes are put on sulfonylurea therapy.

Can we prevent neonatal diabetes mellitus?

Neonatal Diabetes is primarily caused by genetic mutations that can be both spontaneous or inherited. Therefore, currently, it’s not possible to prevent the development of NDM.

However, for families with a strong genetic disposition to diabetes or individuals with a history of diabetes mellitus, genetic counseling can be supportive.

Genetic counseling allows individuals to understand the risks involved and effectively manage potential cases.

Living With Neonatal Diabetes Mellitus

For parents, dealing with neonatal diabetes mellitus is a challenging task. However, with proper care and support from a medical team, the condition can be managed effectively with a significantly positive outcome. Newborns suffering from diabetes can then lead a perfectly normal life.

  • First of all, therapy must be flexible, because kids eat irregularly and in quantities that are difficult to assess.
  • Modern advances to manage diabetes should be adopted like fast-acting insulin analogs and insulin pumps to maintain the right levels of blood glucose levels at all times.
  • Young children couldn’t alert their parents for hypoglycemia, therefore glucose sensors, preferably with alarm sensors should be used in children above 2 years of age.
  • Parents should take proper training for better management of diabetes.

Summary

Neonatal Diabetes Mellitus can be scary for parents and life-altering situations for kids. Although rare, it presents a unique challenge that demands proper care and constant monitoring. Early diagnosis and continuous glucose management are critical for better outcomes. Although, diabetes mellitus in kids turns into a lifelong ailment, rapid advancement in diagnostic procedures and new treatment methods like sulfonylurea therapy have significantly contributed to effective management of the condition.

Living with NDM is indeed challenging, however proper medical intervention and lifestyle adjustment allow individuals to lead a healthy life.

References

Huopio H, Miettinen PJ, Ilonen J, Nykänen P, Veijola R, Keskinen P, et al.. Clinical, genetic, and biochemical characteristics of early-onset diabetes in the Finnish population. J Clin Endocrinol Metab. (2016) 101:3018–26. 10.1210/jc.2015-4296 [PubMed]

Iafusco D, Massa O, Pasquino B, Colombo C, Iughetti L, Bizzarri C, et al.. Minimal incidence of neonatal/infancy onset diabetes in Italy is 1:90,000 live births. Acta Diabetol. (2012) 49:405–8. 10.1007/s00592-011-0331-8 [PMC free article]

Dr. David G Kiely is a distinguished Medical Reviewer and former General Medicine Consultant with a wealth of experience in the field. Dr. Kiely's notable career as a General Medicine Consultant highlights his significant contributions to the medical field.

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