Diabetes affecting children is a relatively common problem. Most cases of diabetes in childhood are Insulin-Dependent Diabetes Mellitus, which has a peak age of onset at 12 years. The basic disease process is identical to that in adults, but the treatment of diabetes in childhood is greatly influenced by the physiological processes of growth and maturation. These, together with changes in the child’s capacity for self-management, his emotional and social development, play a significant role in treatment of this problem.<\/p>\n
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Symptoms of IDDM in Childhood<\/span><\/p>\n \u2022 Polyuria, including Nocturia A child who is unwell with any of the above symptoms, should be screened for diabetes by urine or capillary blood glucose testing.<\/p>\n Management of Childhood Diabetes<\/span><\/p>\n Management Immediately after Diagnosis Children with diabetic ketoacidosis and dehydration must be treated urgently with intravenous fluid and insulin. Those without ketoacidosis, however, do not usually require emergency treatment.<\/p>\n Initial Diabetes Education<\/span><\/p>\n The diagnosis of diabetes in children and teenagers causes considerable anxiety to the patients and their parents. The diagnosis should be given by a senior doctor, preferably the paediatrician taking charge of the child’s diabetic management. Initial education is vitally important. Basic information about diabetes, insulin, its action, and blood glucose monitoring, should be given together with first-aid advice, regarding, what to do if hypoglycemia or hyperglycemia or vomiting develops. The family should be educated on handling an emergency. Diabetes education must be initiated.<\/p>\n Parents often query about the inheritance of diabetes and the risk of their children developing the disease. Other common questions concern a possible ‘cure’ for diabetes. Counselling would help. The child and his parents must understand that diabetes can be controlled, if not cured, and that its prognosis is increasingly hopeful.<\/p>\n Insulin Therapy in Childhood Diabetes<\/span><\/p>\n The daily insulin requirement of the newly diagnosed diabetic child varies considerably. The frequency of insulin injections must be determined individually for each child.<\/p>\n Their differing needs may be due to variables such as persisting basal residual insulin secretion, number of meals and level of exercise.<\/p>\n Insulin Injection<\/span><\/p>\n Basic injection technique is similar to that in the adult. Accuracy in drawing up the insulin should be checked. Most children and their parents become confident with injections and settle into a routine. For the very young child, the injection has to be given by the parents, which requires both confidence and time. Both parents should be instructed and should be able to give injections. The child should gradually be encouraged to inject himself with no specific target age set for him to become independent. Some children and their families find the trauma of injections hard to overcome. Simple advice about techniques, best given by the Diabetic Specialist Nurse, should solve the problem.<\/p>\n Assessment of Diabetic Control<\/span><\/p>\n The basic method of monitoring can also be used by children. Urine glucose testing (nowadays using disposable strips) is being favoured. Children should not be overburdened with too many requests for tests. Other Measures of Control<\/p>\n The overall quality of control can be assessed by comparing the child’s growth, particularly his height, with the expected population per-centile charts. Height must be measured twice a year. Severe growth failure due to chronic poor blood glucose control is a rare phenomenon. However, if growth failure still occurs, then issues other than diabetes but associated with diabetes, such as Coeliac Disease, Hypothyroidism, should be looked into.<\/p>\n Exercise and Diet<\/span><\/p>\n The metabolic effect of exercise in normal and diabetic people is discussed in the chapter on Diabetes and Exercise. Exercise-induced hypoglycemia can be prevented by decreasing the insulin dosage and increasing carbohydrate intake, like candy and chocolates, before exercise. However, for all children, sports activity and exercise should be encouraged. Dietary recommendations for children with IDDM are the same as for adults. Food rich in complex carbohydrates and fibre should be encouraged, whereas fats and simple sugars should be avoided. Diet and exercise are also important in improving glycemic control.<\/p>\n Living with Diabetes<\/span><\/p>\n Diabetic control in children is affected by different complex influences, both physiological and psychological. However, most families generally cope up well with the practical management of the disease. Growth development, school attendance and success in higher education of diabetic children is generally as expected of non-diabetic children. However, a few forms of sports activity and employment are not suitable for diabetics. Confidence to achieve success in their chosen careers and leisure activities must be instilled in a diabetic teenager.<\/p>\n To sum up, diabetes in children presents many challenges of emotional, social and medical nature. Its treatment, whether routine or in emergencies, emphasises the need for an integrated, carefully planned approach. Correct and careful management is significant as it lays the foundation for the child and his family to successfully endure a lifetime of diabetes. A registry for childhood diabetes has been initiated in our country in the capital. The objective of this registry is:<\/p>\n \u2022 To provide a central facility for registration of diabetes in children in the capital. Parents will be educated about the cause, course and prognosis of diabetes. Treatment will be supervised by a clinic. With appropriate facilities for the management of diabetes in children being provided, better control of diabetes is possible, thus reducing and preventing late complications. Such a facility will provide a model foundation and insight for the future care and management of ‘Childhood Diabetes’ in our country.<\/p>\n An Experience of Juvenile Diabetic<\/span><\/p>\n Master X gets up early in the morning A story that is repeated every morning in millions of households around the world. Master X is no different from any other 12-year old and gets no special treatment on account of his diabetes.<\/p>\n Yes, the routine has to be somewhat different from non-diabetic children, but the special routine quickly becomes a way of life and neither the child nor the family consider any part of it extraordinary.<\/p>\n Master X was diagnosed to have juvenile diabetes about 6 months ago. Master X and his entire family went through an agonising period of adjustments, introspection and lifestyle changes. But soon enough everybody, including friends, classmates and teachers, accepted the problem most naturally and beautifully.<\/p>\n Master X starts his day by checking his urine sugar every morning. “If urine sugar is positive, I check my blood sugar,” he says. If the urine sugar is positive, he drinks two glasses of water, waits for a few minutes and repeats the urine sugar. If it is still positive, he does a blood test himself. In any case, fasting blood sugar is checked at least once a week.<\/p>\n The next step is injecting insulin. This must be done without failure and since the diagnosis was done 6 months ago, Master X has never once refused to take the injection or created a fuss about it. In fact, he injects himself without having to be told and now without supervision. He uses the injecting device Novopen twice a day. Using disposable insulin syringes is just as effective and more economical, though not as convenient.<\/p>\n Going to school, studying, running in the field during break time – the rest of his day is just the same as for all other classmates of his. Of course, he cannot ignore the fact that he could get a hypoglycemic event. So, it is second nature for him to eat a little snack before doing vigorous exercise. He plays cricket, basketball and is an avid tennis player. He regularly participates in tournaments and doesn’t have to miss any activity on account of his diabetes. He plays several musical instruments, is a computer- whiz and tops in his studies. Infact he has been a regular prize winner every year since Class I.<\/p>\n As soon as he gets back from school, he checks his urine sugar again and a third time before the dinner-time again injection of insulin.<\/p>\n With these adjustments and a basic awareness of his condition and dietary requirements, Master X leads a complete life free from worry, tension or disability. Every child has the right to live life to its fullest and every child can do it.<\/p>\n","protected":false},"excerpt":{"rendered":"
\n\u2022 Thirst and Polydipsia
\n\u2022 Weight loss
\n\u2022 Growth failure (falling below height and weight per-centiles).
\n\u2022 Increased appetite, especially for carbohydrate-rich foods
\n\u2022 Abdominal pains and vomiting
\n\u2022 Blurred vision
\n\u2022 Muscle cramps
\n\u2022 Infections
\n\u2022 Boils, urinary tract infections
\n\u2022 Itching of genitals
\n\u2022 Behavioural disturbance, poor school performance
\n\u2022 Inability to concentrate
\n\u2022 Tiredness, lack of energy
\n\u2022 Ketoacidosis, coma<\/p>\n
\n\u2022 To evaluate occurrence of diabetes in childhood.
\n\u2022 To estimate the inputs for health care provisions for children with this disease.<\/p>\n