The Hindu : Karnataka News : Diabetes in children and adolescents

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Friday, Nov 14, 2008
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Karnataka

Karnataka

Diabetes in children and adolescents

World Diabetes Day observed today, promotes awareness that every person with diabetes or at risk of diabetes deserves the best possible quality of education, prevention and care available. Diabetes has become a problem of epidemic proportions. It touches us in every walk of life - physician and scientist, family and friend, even governments and communities - and it exacts a costly toll. India with its dubious distinction of being called, "the diabetic capital of the world" is presently estimated to have over 30 million individuals affected by this deadly disease. India is ahead of China and USA, which are in second and third place respectively. This rising proportion has driven the thought to focus Diabetes care in Children and Adolescents.

What is Diabetes?

Diabetes Mellitus (meaning “sweet urine”) is a chronic condition caused by a lack of the

hormone insulin – either an absolute lack wherein the body does not produce any insulin or a relative lack wherein the body makes insulin but insufficient to cause the effect of lowering blood glucose.

What are theTypes of Diabetes?

Type 1 Diabetes

This is a condition in which the pancreas, an organ in the abdomen makes little or no insulin. Insulin is a hormone that helps the body absorb and use glucose and other nutrients from food, store fat and build up protein. Without insulin blood glucose does not enter the cells where it is used for energy and the blood glucose levels are elevated.

Type 1 Diabetes usually occurs in children and adolescents. Previously all diabetes in this age group was type 1. It accounts for 5 – 15 % of diabetes worldwide.

Over the last 2 decades due to increasing obesity and sedentary behavior in children, type 2 diabetes is being diagnosed at a younger age.

Type 2 Diabetes

Type 2 Diabetes occurs when the body becomes resistant to the effects of insulin and then cannot make enough. This results in an increase in blood sugar.

What Causes Diabetes? Is My Child at Risk for Diabetes?

Type 1 diabetes usually occurs when a person’s immune system destroys the insulin producing cells (called beta cells) in the pancreas. This is an autoimmune process that occurs over months or years when the patient has no signs or symptoms. Symptoms occur when 90 % of the beta cells have been destroyed.

Type 1 diabetes may occur in persons with or without a family history of the illness. In either case the person has one or more genes that make them susceptible to diabetes.

The risk of diabetes in the offspring of a patient with type 1 diabetes is, 3 – 5 % if the father has diabetes, 1 – 3 % if the mother has diabetes 6 % if both parents have diabetes 5 % if a sibling has diabetes 50 % in identical twins

Type 2 Diabetes occurs in individuals with the following risk factors

Obesity, Lack of exercise, Family history of Diabetes, Indian ethnicity, Being born to a mother with diabetes in pregnancy

PCOS (polycystic ovarian syndrome: a condition in women with irregular menses and excess unwanted hair)

Acanthosis nigricans : dark shiny patches on the neck, fingers and toes.

High blood pressure of cholesterol

How Will I know if my Child has Diabetes?

Type 1 diabetes is diagnosed only once the symptoms develop. Symptoms of high blood sugar are excessive thirst, tiredness, frequent urination, weight loss or blurred vision.

Sometimes a person may develop signs and symptoms of a complication of diabetes called diabetic ketoacidosis (DKA). They will have symptoms of high sugars and the following: nausea, vomiting, abdominal pain, lethargy and drowsiness.

A blood test of the glucose level has to be made for the diagnosis and a Fasting Blood Glucose of = 126 mg/dl and a random blood sugar of = 200 mg/dl in the presence of symptoms confirms the diagnosis.

Type 2 diabetes maybe present for several months or years before it is diagnosed. The patient will have any of the above symptoms then and the diagnosis is made by means of a blood test for glucose levels.

How is Diabetes Managed?

Treatment of Diabetes requires a team comprised of a doctor, nurse, diabetes educator and dietician. Diet and exercise are critically important to keep blood glucose levels normal. The blood glucose levels need to be frequently monitored by the patient. This monitoring is very important as it helps the doctor evaluate the effect of food, exercise and insulin on the blood glucose levels and these maybe adjusted to achieve normal values. Type 1 diabetes requires insulin injections. Patients need at least 2 shots a day and those on this type of regimen need to maintain consistency in meal timings and quantity of food. Intensive treatment includes multiple daily injections or an insulin pump (a device the size of a pager worn by the patient and insulin in delivered through that) and these allow more flexibility in their lifestyle. Type 2 diabetes may be managed with diet, exercise and oral medications or insulin. Weight loss in obese children goes a long way in controlling the disease.

Can Diabetes be Prevented?

As of now, research is still ongoing for prevention of type 1 diabetes and there is no proven method for prevention.

Type 2 diabetes may be prevented by means of a healthy diet, exercise and weight loss to achieve and maintain a healthy body weight. These life style measures are better than medications to prevent diabetes.

What is the Role of Parents?

Family support is critical in the long term management of diabetes. Children may face peer pressure, insecurity or denial of their disease. Support and encouragement is essential. The entire family should follow a healthy lifestyle.

By Dr Priya Chinnappa,

Consultant Endocrinologist

Mallya Hospital, Bangalore