On the occasion of World Diabetes Day, let us take a look at a group of people, namely children, with whom we normally do not associate adult diseases like diabetes. We are all familiar with adult diabetes, having come across a friend or a relative who suffers from it. We have a fair idea that diabetes has something to do with insulin and an abnormal glucose metabolism, needing dietary management, exercise and medications.
But what about children? Can they get diabetes? Yes, unfortunately, children too are prone to get diabetes.
Diabetes is broadly classified into two types:
- Type I diabetes or Insulin Dependent Diabetes and
- Type 2 diabetes, of Non-Insulin Dependent Diabetes (also called maturity onset diabetes of young, MODY)
Why do children get diabetes?
Normally, adults over the age of thirty five or forty get type two diabetes while children get type 1, although there can be cases where the reverse is true too.
In children, as opposed to adults, the main problem with diabetes is the absence or a very poor production of the hormone insulin, by the Islet cells of the pancreas. In adult onset diabetes, the cells do produce a fair amount of insulin, but the body gets resistant to the effects of insulin. The exact reasons why the insulin producing cells get destroyed in children is unknown, although there are many reasons postulated- genetic, viral infections, autoimmune phenomena, mother suffering severe disease in pregnancy, introduction of certain weaning foods too early in children like cow’s milk or wheat products, low levels of vitamin D, drinking water polluted with nitrates, etc.
Whatever the reason, childhood or juvenile diabetes is a chronic, lifelong condition, which makes the young ones suffer tremendously.
Childhood diabetes peaks at two ages commonly—between 4 to 7 years, and between 10 to 14 years.
The common symptoms of diabetes in children include:
- Losing weight without trying to lose weight
- Excessive thirst, hunger or urination
- Non-healing wounds
- Tingling and numbness in the extremities, especially legs
- Bedwetting in a child who was previously continent at night
- Extreme irritability and mood swings
- Fatigue, weakness and blurred vision
- Excessive and unexplained fungal infection of the skin and mucus membranes
Many a times, diabetes exists in children and goes undiagnosed, and comes to light only when the blood sugar levels go very high, and the child develops a serious condition called Diabetic Keto-acidosis, where the child becomes comatose with rapid breathing and dehydration, requiring hospitalization and intensive treatment.
Mechanism:
The main problem in diabetes is that since insulin is not available, the glucose which is produced from the foods we eat is not able to enter the cells of the body, and keeps accumulating in the blood, pushing up the blood sugar levels, pushing up the level of cholesterol and triglycerides in the blood, and causing damage to the small blood vessels of the eye, the lungs, heart, kidney and brain.
Diagnosis
The disease is diagnosed when there is a high index of suspicion with the help of blood tests to measure blood sugar levels (both short term and long term).
Once is it established that the child has juvenile diabetes, both the child and the parents need to be counselled and informed about the full spectrum of the disease.
Treatment
Treatment consists of strict dietary regimen and monitoring, by reducing the amount of simple sugars in the diet (sugar, artificial fruit juices, desserts, chocolates, ice creams, sugar syrups, pastries etc.) and increasing complex carbohydrates like whole grains, vegetables and fruits, in the diet.
Exercise also forms a major part of the treatment and should be customized for each child.
Regular monitoring of food intake, weight and urine and blood sugar levels is a must, for proper treatment and for adjustment of dosages of medicines.
Alertness, to pick up the complications of both high blood sugar levels (due to inadequate insulin) or low blood sugar levels (too much insulin and too less sugar) are of paramount importance.
Treatment consists of taking injections of insulin, calculated depending on the blood sugar levels throughout the day, lifelong.
Diabetic children, who are properly monitored, who eat sensibly, exercise regularly, and take their treatments seriously can lead a normal life. Failure to adhere to the principles of treatment is what results in complications and a reduced lifespan for these children.
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Dr. P. V. Vaidyanathan
M. D. D. C. H (Pediatrics)
After acquiring an M. D. in Pediatrics in 1990, Dr. Vaidyanathan started his own private practice in Mumbai and has been practicing there since the last 22 years, treating children with various physical and psychological problems. He is also a free lance writer and an author. He has written a total of five books—-3 of them on parenting and 2 on spirituality.