The Hindu : Kerala News : Diabetes in Children & Adolescents

Online edition of India's National Newspaper
Wednesday, Nov 14, 2007
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Kerala

Kerala

Diabetes in Children & Adolescents

The World Diabetes Day (WDD) is celebrated on the 14 th of November, in memory of Sir Frederick Banting, the discoverer of insulin. The theme of this year’s WDD campaign is Diabetes in Children and Adolescents.

Today, more than 240 million people worldwide are affected with diabetes. The common cause of diabetes in adults is type 2 diabetes. In children the commonest type of diabetes used to be type 1 diabetes due to self-destruction of pancreatic beta cells producing insulin.

With increase in obesity among children associated with sedentary lifestyles and consumption of unhealthy fast food, the adult variety of diabetes (type 2 diabetes) has started appearing in children.

Diabetes in children may present acutely as increased thirst, increased appetite, weight loss and increased urination. If ignored, the child can develop vomiting, difficulty in breathing and unconsciousness leading to diabetic ketoacidosis. If not identified and treated on time with insulin, ketoacidosis can be lethal.

All children with diabetes are exposed to diabetic complications that affect the eye (retinopathy), nerves (neuropathy), heart and blood vessels in later life.

Type 2 diabetes in children may be managed with diet, exercise and oral medications once the acute stage is over. Insulin is a life saving medication in children with type 1 diabetes and many children in underdeveloped and developing nations including India die due to lack of availability of insulin.

The challenges of managing diabetes in children are different from that of adults. Poor control of blood sugars can affect the growth, development and puberty in children.

Children with diabetes can develop other organ involvement like thyroid disorders, anemia and celiac disease. The child has to monitor blood sugars, maintain discipline in diet and activity, anticipate and treat hypoglycemia (low sugars) in addition to the routine activities of school and home.

These can have significant impact on the well being of children and parents. Transition to adolescence can bring its share of adjustment problems control of blood sugars worsen during this period.

Blood sugars are classically managed by using insulin. This can be used as syringes (and vials), as pen devices and insulin pump.

The pump delivers a user set constant rate of insulin along with bolus doses to control the increase in sugars during the meal. Insulin analogs are now used more commonly in children, achieving more stable control of sugars.

Inhaled insulin that was in the market for a year was recently withdrawn. Islet cell transplantation is an experimental therapy where a donor’s islet cells (cells producing insulin) are transplanted to a patient with type 1 diabetes. Pancreatic transplantation (along with kidney) can be used in some patients.

A multidisciplinary team with endocrinologists, pediatricians, dieticians, educators and psychologists can help improve management of children with diabetes addressing their unique issues. Till date, type 1 diabetes is not preventable.

However, improving physical exercise and healthy eating habits can delay and prevent type 2 diabetes. The WDD 2007 campaigns plans to raise awareness among general public, health care providers and health policy makers so that no child dies of diabetes.

Dr. Mathew John, MD, DM, DNB

Consultant Endocrinologist,

Kerala Institute of Medical Sciences, Thiruvananthapuram

E-mail: drmathewjohn@yahoo.com

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