Diabetes mellitus in children: how to cope with a “sweet” disease

Diabetes in children is usually more difficult to tolerate than in adults. Moreover, not because of severe symptoms or the course of the disease. It is more difficult for a child with high blood sugar to socialize among his peers and take his place in the team.

In the West, diabetes has long been called not a disease, but a way of life. And the task of parents is to make this life safe and as saturated as possible.  

Diabetes mellitus in children. General information

Today in Ukraine there are more than 1 million patients with type 1 and type 2 diabetes, 8 thousand of them are children. Most of all cases of the detection of a “sweet disease” in children are of exactly 1 type.

Doctors cannot answer the question why children and adults have diabetes. The possibility of genetic transmission has been scientifically proven, but diabetes is not transmitted 100% from parents to children. In some cases, past infections of the past (e.g. rubella) are triggers for diabetes.

Diabetes in children: a developmental mechanism

In the human body there is a special hormone – insulin. It helps glucose molecules to enter cells from the bloodstream, where they are already used as fuel.

Thanks to insulin, glucose freely enters the cells, while in the blood its level decreases.

In a healthy person, immediately after a meal, a large amount of insulin is injected into the blood at the same time – this is necessary for the rapid reduction of sugar in the bloodstream. As soon as insulin copes with its task, the pancreas ceases to produce it with the same intensity (so that the sugar level does not fall to a critical level). Thus, the exchange of glucose and insulin in the body occurs according to the feedback principle.

At some point, the immune system of a person with diabetes begins to destroy the beta cells of the pancreas, which are responsible for the production of insulin. As a result, sugar no longer enters the same amount from the bloodstream into the cells. There is too much glucose in the blood, but the tissues are starving without the fuel they put.

Causes of diabetes in children

Doctors do not know why the immune system, which normally fights viruses and bacteria, destroys pancreatic beta cells. There are a number of provoking factors , among them: 

• Heredity (the risk of transmitting diabetes from parents to children is quite high, especially if both parents are ill)
• Frequent viral diseases
• Increased birth weight (more than 4.5 kg)
• Metabolic disorders (obesity, hypothyroidism)
• Decreased immunity

Forms of diabetes

• Type 1 diabetes in children (autoimmune, idiopathic)
• Type 2 diabetes
• Gestational diabetes
• Other types of diabetes (MODY, mitochondrial diabetes, type A insulin resistance and so on)

The first signs of diabetes in children

Parents do not always notice signs of diabetes in children (especially young children). It is not always easy to identify them due to the peculiarities of the development of a young organism, but there are a number of characteristic signs:

• Night incontinence (in children with diabetes, 2-4 times more urine is excreted than in healthy ones)
• Skin lesions, itching (furunculosis)
• Digestive upset (constipation, vomiting, diarrhea), especially in infants
• A child with diabetes eagerly sucks a breast or drinks water
• After emptying, the baby’s diaper becomes starched (due to “sweet” urine – this symptom is typical for diabetes with moderate or severe course)

If the child has a mild form of diabetes, he may not experience any health problems, with no symptoms. The diagnosis in this situation is made only on the basis of a blood and urine test. For this reason, even the most minor symptoms of diabetes in children should be noticed by their parents on time.

Symptoms of diabetes in children

The list of symptoms indicates the most obvious manifestations of the disease, upon detection of which the parent should immediately seek medical help.

• Severe dehydration
• Muscle loss
• Frequent vomiting
• Unusual breathing (uniform, but rare, noisy inhale, deep exhale)
• Smell of acetone from the mouth
• Lethargy
• Loss of orientation in space
• Heart rate
• Blue hands and feet
• In especially serious cases, loss of consciousness due to coma

Diagnosis of childhood diabetes

If parents, knowing how diabetes is manifested in children, notice characteristic symptoms, the first thing to do is to measure the sugar level with a glucometer. In the absence of a home blood glucose meter, this can be done in a hospital laboratory (on an empty stomach). But, alas, as practice shows, parents too late pay attention to changes in the health of their son or daughter and call an ambulance. The arrived team has only one thing left: to provide emergency care and deliver the child to the hospital to confirm an accurate diagnosis.

The differential diagnostic method helps to understand what type of diabetes a child has – 1 or 2. In the CIS, type 2 diabetes is rare, it is usually detected in adolescents (12 years and older) who are overweight.  

Type 1 diabetes in children is characterized by acute symptoms and can be detected by the presence of antibodies to: 

• Glutamate decarboxylase
• Langerhans islet cells
• Tyrosine phosphatase
• Insulin

This is evidence that the immune system attacks pancreatic beta cells. In type 2 diabetes, such antibodies are not found in the blood; instead, the child has an increased level of insulin in the blood, especially on an empty stomach or immediately after eating.

Doctors recommend testing for diabetes for those with a history of diabetes (relatives with diabetes).

Treatment of childhood diabetes

Today, alas, even detected in the early stages, diabetes is incurable. The only thing that the attending physician can do for the patient is to prescribe lifelong insulin replacement therapy.

Following certain rules, a child with diabetes will be able to live a long, full life, but parents should clearly understand that diabetes in a child is forever.

The disease provides for such a complex of daily therapeutic measures:

• Insulin injections (via a syringe pen or using an insulin pump ) 
• Diet
• Physical exercise

It is necessary to measure the level of glucose in the blood several times a day, simultaneously keeping a diary of the state of the child. As for insulin injections, in most cases one injection per day is not enough. Usually, insulin is injected “for food” three times a day in accordance with each main meal and “for life” once or twice a day (to ensure the normal functioning of the body). But the specific dosage and schedule of administration is determined only by the attending physician.

When a child begins to receive insulin injections, his health usually improves markedly (after a few days or weeks). This period of remission is called the honeymoon. At this time, the sugar level is able to stay at normal levels even without injections and the need for insulin from the outside supposedly completely disappears. But doctors warn parents: this condition does not last long and does not mean at all that the disease was defeated, it only receded for a while.

Most parents experience difficulties with daily treatment of the child only at the very beginning, over time, all therapeutic measures are reduced to 10-15 minutes a day, and the rest of the time the child leads a full life as his healthy peers.

Nutrition for Children with Diabetes

The child’s diet should be as balanced as possible (with the right ratio of proteins, fats, carbohydrates and vitamins).

With diabetes, as a rule, the consumption of products such as:

• Bakery products
• Pasta (allowed only 100g per day)
• Potatoes
• Semolina, rice porridge (buckwheat, corn and oatmeal – not more than once a day)
• Spicy, fatty, salty sauces
• Sweet Gravy

There are practically no obvious restrictions on fruits and vegetables: in diabetes, the main indicator is the rate of rise in blood sugar after a certain meal, that is, you need to understand the glycemic index of the product and how much you can eat this product.

We recommend that you find a more detailed diet with the calculation of the so-called “bread units” XE on the open spaces of the worldwide network, and remember, no one knows your child better than you and will not help him learn to eat right. And the diet for diabetes is in many ways similar to the basic rules of a standard healthy diet. The composition of the diet is best discussed in advance with your doctor.