Childhood Diabetes Information: Basics

Childhood Diabetes Information
Basics for All in Diabetic Child’s Environment

Gravity of diabetic disease in childhood

Childhood diabetes is the most common chronic metabolic syndrome affecting children.

It is characterized by high blood sugar levels: Impaired insulin secretion and action leads to poor glucose tolerance, which forms the basis of this disease.

Several diverse disorders in carbohydrate metabolism attribute to impaired glucose utilization seen in both the types of diabetes mellitus.

Autoimmune mechanism and genetics of many of these contributing disorders have been documented. The autoimmune mechanism is known to be triggered by several external factors.

Though there is definite proof that several environmental triggers set off the autoimmune mechanism that plays crucial role in clinical presentation of diabetes in children who are genetically susceptible to the disease, the search for precise triggers yet continues.

The two forms of childhood diabetes

1. Type 1 diabetes (T1DM)

In Type 1 diabetes, pancreas' ability to secret insulin is reduced due to damage of insulin producing cells; beta cells in islets of Langerhans. It is therefore commonly known as "insulin dependent diabetes."

Being the most common endocrine disorder of childhood and teens, it is also referred as “juvenile diabetes”.

Childhood diabetes leads to significant consequences on physical and emotional development of children.

Rising incidence of childhood diabetes is a cause of great concern.

Worldwide millions of children below 14 years of age are suffering from Type 1 diabetes. Incidence of diabetes in children increases as the age advances.

A worrisome rise in childhood diabetes mediated metabolic syndrome during the early development years of childhood (1-2 years of age) has however been noticed in recent years; especially among toddlers of the high-risk groups.

Type 1 diabetes most frequently strikes at the onset of school (5-6 years of age) and at onset of puberty (10-14 years of age). Boys and girls are equally affected; incidence in girls may be marginally more.

2. Diabetes type 2 (T2DM)

In this form of diabetes the action of insulin is impaired at the cellular level. Thereby the glucose is not optimally utilized by muscles, liver and fatty tissue. It may also be associated with various degree of functional impairment of beta cells in the pancreas.

Lifestyle modifications

Children with diabetes need to implement serious modifications in their lifestyle from a very early age, which often is a cause of considerable anxiety in them and their parents:

An absolute daily requirement for insulin supplementation.
Need to conscientiously monitor their own glucose level.
Comply by regular controlled dietary regime.
Playground games and daylight outdoor activities do not remain just fun of growing years, but an essential part of diabetic child's lifestyle. The easiest way to keep children active is to find sports that interest them.
Team games are fun. They take away the nagging compulsion of having to exercise because of illness, and the routine gets happily set. Besides, interaction with the members of the team helps develop emotional intelligence. Appropriate perception of emotions, of self and others, guides through decision making, the course of actions, along with seeking help and support in time of need. It thereby improves the game and builds rewarding relationships with peers.

Childhood Diabetes: Playground games and daylight outdoor activities do not remain just fun of growing years, but an essential part of diabetic child's lifestyle.

Team Games
Take Away The Nagging Compulsion of Having to Exercise Because of Diabetes

The fear of metabolic derangement is almost constant:
Frequent acute episodes of metabolic imbalance are commonly experienced by children with diabetes. And it is the root cause of undesirable long term health consequences that have clinical presentation usually during adulthood.
Impact of metabolic derangement on small and large vessels jeopardizes the blood flow, which significantly increase the risk of retinopathy (eyes), nephropathy (kidneys), neuropathy (nerves), heart disease in the diabetics. In severe cases diminished blood flow through small arteries may even lead to diabetic ulcers and gangrene of the limbs.

Emergencies associated with childhood diabetes

1. Hypo-insulinemic Hyperglycemic Ketoacidosis

Low insulin levels in the body leads to dangerously high blood glucose levels.

Effect of stress hormones:
It often gets effectuated in periods of stress.
The stress hormones block the effectiveness of insulin.
It is commonly seen in new cases before their insulin dosage, activity needs and diet regimes are well coordinated.
Loss of patient compliance:
Intermittently children with diabetes skip insulin dose, defy glucose monitoring, give into food cravings and ignore demands laid on their physical activity.
Wanting optimal control of childhood diabetes:
Desired optimization of insulin dose for children with diabetes is difficult. Their food intake and exercise output varies markedly.
Intermittent sickness during childhood often destabilize the metabolic balance.
Symptoms range from mild to severe:
- When mild, child may experiences only low energy levels.
- Severe metabolic ketoacidosis cases present with rapid breathing to depressed ability to breath; drowsiness to different levels of loss of consciousness; and severe dehydration.

2. Low blood glucose levels, Hypoglycemia:

Sudden drop in blood glucose levels often occur in childhood diabetes patients. Such episodes are always acute and may occur any time of day or night.

Low blood glucose levels is a true emergency situation:

Parents and all who are likely to be associated with diabetic children should be well informed on the symptoms and initial management of hypoglycemia. Though complete treatment of low blood sugar levels is a professional multifaceted team work, primary stabilization of blood glucose levels at home, in school or on the play ground is crucial to prevent adverse neurological outcome.

Signs and symptoms of low blood sugar levels:

Besides hunger, low blood sugar in children leads to changes in the pattern of their behaviour seen as fussiness, crying, irritability and aggression. If blood sugar levels fall further, they become pale and sweaty, and develop tachycardia (increased heart rate) and tremors.

Rapid deterioration:

Diabetic children, their family members and significant others in their environment need to be aware of the symptoms of low blood glucose to prevent an adverse outcome. Hypoglycemia progresses very rapidly. Immediate treatment is therefore essential to prevent coma, convulsions and death.

Primary stabilization of blood glucose levels:

In initial stages 5-10 grams of glucose should be given to drink in form of fruit juices or beverages. Sugar containing carbonated beverages are particularly helpful in event of low blood sugar in a diabetic patient.
More sugar containing candies or drinks should be given only on the basis of finger prick blood glucose estimation.

Second line of treatment for hypoglycemia - Seek prompt professional help:

Type 1 diabetes is known to be a brittle diabetes; characterized by wide, unpredictable fluctuations of blood glucose values and difficult to control. Following initial recovery, prompt medical help should be sought to achieve optimal blood sugar maintenance and appropriate adjustment of insulin doses in childhood diabetes cases.