How Diabetes Affects Children
“Affected children may fail to thrive, have delayed puberty and a short stature, if the disease is not well controlled”
There are two types of diabetes mellitus (DM). Type II Diabetes generally has an adult onset and is associated with obesity with a strong family history. Type I occurs in children more than adults and is often called juvenile DM. These children are thin, may hardly have any family history and may present as diabetic ketoacidosis – a dreaded complication of childhood DM.
There are some red flag signs which parents should never disregard and these are: poor weight gain despite a voracious appetite, excessively thirsty all the time, including at night time, with high frequency of urination with or without associated bed wetting.
Type II diabetes is now rampant in growing adolescents who are obese with minimal physical activity, a sedentary lifestyle and those subsisting on junk food. They have early onset of what is caNed metabolic X syndrome In which obesity. hypertension, DM and dyslipidemia are associated.
Parents should be aware that diabetes can affect children and blood sugar fasting and post prandial blood sugar more than 126 mg/dl and 200 mg/dl, respectively confirms diabetes. Another transitional state of impaired glucose metabolism is seen in children whose blood sugar remains in between the normal and diabetic range. A blood sugar of less than 110 mg/dl and post prandial blood sugar of less than 140 mg/dl is considered normal.
Comorbidities And Complications
The child has sudden abdominal pain, vomiting or altered sensorium due to inter current illness, fasting, missed doses or is under stress. Polyuria may also be noticed by observant parents; the child also passes sugar and ketones in the urine. Parents are later taught to check urine dipstick. for ketones at home, whenever the child is unwell.
Affected children may fail to thrive, have delayed puberty and a short stature, if the disease is not well controlled.
Other autoimmune disorders like hypothyroidism are commonly associated and screening should be done for the same.
A wheat allergy is common in children with diabetes. They need regular serologic monitoring and even gastroenterologist referrals for endoscopy it the serology is positive.
Ophthalmological / Nephrology Complications
Also, ophthalmological and nephrology complications develop mostly after five to ten years of longstanding uncontrolled DM, which needs evaluation and management.
Management And Follow-Up
- Regular exercise and dietary management are important tenets of DM management
- The disease though is controllable, but not curable but with regular treatment a child can lead a normal
- DM I patients require injectable insulin therapy whereas DM II, predominantly require lifestyle modifications and oral drugs
- A follow-up with a paediatric endocrinologist and dietician is a must
- Trends in blood sugar control need to be regularly monitored
- Modern insulin pumps are increasingly being used for continuous sugar monitoring4 Nowadays, diabetic clinics are run especially for such children to allow better compliance as different families with the same problem come together to discuss their concerns.
- Counsellors are available for children as well as caretakers
- Free glucose monitoring devices and dipstick for urine and ketone are given to economically deprived sections at government hospitals
- Principles of positive reinforcement are applied and such children are awarded for good sugar control at social meets, held by the hospital for the children with diabetes