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Childhood Diabetes
Dr Ramesh Goyal
What Is Diabetes?

Diabetes is a disease that affects how the body uses glucose, the main type of sugar in the blood. Glucose comes from the foods we eat and is the major source of energy needed to fuel the body’s
functions.  
After you eat a meal, your body breaks down the foods you eat into glucose and other nutrients, which are then absorbed into the bloodstream from the gastrointestinal tract. The glucose level in the blood rises after a meal and triggers the pancreas to make the hormone insulin and release it into the bloodstream. But in people with diabetes, the body either can’t make or can’t respond to insulin properly.

Signs and Symptoms of Type 1 Diabetes
A person can have diabetes without knowing it because the symptoms aren’t always obvious and they can take a long time to develop. Parents of a child with typical symptoms of type 1 diabetes may notice that their child:
  • Urinates frequently and in larger volumes as the kidneys respond to high levels of glucose in the bloodstream by flushing out the extra glucose in urine.
  • Is abnormally thirsty and drinks a lot of water in an attempt to keep the level of body water normal, considering that he or she has lost a lot of fluid by urinating.
  • Loses weight (or fails to gain weight as he or she grows) in spite of a good appetite. This is because the body breaks down muscle and stored fat in an attempt to provide fuel to the hungry cells.
  • Feels tired often because the body cannot use glucose for energy properly.
 
Living with diabetes is a challenge, no matter what a child’s age, but young children and teens often have special issues to deal with. Young children may not understand why the blood samples and insulin injections are necessary. They may be scared, angry, and uncooperative.
 
Insulin works like a key that opens the doors to cells and allows the glucose in. Without insulin, glucose can’t get into the cells (the doors are “locked” and there is no key) and so it stays in the bloodstream. As a result, the level of sugar in the blood remains higher than normal. High blood sugar levels are a problem because they can cause a number of health problems.

What Is Type 1 Diabetes?
There are two major types of diabetes: type 1 and type 2. Both type 1 and type 2 diabetes cause
blood sugar levels to become higher than normal. However, they cause it in different ways. Type 1 diabetes (formerly called insulin-dependent diabetes or juvenile diabetes) results when the pancreas loses its ability to make the hormone insulin.

Here, the person’s own immune system attacks and destroys the cells in the pancreas that produce insulin. Once those cells are destroyed, they won’t ever make insulin again. Although no

one knows for certain why this happens, scientists think it has something to do with genes, though not entirely that. A person probably would then have to be exposed to something else - like a virus - to get type 1 diabetes. Type 1 diabetes can’t be prevented, and there is no practical way to predict who will get it. There is nothing that either a parent or the child did to cause the disease. Once a person has type 1 diabetes, it does not go away and requires lifelong treatment. Children and teens with type 1 diabetes depend on daily insulin injections or an insulin pump to control their blood glucose levels.

Type 2 diabetes (formerly called noninsulin-dependent diabetes or adult onset diabetes) is different from type 1 diabetes. Type 2 diabetes results from the body’s inability to respond to insulin normally. Unlike people with type 1 diabetes, most people with type 2 diabetes can still produce insulin, but not enough to meet their body’s needs.

But in some cases, other symptoms may be the signal that something is wrong. Sometimes the first sign of diabetes is bedwetting in a child who has been dry at night. The possibility of diabetes should also be suspected if a vaginal yeast infection (also called a candida infection) occurs in a girl who hasn’t started puberty yet. If these early symptoms of diabetes are not recognized and treatment is not started, chemicals called ketones can build up in the child’s blood and cause stomach pain, nausea, vomiting, fruity-smelling breath, breathing problems, and even loss of consciousness. Sometimes these symptoms are mistaken for the flu or appendicitis. Doctors call this serious condition diabetic ketoacidosis, or DKA.

A1C Test
Checking your blood sugar at home tells what your blood sugar level is at any one time. But if you want to know how you have done overall, the A1C (also known as glycated hemoglobin or HbA1c) test that gives you a picture of your average blood glucose control for the past 2 to 3 months. The results give you a good idea of how well your diabetes treatment plan is working. The A1C test is like a cricket player’s season batting average. Both A1C and the batting average tell you about a person’s overall success. Neither a single day’s blood test results nor a single game’s batting record gives the same big picture.

You should have had your A1C level measured when your diabetes was diagnosed or when treatment for diabetes was started. To watch your overall glucose control, your doctor should measure your A1C level at least twice a year. This is the minimum. There are times when you need to have your A1C level tested about every 3 months. If you change diabetes treatment, such as start a new medicine, or if you are not meeting your blood glucose goals, you and your doctor
will want to keep a closer eye on your control.

Living With Type 1 Diabetes Living with diabetes is a challenge, no matter what a child’s age, but young children and teens often have special issues to deal with. Young children may not understand why the blood samples and insulin injections are necessary. They may be scared, angry, and uncooperative. Even when they faithfully follow their treatment schedule, teens with diabetes may feel frustrated when the natural adolescent body changes during puberty may make their diabetes somewhat harder to control.
 
Parents can help their children lead happier, healthier lives by giving constant encouragement.
Monitoring and controlling glucose levels is something they need to get used to. They should:
  1. Check blood sugar levels a few times a day by testing a small blood sample.
  2. Give themselves insulin injections, or have an adult give them injections, or use an insulin pump.
  3. Eat a balanced, healthy diet and pay special attention to the amounts of sugars and starches in the food they eat and the timing of their meals.
  4. Get regular exercise to help control blood sugar levels and help avoid some of the long-term health problems that diabetes can cause, like heart disease.
  5. Work closely with their doctor and diabetes health care team to help achieve the best possible control of their diabetes and be monitored for signs of diabetes complications and other health problems that occur more frequently in children with type 1 diabetes.
Until scientists have perfected ways to  better treat and possibly even prevent or cure diabetes, parents can help their children lead happier, healthier lives by giving constant encouragement, arming themselves with diabetes information, and making sure their children eat properly, exercise, and stay on top of blood sugar control every day. Doing so will enable kids to do all the things that other children do while helping them grow up to be healthy, well-adjusted, productive adults.
 
Dr Ramesh Goyal is Consultant in Diabetology &Endocrinology, Apollo Hospitals, Ahmedabad

    
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