19 Nov 2022 10:32 AM GMT
Image used for representative purposes only (Photo credit: Pixabay)
Diabetes is a condition in which the body can’t make enough insulin, or can’t use insulin normally. The most common diabetes in children and adolescents is type 1 diabetes mellitus (T1DM) which is an autoimmune disorder. The body’s immune system damages the cells in the pancreas that make insulin. T1DM is a long-term (chronic) condition. It may start at any age.
Insulin from the pancreas must be replaced with insulin injections or an insulin pump. T1DM often appears suddenly. In children, type 1 diabetes symptoms may be like flu symptoms. Symptoms can occur a bit differently in each child. They can include, high levels of glucose in the blood and urine when tested, unusual thirst, dehydration, frequent urination, excess hunger but weight loss, loss of appetite, weakness and fatigue, and infections not getting better.
If undetected and untreated nausea, vomiting and alteration of consciousness set in. The condition is detected by measuring plasma glucose either in the fasting, post-meal or random state along with HbA1c level. Low fasting c peptide levels and positive autoantibodies against pancreatic antigens characterise the condition.
Children with type 1 diabetes must have daily injections of insulin to keep their blood glucose levels within normal ranges. Insulin is given either by injection or insulin pump. Your child’s healthcare provider will show you how to give your child insulin with either method.
Treatment will also include eating the right foods to manage blood glucose levels. This includes timing meals and counting carbohydrates, exercise, regular blood testing to check blood-glucose levels, prevention, detection and management of acute hypoglycaemia, urine testing during sick days to check ketones and prevent the development of ketoacidosis and adjustment for special situations. Periodic surveillance, complication screening, and ongoing diabetes education are essential components of ongoing type 1 diabetes mellitus care.
With the provision of contemporary standards of multidisciplinary care in the modern era, most children with type 1 diabetes mellitus are able to lead productive healthy lives with a near-normal life span.
Type 2 Diabetes Mellitus (T2DM) is a metabolic disorder usually caused by insensitivity to endogenous insulin. T2DM may have an underlying polygenic predisposition. It usually takes another factor, such as obesity, to bring on the condition. T2DM may have an asymptomatic, indolent presentation and may be detected while screening or may present with frank symptoms as in patients with T1DM.
Children at higher risk of type 2 diabetes should be screened with HbA1c levels and plasma glucose levels in the fasting or post-glucose state. Treatment will depend on your child’s symptoms, age, and general health. It will also depend on how severe the condition is. The goal of treatment is to keep blood glucose levels as close to normal as possible.
Treatment will include a healthy diet, weight loss, if needed, regular exercise, regular checking of blood sugar levels more so initially, oral medicines, if needed and insulin replacement in certain situations. Children with T2DM are at risk for problems such as high blood pressure, high cholesterol, non-alcoholic fatty liver disease, depression, and eating disorders. Chronic micro and macrovascular complication of diabetes mellitus are similar in both subtypes. Lifestyle changes that may prevent or delay type 2 diabetes include a healthy diet, weight loss if needed and regular exercise.
Type 2 diabetes is a chronic condition. It requires lifestyle changes in order to keep healthy blood glucose levels. It’s important to work closely with your child’s healthcare team to create an ongoing plan that works for your child. It helps if the whole family makes lifestyle changes together to develop healthy habits.

(The author is a consultant pediatric & adolescent endocrinologist, department co-ordinator & fellowship program Director at SRCC Children’s Hospital, Mumbai)
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