Understanding diabetes in children

A girl with a glucometer to test her blood sugar level. AI-generated photo, freepik -

Bavina Sookdeo

While diabetes is commonly associated with adults, an increasing number of children are now being diagnosed.

Dr Leonardo Akan, a paediatrician specialising in paediatric endocrinology, explained the condition and its impact.

The body’s ability to regulate blood sugar depends on a hormone called insulin. Akan explained, “Insulin is a chemical messenger travelling through the bloodstream to tell your cells to take up sugar from the blood. It helps manage blood glucose levels and allows for the storage of extra sugar for later use.”

When this delicate system is disrupted, it can lead to a condition known as diabetes mellitus (DM). The two most common types of diabetes mellitus in children are Type 1, which is an autoimmune condition where the body decreases insulin production, and Type 2, which is caused by a growing tissue resistance to how insulin works.

“Type 1 diabetes mellitus is an autoimmune disorder in which the body’s immune system mistakenly attacks and destroys the insulin-producing beta cells in the pancreas,” Akan said. “This results in little or no insulin production. Therefore, the affected person needs insulin replacement to correct the condition.”

He noted that genetics can increase susceptibility, particularly in children with a parent or sibling with Type 1 diabetes mellitus. He added that exposure to certain viruses (like mumps, rubella), diet (like cow's milk protein in infancy), and geography (risk increases with distance from the equator, possibly related to vitamin D levels) may trigger the autoimmune response in genetically predisposed individuals.

Type 2 diabetes mellitus, on the other hand, is largely associated with obesity, poor diet and a sedentary lifestyle. Akan said, “Excess fatty tissue significantly contributes to insulin resistance.” He said a strong family history, unhealthy eating patterns and low physical activity significantly raise the risk, as do genetic and ethnic factors.

“Certain ethnic groups (African, Hispanic, Indian and Asian) are at higher risk,” he noted “and children born to mothers who were obese or had gestational diabetes during pregnancy are at increased risk.”

While oral medication for Type 2 diabetes may improve natural insulin efficiency, others may still require insulin injections or other anti-diabetic treatments.

Although Type 1 and Type 2 are the most prevalent, Akan said there are also rarer forms of diabetes in children, including genetic abnormalities in insulin production and other medical conditions. However, he noted, “All the conditions lead to an abnormal elevation of sugar in the blood stream which leads to the symptoms of diabetes mellitus.”

Akan said parents should pay attention if a child urinates often which may be a sign of diabetes.

“Frequent urination due to elevation of blood sugars is one of the earliest signs of diabetes. This leads to increased thirst.” Other symptoms include weight loss (despite increased hunger), fatigue, headaches and blurry vision.

“More serious symptoms like fruity-smelling breath, rapid breathing or confusion, require immediate medical attention, as they can indicate an impending life-threatening emergency called diabetic ketoacidosis coma.”

When symptoms are present, a simple test can make the difference. “Checking the blood sugars especially with oral glucose tolerance challenge testing, urine testing, glycosylated haemoglobin A1C blood test and autoantibody tests can help confirm the diagnosis,” he said.

Once a child is diagnosed, Akan said he/she should be referred to a healthcare professional team trained to manage newly diagnosed diabetes mellitus patients and assessment for potential complications.

Akan said the diagnosis can be overwhelming for families, but parental support is crucial. “It’s always a lot to handle for everyone…painful needle injections, guilt, shame, frustration, worries about the future and 'Why me?' questions,” he said as he offered some tips:

* Encourage self-care and choosing healthy options

* Provide emotional support through open communication and validation

* Praise efforts

* Maintain routines

* Return to age-appropriate activities

* Seek external support for both the child and caregivers and lean on your healthcare team and diabetes support groups.

Akan said healthy living plays a vital role. “You cannot manage diabetes mellitus properly without adequate nutrition and physical activity,” he said, adding that each individual’s diet and activity level should be tailored to their specific needs, especially those on insulin.

Dietitian Dana Chong said balanced eating habits were crucial, particularly for children with Type 1 diabetes. “It’s important to ensure that they consume appropriate amounts of carbohydrate-containing foods throughout the day when taking insulin,” she said.

Chong said all carbohydrates break down into sugars in the body, therefore if a child who is taking insulin does not eat regularly it is possible that he/she can experience low blood sugar leading to feelings of weakness/fatigue and can lead to the child passing out.

She encouraged parents to plan consistent meals with basic carbs. Examples include bread, rice, pasta, ground provisions and fruits between meals to maintain steady blood sugar levels. “A simple, balanced day could look like this: breakfast might be a tuna sandwich with lettuce and cucumbers, a healthy snack of watermelon at school, lunch with rice, lentils, stewed chicken and sautéed carrots, an afternoon snack of crackers with peanut butter, and dinner like pizza bread topped with tomato sauce, cheese and mushrooms,” Chong suggested.

Akan, in a message to parents, said, “Empower yourselves through education and action. Learn as much as you can about diabetes care and management. Carefully sort through the good and bad advice. The more you know, the more confident and capable you and your child will be in making informed health decisions.”