Created by Payal Updated on Feb 11, 2013
By the age of 3, little Srini was toilet trained, so when, at the age of 5 he started bed-wetting again, his parents were very surprised. They thought he would get over it. Even when he started talking of being tired just after minutes of play they thought it was just a phase.
They also saw he complained of thirst much more than usual but it was summer and they blamed the tiredness and thirst to the summer heat. After all, both Srini’s parents were busy working people who could not be there for him all the time to notice small changes in Srini.
But when he started losing weight, and started getting dark circles under his eyes, they got alarmed and took him to the pediatrician. The doctor immediately put him through a simple pinprick blood test that proved beyond doubt that Srini was suffering from Type 1 Diabetes.
On the other hand, Kirthi’s parents are both on the heavier side and she thinks nothing of the chips and the fizzy drinks she has been having on a regular basis since a very young age. Her weekend activity is limited to watching the latest reality shows on TV and playing with her iPad. At the age of 12, a recent blood test done in her school, established that she was suffering from Type 2 Diabetes in her.
Today there are plenty of little ones in need of immediate diagnosis and treatment for type 1 and type 2 diabetes. An estimate puts the worldwide numbers at more than 4.5 lakh children between the ages of 2 and 15. Juvenile diabetes is rising in India at an alarming rate of 3% annually, which approximately means that 3-10 in every one lakh children have diabetes.
Types of Diabetes in Children
There are usually three types of diabetes seen in children 2-15 years of age:
Type 1 or Immune Mediated Diabetes:
There is no lifestyle related cause for this disease and the cause is usually not known. The hereditary factor is also very minimal here, with only 5% cases seen to have a family history of diabetes. These patients are not obese; in fact there are cases of weight loss among sufferers. The symptoms include thirst and frequent urination.
Type 2 or Insulin Resistant Diabetes:
Obesity is one of the major hallmarks of this type of diabetes. The symptoms of thirst or urination are not present and there is usually a strong family history of diabetes, with 45- 80% patients having at least one parent who is a diabetic. These patients have insulin resistance too.
MODY or Maturity Onset Diabetes of the Young:
This is a rare form and testing and identification is also difficult in normal labs. It can extend from a mild increase in blood sugar levels to extreme levels.
Causes and Symptoms
Type 1 Diabetes
Doctors and researchers do not understand the causes for Type 1 diabetes. It is believed to be caused by a combination of genetic and environmental causes. The children who get Type 1 diabetes are neither obese nor do they have a family history of diabetes. The two reasons usually given are :
• Non functioning of pancreatic beta cells
• Auto immune destruction
The 4 T’s :
• Toilet: Frequent need to go to the bathroom; bed-wetting, heavier nappies in smaller children than usual.
• Thirsty: Constant need to drink water and not being able to quench thirst.
• Tired: Frequent and constant tiredness, complaining of not being able to play after short durations due to tiredness.
• Thinner: Weight loss is a major sign on Type 1 diabetes.
Tummy aches, headaches and certain behavioral problems, hunger, blurred vision, vomiting, flu like symptoms and lethargy might accompany the above. Any complain of these without explanation in children who don’t usually suffer from these symptoms should be immediately checked.
Screening is done by a simple finger prick blood test.
If diabetes is not diagnosed and treated in time, it can lead to a condition called Diabetic Acidosis or Diabetic Ketoacidosis (DKA), which is potentially fatal to the child. A new report in British Medical Journal suggests that 25% of children diagnosed with diabetes are diagnosed so late that they are already seriously ill with DKA. A large majority of these children are in fact, less than 5 years of age. Thus knowing these symptoms well and getting the test done is very important in getting a quicker diagnosis and saving lives. The symptoms of DKA may include vomiting and stomach or abdomen pain, deep or sighing breathing and lethargy.
• Medical treatment with insulin (as prescribed by the physician)
Prevention: Since the cause of Type 1 diabetes is not known, it is difficult to say how to prevent this in children. The best we can do is ensuring a nutrition diet, stress free environment and proper physical activity and non-sedentary lifestyle for our children.
Type 2 Diabetes
• Sedentary Lifestyle
• Stress of school
• Fast food and unhealthy food consumption, soft drinks or energy drinks
• Sometimes changes in hormonal activity during puberty might give rise to insulin resistance
• Overweight or obesity
• Family history of Diabetes
• May have dark shiny patches on skin, often between fingers and toes and in the back of the neck.
• PCOS or polycystic ovary syndrome in girls
If your child is above 10 years of age and his/ her Body Mass Index (BMI) is greater than 85% for their age and sex and if your child’s weight is more than 120% of what is ideal for his/ her height, you should get him or her screened for Type 2 diabetes. The chances of the disease are highly increased by family history of diabetes, and presence of other symptoms like high blood pressure, blood fat disorders and polycystic ovary syndrome (PCOS). Screening should be done every 2 years. A fasting blood sugar test is required for screening.
The objective of treatment, of course is to bring blood sugar levels to as close to normal as possible and to prevent any further complications.
• Dietary and lifestyle changes: dieting may not be a solution instead eating healthy food should be the objective. Meal plans with exercise regimen may be adopted. A dietician or a nutritionist keeping in mind the family culture, finances and lifestyle, can be consulted to make a meal plan. A sedentary lifestyle has to be changed and weight reduction must be stressed upon.
• Oral medication and insulin
Along with this, proper education of both child and parent is required to understand how to deal with diabetes at a daily level. A good diabetic center that has pediatricians and trained nurses along with physical trainers and dieticians available would make things easier. Children with high blood pressure or blood fat disorders need close monitoring too.
The only way one can prevent Type 2 diabetes is to identify high-risk children and by early intervention. The nutrition and physical activities of children should be monitored and a strict health program should be followed and supported.
How can you help as a parent?
Living with diabetes can be challenging to say the least and requires a day-to-day preparedness and education. Even though understanding the disease and its effects can require considerable time and energy it is ultimately better for the child as well as the family.
Here is what you may want to do or learn, to make life a little easier.
• First and foremost, you may want to be aware. Knowing the symptoms of low blood sugar and diabetic acidosis is important. You could prepare yourself to handle diabetic emergencies.
• Blood sugar levels may dip during physical activity; having some form of glucose at hand may help.
• Learning how to measure blood sugar levels and teaching your child when he or she is old enough might be a positive approach.
• Ask a nurse or chemist to teach you how to administer insulin injections
• Check with the doctor at regular intervals, especially if your child becomes sick for any reason.
• Keeping the School and close friends informed might be a good option for when you are not with your child. Diabetics patients need 24 hour care, especially when they are young.
• Most cities now have diabetes control centers. Checking what is available locally and taking their help and support to fight the disease may keep you informed of the latest developments.
• In the long term; diabetes affects organs like eyes and kidneys. The earlier a person gets diabetes the higher the risk becomes. So regular check ups for such organs are a must.
• A proper diet chart with 3 meals, 2-3 snacks is ideal. Making sure the whole family eats the same meals so the child is motivated can have great positive effects on the child. The quantity of food should depend on the age and weight of the child. Nowadays sweets in moderation are allowed for diabetics with the proper medication. But the child should be made aware how much is too much.
• A diabetic child is doing well if he or she stops bed wetting or frequent urinating, emotionally and psychologically doing well, not easily fatigued and are free of or have less hypoglycemic attacks.
o Emotional and psychological effects and management: A child should not be made to feel s/he is different in any way. An immature mind may become affected negatively and s/he will be left miserable. Thus, stress should be made on keeping a child happy and making sure that proper mental maturity takes place.
o Due to infection or poor home care a diabetic child may suffer from repeated ketoacidosis. It may even have psychological ramifications.
o Poor care in the form of delayed meals or sudden unscheduled exercise may involve a hypoglycemic attack. Frequent and severe attacks indicate poor home control.
o The disease may affect a child while in school, however the child must be made to feel comfortable in a school setting making sure that such instances are handled properly. S/he should be made to feel able to participate in any sports or outdoor activities with proper training about insulin intake.
Once Type 1 diabetes was diagnosed, Srini’s doctor immediately put him on to the specialist pediatric diabetes team that ensured immediate treatment and now Srini is undergoing treatment to bring his diabetes under control and prevent DKA (diabetic ketoacidosis).
On the other hand, Kirthi has met with a dietician and a personal trainer and now undergoes a slew of physical activities that are both fun and also ensures enough exercise. She is also eating healthy, as are both her parents.
With proper and continued guidance, regular screening and a healthy lifestyle along with appropriate medication, both Srini and Krithi are expected to lead fun filled and fulfilling lives. If diabetes is controlled well and with a supportive family, a diabetic child well in school as well as all other aspects of life.
Image source - eudaemoniaforall.blogspot.com
| Jul 14, 2015
very informative! even kids should be eating healthy. outdoor play is more important than so many hobby classes.
| Jul 13, 2015
Hi.. m from pune... my 7 yr old son recently two months back diagnosed with Type 1 diabetes. The symptoms were exactly same mentioned in above article and he is on insulin now. Its very very difficult to handle kids like this at times... birthday parties where all other kids are having snacks.. he can not have. Too difficult to tell him no for sweets. Are u aware of any such parents group going on where like kids parents are there(preferably India) thanks in advance.
| Jun 01, 2015
Thanks for sharing. Very informative.
| Jul 24, 2013
Good article , thanks for sharing
| Feb 17, 2013
We normally refer to diabetes as a disease which can affect an adult. But as you have so well put it Payal, it is a condition which affects many children. We all need to know the symptoms and how to handle any such cases. Thanks Payal, great article.
| Feb 12, 2013
Thanks Indu and Neena, yes children do need screening for various things including diabetes. In fact the reason for writing articles such as this in a forum like parentune is parents be aware of the symptoms so that early intervention may be possible for our children.
| Feb 11, 2013
We do have diabetes in our genes, and I am very much concerned about it. Thanks Payal for the detailed compilation, well written. I am going to follow the written points as parent. I think along with kids, now a days kids too need Annual checkups.
| Feb 11, 2013
With changes in lifestyle, these days type 2 is rapidly becoming common in young children. Parents need to be aware that it is not an adults' disease anymore. Very well compiled.. thnks
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