Nuances of tackling Juvenile Diabetes

by Namratha Upadhya, Paediatric endocrinologist, Aster RV Hospital, Bangalore

India is already known as the world’s capital of diabetes with a vast adult population with diabetes. In children, Type-1 diabetes is the most common form of diabetes and can affect children as young as 1 year of age. Childhood diabetes is on the rise with a worldwide estimate of 1 lakh children under 15 yrs likely to develop Type- 1 diabetes. It develops due to a process called autoimmunity leading to permanent destruction of beta cells of the pancreas leading to little or no insulin production. This gives rise to high blood sugars resulting in multiple short term & long-term damage to organs if untreated.

Type 2 diabetes which was once regarded as a disease of adults is increasingly on the rise in children and results from a combination of genetic and environmental factors. Children born with low birth weight and who grow rapidly during childhood can be at increased risk. Lifestyle factors such as excessive consumption of foods which are high fat & calorie dense, pre-packaged, refined & processed foods, coupled with minimal physical activity, increased amount of screen time as in watching TV, computer games, texting etc. than playing outdoors lead to children becoming overweight & obese. This puts them at a higher risk to develop type- 2 diabetes and its complications by pushing the insulin production & action on an overdrive. Studies have shown that earlier onset of Type-2 diabetes in children tends to be more severe and progress faster than in adults.

There are also other rarer forms of diabetes which may occur due to genetic defects in insulin production or action and diabetes occurring in children with certain chronic diseases, and taking medications for other illnesses.

Symptoms of diabetes in children

Symptoms of diabetes-Children with diabetes can present with classic symptoms of increased thirst, urination, recent onset bed wetting, weight loss despite having a normal or increased appetite. Younger children in addition, may present with increased frequency of infections, and failure to gain weight. Children with untreated Type- 1 diabetes can present with ketoacidosis, wherein keto acids accumulate in the body which can lead breathing difficulty and vomiting, dehydration and excessive fatigue which is often the first time the child is diagnosed with Type -1 D. These children will need to treated as an emergency. Children with Type-2 diabetes are often overweight or obese and can also have increased thirst and urination and feel tired easily and may be unable to perform well at school.

Managing childhood diabetes

Type 1 diabetes -is managed with the help of daily insulin shots to the skin, blood glucose monitoring, meal planning with supervision from trained professionals and family support. Timely diagnosis & screening periodically under the guidance of a trained professional can help prevent complications.

Type 2 diabetes is largely preventable. Preventing children from becoming overweight by promoting and opting for healthy eating, keeping oneself physically active and keeping screen time to the minimum.

Parental Support

It’s necessary to get your child’s blood sugars checked if you feel your child might have any of the symptoms of diabetes. Children with type 1 diabetes, once started on treatment, might temporarily go into a phase of very low insulin requirement which is referred to as the “honeymoon” phase and some might mistake this phase to be a cure for diabetes. Omitting insulin without supervision by your doctor might lead to serious consequences in the child. Hence it is necessary to get your child evaluated by a professional who can guide appropriately. Children with diabetes can lead a normal life with professional and family support. As parents, the best gift they can give to their child is by being role models themselves and lead by example, especially in adopting healthy eating practices, keeping oneself physically active and get your child checked if you feel your child is having symptoms of diabetes and also get your child screened for obesity.

Keeping the intake of high calorie/high sugar & processed food, sugary drinks to a minimum, adopting healthy eating practices- eating a rainbow everyday- at least 5 different types of whole fruits & vegetables in a day, consuming whole over refined foods, avoiding screen time during meals and engaging in any form of physical exercise for at least 30 minutes a day.