Diabetes mellitis is a condition in which the amount of glucose in the blood is not controlled properly, and is either too high or two low. About 15,000 children under the age of 15 in the UK have been diagnosed with diabetes.
In diabetes, the hormone, insulin, which regulates the level of glucose in the blood, is either not produced at all (Type 1 diabetes) or is produced in too small quantities, or does not work properly (Type 2 diabetes). Type 1 diabetes is found in children or young people, while Type 2 usually occurs in people over 40. Type 1 diabetes is thought to be an auto-immune disease, in which the body produces antibodies which attack and destroy its own insulin-producing cells.
Type 1 diabetes symptoms can be quite sudden and severe, while Type 2 is more gradual in onset. The main symptoms are increased thirst, going to the toilet all the time (especially at night), extreme tiredness, weight loss and blurred vision. It is a serious condition, and if it is not treated it can cause severe weight loss, coma and even death. Diabetes may also cause long-term health problems such as heart disease, kidney failure, stroke, eye disease that can lead to blindness, and foot ulceration that can lead to amputation. However, these can be prevented with good management.
Insulin injections
People with diabetes must have their blood glucose levels monitored regularly.Those with Type 1 diabetes need daily injections of insulin and a healthy lifestyle, including a balanced diet and lots of physical activity to keep the blood glucose levels steady. This is clearly a difficult task with young children, who will need to have regular pin-pricks to test blood glucose levels and twice-daily injections. The recent development of insulin pens has made injecting easier. Insulin pumps, which provide a continuous supply, are available in the UK, but are still only used by a minority. There are other developments on the horizon (see box) The insulin that is given nowadays is human insulin from genetically engineered bacteria. There are different forms of slow, medium and quick-acting insulin which are normally mixed. Insulin cannot be taken by mouth, as the protein would be broken down in the stomach, so it must be injected. The needle is very small as the insulin only needs to be injected into subcutaneous tissue, under the skin, not into a muscle or vein. Once its been injected into the skin it soaks into small blood vessels and is taken into the bloodstream.
The thighs, stomach and buttocks are the best areas for injecting. A diabetic child's parents are taught to rotate these areas to avoid building up lumps under the skin. The skin can be slightly numbed by rubbing a piece of ice on the site for 15 to 20 seconds before injecting. This can make the anticipation worse for a young child , who will have to be held still for longer.
Management difficulties
Good control of diabetes is not always easy to achieve. Most children, and their parents, have difficulties with this at one time or another. It may happen when the balance of insulin, food and exercise is upset, or when the child is unwell. When a child is more physically active and burns up more sugar, there is a risk of developing low blood glucose and becoming hypoglycaemic. This can result in erratic behaviour, tantrums in a younger child, or sleepiness and unresponsiveness. It is then vital for the child to be made to drink a sugary drink or eat sugary foods to rapidly raise the blood sugar levels.
In cases where the child has gone so far that they cannot eat or drink, a glucagen injection may be required. It is very important that parents and carers are aware of the child's individual warning signs that their blood sugar may be getting low. Children may become anxious, nervous, irritable, clingy, whiny or aggressive. In children under three, misbehaviour or crankiness is a common sign that their blood sugar level is getting low.
Normal life
Despite the problems, most children with diabetes are able to lead an active, healthy life with normal growth and development. Diet is highly important. Except when children are at risk of becoming hypoglycaemic (see above), they should be limited to only small amounts of sweet, sugary or highly refined carbohydrates which make blood glucose levels jump. Starchy foods, such as bread, pasta, rice, potatoes and cereals, should form the basis of meals and snacks as they ensure stable blood glucose control. Children may need to eat little and often and should never delay or miss a meal. It helps to carry a snack to eat if a meal is delayed by, say, a special nursery or school outing or activity.
Parents usually explain to nursery staff and teachers about their diabetic child's regime and any dietary restrictions, and sometimes a specialist diabetes nurse will visit the nursery or school to explain to the staff about hypos, meals and snacks, exercise, and who to contact in an emergency.
Continuing research will make diabetes easier to manage, but it remains a worrying fact that childhood diabetes is on the increase. One study published in the BMJ in 1997 showed there had been a doubling in numbers of under-fives developing insulin-dependent diabetes between 1985 and 1995, an increase which has been echoed by other studies.
Although the exact cause of diabetes is not yet understood, there is clearly a genetic predisposition to developing it. Diet and environmental factors have also been implicated. Research in Finland published in the journal Diabetes last year showed that consuming large quantities of cow's milk during childhood may increase the risk. There is also evidence that infants who are breast-fed in infancy are less likely to develop diabetes.
Further information
Diabetes UK is the new name for the British Diabetic Association. It can be contacted at 10 Queen Anne Street London W1M OBD (020 7323 1531)
website:www.diabetes.org.uk
