By Dr Suruchi Goyal
The widespread incidence of diabetes among children is a rising concern in India. A child as young as a few months old can develop Type 1 diabetes (Juvenile diabetes). With this condition, the symptoms can easily be misinterpreted by parents as a change in the habits of the child which leads to a delay in diagnosis and appropriate management. Another reason for this is the lack of awareness about the growing incidence of Type 1 diabetes in children.
Not many people know that about 3/100,000 children are diagnosed with Type 1 diabetes every year. In addition to this, because we do not yet have a single common diabetes registry in our country, there is a suspicion that these numbers are under-reported and are only a fraction of the real numbers in India.
Type 1 diabetes is a distinct form of diabetes which occurs due to the lack of Insulin leading to high blood sugar levels. It is not the same as Type 2 diabetes.
Beta cells in pancreas make insulin and in patients with Type I Diabetes, the beta-cells are destroyed by the body’s own immune system (autoimmunity) leading to insufficient insulin secretion and hyperglycemia. Certain infections have also been implicated in the trigger of the immune system.
The symptoms can take months or years to develop. Once they appear, they progress rapidly and can lead to life threatening events if not detected early.
It is important to note that Type 1 diabetes is not caused due to eating habits or lifestyle.
Early symptoms of Type 1 Diabetes in children are (4Ts):
Thirst: Increased thirst
Toilet: Increased urge to pass urine (bedwetting)
If these early symptoms are missed, then children can develop a condition called Diabetic Ketoacidosis, which is the result of the build-up of ketones in the blood that can cause the child to become severely sick. A simple finger prick blood sugar level is used for the diagnosis of Type 1 diabetes.
The management of Type 1 diabetes in children:
Type 1 Diabetes is managed through a multidisciplinary team with the child and family in the centre supported by the diabetologist, diabetes specialist nurse, educator, nutritionist and psychologist.
The aim is to maintain blood sugar levels within a tightly controlled range, prevent swings between high and low sugars, allowing the child to continue their activities safely and preventing long-term complications from high blood sugar.
Insulin forms the primary hormone in the management of diabetes and is available in the injectable form only. It is administered with the help of an insulin pen or insulin pump and is required life-long. Insulin is given many times a day, and its dose determined by:
Blood sugar levels which need to be checked multiple times a day using a glucometer or a continuous glucose monitoring device.
Carbohydrate count in the food consumed.
Level of exercise and activities.
Research on Type 1 Diabetes in children is an ongoing process with innovations and advancements in technology to be expected. Insulin pumps and continuous blood glucose monitors have helped reduce the need for pricks and improved blood sugar controls and flexibility in managing Type 1 diabetes in children.
(The writer is Consultant – Paediatrics and Paediatric Endocrinology, Columbia Asia Hospital Whitefield.)
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