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 Mrs Sulfiya Jabbar, Diabetic Educator,Aster Medcity, Kochi Most of us have someone at home with diabetes, adults or
kids. We have seen them controlling their diet by avoiding sugars, sweets, etc.
How long will they be able to control themselves avoiding all sugary items? Is
it possible to adopt a diet which is entirely different from the one that the
patient was following till yesterday? It is possible if the patient is really
motivated. Every successful patient has a motivating family behind. This year,
the theme of World Diabetes Day has been announced as ‘The Family and Diabetes’.
Diabetes in children, known as Type 1 Diabetes Mellitus, is very much
different from the diabetes that affects adult. We all know that the hormone
insulin, produced from the β-cells of the pancreas, controls the blood sugar
level in our body. Just imagine a condition where the pancreas completely stops
its insulin production due to the complete destruction of these β-cells. Then
our body will no longer be able to control the sugar level in the blood. The
blood sugar level starts increasing resulting in diabetes. The condition is
similar in children too. A child at any age, even toddlers and infants can get
diabetes.
Diabetes in adults i.e., Type 2 diabetes mellitus, is due to the decreased
insulin secretion from pancreas or due to the resistance of the body cells to
the insulin produced, whereas type 1 diabetes mellitus is due to autoimmune
condition where the body’s immunity acts against our own body resulting in the
destruction of β-cells of the pancreas.
Symptoms
- Increased thirst
- Extreme tiredness
- Sudden weight loss
- Increased urination
- Hungriness
- Abdominal pain
- Dry mouth, etc.
Usually parents or teachers neglect these symptoms as they never expect a child
to get diabetes. If these symptoms go unnoticed or untreated, a dangerous
situation known as DIABETIC KETOACIDOSIS may develop. Their breath will have a
fruity smell and the child will also complain of abdominal pain. Usually
children come to the hospital with this condition and get admitted to the
Intensive Care Unit as this condition need to be corrected at the earliest to
save the child.
Treatment
Diabetes in adults can be managed initially with diet control and exercise. If
this fails, tablets or insulin are added to control the sugar level. But insulin
is the only treatment for managing type 1 diabetes. The child will be given
multiple doses of insulin to bring down the sugar level to normal and need to
continue it lifelong. Both the child as well as the parents should get proper
education regarding the management of diabetes.
Role of family
Family education is very important in managing the blood sugar level of type 1
diabetic children. Both the child as well as the parents should learn how to
inject insulin. The child may be afraid of injecting insulin or pricking
themselves for checking the sugar levels. The support of family is very
important here.
Blood sugar levels need to be monitored several times a day. In order to avoid
the practical difficulty of depending a laboratory to check blood sugars, a
glucometer can be used. This is a small electronic device which helps to check
the blood sugar level from a drop of blood. A lancet is provided with every
glucometer which helps to prick the finger without pain. It is always advisable
to record the reading in a small book or a personal diary with date and time of
testing. Always remember to bring this book or diary during your consultation
with your Endocrinologist as these reading will help the doctor to adjust your
insulin dose accordingly. The children should be given proper nutrition needed
for their growth, but it should not increase the blood sugar level too. Hence it
is advisable to seek the help of a clinical nutritionist or a dietician to plan
their meals according to their food habits and lifestyle. All sweets and sugars
need to be avoided. Children usually find it very difficult to avoid sweets or
sugary foods. Consumption of sweets or sugars increases the blood sugar level.
Exercises have an important role in controlling the blood sugar level. Always
choose an exercise or sport the child like. The child can also participate in
all extracurricular activities at school like sports, dancing, karate, judo,
etc. The only precaution need to be taken is to check the blood sugars before
any of these activities. If normal or low, have some carbohydrate snacking to
prevent the hypoglycemia.
Diabetes – A double-edged sword….!
Hypoglycemia
Hypoglycemia and Diabetic Ketoacidosis are nightmares for the treating doctors,
parents and the children with diabetes. Hypoglycemia is caused when the blood
sugar level falls below normal, i.e., 70 mg/dl. The child may feel tremors,
shakiness of the body, palpitation, hunger, sweating, headache, dizzy, etc. Some
children, at times feel embarrassed during such situations. Skipping meals or
consuming lesser amount of food or not adjusting the insulin dosage for long
time, etc. can be the reasons for this condition. Meals at correct timings and
small snacking in between the meals and adjusting the insulin doses are very
important to prevent hypoglycemia. 15 grams or 3 teaspoons of powdered sugar or
glucose is the best treatment once hypoglycemia occurs. Never give anything
orally if the child is unconscious. Seek for medical help immediately.
Diabetic Ketoacidosis
- Diabetic Ketoacidosis occurs when the blood sugar level goes above 250 mg/dl.
This happens usually when the child is sick or skips or omits insulin. The body
becomes acidic due to change in the normal metabolism of the body. Both the
child as well as the parents should know the measures to prevent such situations
and how to prevent such condition.
- Never stop insulin when the child is sick.
- Drink plenty of fluids and monitor the blood sugar level every two hours.
- Check for ketone level in the urine (ketone strips are available).
- If the blood sugar value seems to be continuously above 250 mg/dl, or if
ketones are present in the urine, the chance of getting diabetic ketoacidosis
increases. Immediate medical care is necessary in these situations.
Remember!
In our social setup, there is a high chance for the parents to get wrong
information. It’s often seen that the parents seek the advice of friends or
neighbors and stop injecting insulin. This is very dangerous. If insulin is
stopped, the sugar level rises up resulting in diabetes ketoacidosis as
mentioned earlier. If they are able to meet the parents of other children with
diabetes and discuss or share their experiences, the confidence level of both
parents as well as the child can be increased.
It is always recommended to inform the teachers and the close friends at school
if your child is diabetic. They will be able to help the child in situations
like hypoglycemia by providing 3 teaspoons of sugar or glucose. Examination
times are nightmares for kids. Their stress level can increase the blood sugar
level. Hence psychological supports need to be given to child to overcome such
stress situations. They should have healthy meals or snacking and should also
counsel them not to skip their meals during exam.
Diabetes need to be managed lifelong. At times, the parents or the child
neglects diabetes as they lose their enthusiasm in controlling the sugar level.
Hence it is always recommended to learn more about diabetes and get updated with
newer techniques for the diabetes control. If the child gets support from their
parents, friends, teachers together with the medical team, nothing can stop them
from conquering heights….
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