Understanding diabetes in children – all the ups and downs, ins and outs and advice on treatment and management.
Diabetes is the world’s fastest growing chronic disease, affecting people of all ages, including infants. This article aims to help you in understanding diabetes better and the treatments available.
Understanding diabetes types
There are many different types of diabetes, with type 1 diabetes mellitus and type 2 diabetes mellitus being the most common.
Type 1 diabetes is also called insulin-dependent diabetes, previously known as juvenile diabetes because it most commonly is diagnosed in the young. Diabetes occurs when the pancreas no longer produces the insulin the body needs. Type 1 diabetes develops before the age of 35 years.
In type 2 diabetes, the most common form, there is often a genetic susceptibility, combined with lifestyle choices that lead to obesity, which, in turn, lead to insulin resistance. It usually affects older people with sedentary lifestyles, and is easier to manage.
Understanding diabetes – how it works and what to look out for
There is not necessarily a genetic predisposition for type 1 diabetes. An environmental or viral trigger can set off the autoimmune process. But what exactly that trigger is, doctors do not know.
Once the autoimmune process kicks in, there is no turning back. The body mounts an attack against its own pancreas, and the cells that make insulin are destroyed. Insulin is a hormone manufactured by the pancreas. It “tells” cells how to extract sugar from the blood, turning it into the energy necessary for survival. Without insulin, the unusable glucose remains in the blood. The body then breaks down fat and protein to use as an alternative energy source and weight loss is, therefore, one of the common symptoms of the disease.
Cape Town paediatric endocrinologist Dr Michelle Carrihill lists the symptoms to look out for. If you suspect that your child has diabetes, seek medical help immediately – without treatment, it can be life threatening.
- excessive thirst
- excessive drinking
- excessive urination
- extreme hunger
- sudden weight loss
- infections that don’t heal
- stomach cramps, nausea and vomiting.
Treatment and management
Giving insulin injections, in appropriate doses, is the treatment. Monitor sugar levels frequently to ensure the injections are effective. Use a finger pricker (a technologically advanced device that pricks the skin painlessly) to draw a tiny amount of blood. Then feed this into a glucometer to get the sugar level reading. It is not uncommon to have to check sugar levels 10 times in 24 hours. Most important is to check between midnight and 2am, which leads to sleep deprivation for parents of diabetic children.
A hypoglycaemic attack – how to recognise it, what to do
Parents need to be continually aware of the possibility of a hypoglycaemic attack. A hypoglycaemic attack happens when the sugar levels in the blood drop to unacceptably low levels, due to, ironically, an oversupply of insulin. When blood sugar levels fall below a minimum threshold the child feels unwell, eventually lapsing into unconsciousness. Give sugar or glucose, usually in food or liquid form, immediately to raise blood sugar levels. However, this can be problematic if the diabetic is a young child who is asleep, and not interested in eating or drinking anything at that moment.
In recent years, there have been significant technological advances in the treatment of diabetes. One major innovation has been the introduction of insulin pumps. The insulin pump is connected to the body by tubing that feeds into a canula or indwelling catheter placed under the skin, usually on the buttocks, obviating the need for injections by delivering insulin on a continual basis.
It is important to check blood sugar levels and estimate carbohydrate intake every time the child eats or drinks, then adjust the insulin pump accordingly. The pump is usually clipped to a piece of the child’s clothing. Move the catheter site every three days. The insulin pump makes life for a diabetic more flexible and manageable, but is only affordable for people with a decent medical-aid scheme.
Currently there is no cure for diabetes on the horizon. Stem cell research is showing some promise, however, it will be many years before meaningful results will be seen. The current focus is on more efficient therapeutic technology, such as the insulin pump, and continuous glucose monitoring devices.
Common misconceptions and better understanding diabetes
Type 1 diabetes is not caused by a child’s dietary patterns. People commonly confuse type 1 and type 2 diabetes. Type 2 diabetes is found in older people, and is easier to manage.
It is not true that children with diabetes cannot be given sweet things. If insulin levels are effectively controlled, a diabetic child can enjoy a normal and healthy diet.
Where to turn
- Red Cross Children’s Hospital Diabetes Clinic, Cape Town, 021 658 5035
- Centre for Diabetes and Endocrinology, Johannesburg 011 712 6000
- Diabetes South Africa (non-profit organisation to promote awareness and provide support): 021 425 4440, diabetessa.org.za
- childrenwithdiabetes.com is a valuable forum that provides support by allowing parents to communicate with thousands of other parents in the same position.
- Probably the most authoritative book on the subject is Type 1 diabetes in children, adolescents and young adults by Dr Ragnar Hanas (Da Capo Press).