Diabetes In Children
Increased interest and focus on diabetes in medical circles and press is not without reason. We have a staggering 50 million patients of diabetes which will get doubled by 2030. Implications are huge from the economic and health perspective. As diabetes is associated with complications of eyes, kidneys, nerves, heart and blood circulation, it is very important for people with diabetes to know the measures to be taken to prevent these complications. But not many know that even children suffer
What causes diabetes?
Diabetes is caused due to insulin deficiency. Our knowledge of diabetes and the etiology has increased manifold over the past decade. Now we know that insulin resistance is an important contributing factor. Glucagon, a hormone which causes rise in blood sugar levels or makes glucose available to the body in fasting state is also
deranged in diabetes – we call this alpha cell defect. Our gut plays important role in glucose metabolism and our knowledge of incretin hormones has led to many newer
drugs in the market. The improper handling of glucose by the kidneys in diabetes is an area of current interest.
Can diabetes affect children and babies?
Yes! Type of diabetes that affects children is called Type 1 Diabetes. Usually affecting children between five to 15 years but can affect older and younger age groups.
There is a genetic component but much less associated than Type 2 Diabetes (common variant affecting adults). An environmental cause like foreign protein or viral infection is suspected which causes rapid destruction of insulin producing cells and children usually present in a very sick condition and need insulin immediately and lifelong. Sometimes the requirement of insulin may decrease temporarily and may not even be required for several months but the need for insulin returns. Emergency presentation of this condition is called ‘Diabetic Ketoacidosis’. Older children are, in a small percentage showing occurrence of Type 2 Diabetes (adult variant). These are obese children who constantly indulge in fast food or junk food and no exercise at all. ‘Stress’ is not a tangible parameter but surely an important factor specially in
adult diabetes. There are some genetic variants that can affect older children or young adults like MODY (Maturity Onset Diabetes of the Young) or others as
part of the other syndromes. Secondary diabetes like part of Cushing’s syndrome or other hormonal conditions may also cause diabetes. Drugs and diseases
affecting pancreas (insulin is secreted by beta cells in islets of Langerhans located in pancreas) may cause secondary diabetes.
How to recognize diabetes in children ?
Presentation of Type 1 diabetes is almost always dramatic. The child will be very sick, pass excess urine, very thirsty, with weight loss and usually associated with some kind of infection and fever. Tiredness/fatigue is a common complaint. If untreated may lead to serious consequences warranting urgent medical attention.
Managing diabetes in children
Diagnosis of diabetes is first and foremost. Blood glucose levels are not mildly raised but in the order of 300 mg and above in most cases. Checking urine may show
presence of ketones which is a medical, emergency. These patients are very dehydrated and may have associated infection which has to be treated aggressively. Biggest challenge involved is with respect to introducing insulin and making a plan for lifelong insulin treatment. It is important to remember that good management of diabetes will provide a healthy and productive life for these children.