When diabetes strikes the young

DIABETES is a group of metabolic disorders caused by too much glucose (a type of sugar) in the blood. It does not discriminate and affects adults as well as teenagers and very young children. In 2010, the Ministry Of Health reported that between 2006 and 2008, 630 children and teenagers contracted diabetes, with a 6-month-old baby being the youngest patient. Of these, 80 per cent were diagnosed with Type 1 diabetes and the rest had Type 2.

TYPE 1 AND TYPE 2
According to the World Health Organisation, diabetes occurs “when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces”.

The digestive system breaks down carbohydrates into glucose or sugar, which is then turned into energy. Insulin is the hormone that regulates the process and removes excess glucose which is toxic.

Hyperglycaemia, or raised blood sugar, is a common effect of uncontrolled diabetes. Over time it leads to serious damage to many of the body systems, especially nerves and blood vessels.

Type 1 diabetes is when the body’s own system destroys the cells of the pancreas (Beta cells), thus stopping the production of insulin. The cause of Type 1, formerly known as insulin-dependent or juvenile diabetes (it usually affects children under 10), is not known and it requires daily administration of insulin.

Symptoms include excessive excretion of urine (polyuria), thirst (polydipsia), constant hunger, weight loss, vision changes and fatigue.

Type 2 diabetes results from the body’s inability to use insulin effectively and is the most common type in the world. Previously called non-insulin-dependent diabetes, it is mainly attributed to excess body weight and a sedentary lifestyle.

Type 2 diabetes is often detected years after its onset because the symptoms (which may be similar to those of Type 1) are usually less noticeable.

OBESITY AND DIABETES
“Today, 45 per cent of new diabetes cases involves adolescents. In the past, diabetes that occurred in childhood used to be of Type 1. However, more children are diagnosed with Type 2 diabetes following rising cases of obesity,” says Columbia Asia Hospital consultant paediatrician Dr Margaret Kannimmel.

She says risk factors include being overweight, a family history of diabetes, gender and ethnicity.

“However, the single greatest factor for Type 2 diabetes in children is obesity. Among factors that contribute to obesity are unhealthy eating patterns, heavy fast food consumption and lack of physical activity. Children are spending more time on computer games and obviously this doesn’t help,” she says.

Over time, children with unmanaged diabetes can develop kidney failure, heart disease, damaged blood vessels or nerves and go blind, says Dr Margaret.

Some may die an early death due to these complications.

MANAGING CHILDREN’S DIABETES
Parents should know that their child having diabetes at a young age does not mean that he or she can’t enjoy childhood.

They can eat ice-cream or cakes (in moderation), and enjoy sports or other physical activity like normal children.

Instead of preventing the children from indulging, parents should focus on managing the illness — such as adjusting insulin dosage or food intake — to suit the child’s activities.

“Children, especially teenagers, may have a difficult time adjusting to their illness. They may become rebellious, especially when they hit puberty.

“It’s important for the family to understand the illness and talk to the child on how to best cope with it.

“It’s also important to work closely with the paediatrician, dietitian and other health care providers as well as teachers to help him or her cope with the illness,” says Dr Margaret.

Controlling the child’s fat and sugar intake and monitoring his growth or body mass index (BMI) during visits to the paediatrician is an important part of managing diabetes.

“Make sure that your child gets at least 30 minutes of physical activity every day to maintain a normal weight and blood sugar level. Encourage the whole family to participate and cut down the time spent watching TV or playing computer games,” says Dr Margaret.

There is no need to put the child on a special diet. A healthy, balanced meal will benefit the whole family.

“Make lifestyle changes gradually. Set small steps in achieving goals that can help your child reach an ideal body weight, and reward him appropriately,” she adds.

IT RUNS IN THE FAMILY
MAISARAH Ahmad*, a 36-year-old IT executive, is the eldest of four siblings. Both her parents are diabetics. Her 62-year-old mother had her left leg amputated due to the disease and her three brothers — Zikri*, Azhar* and Naufal* — were diagnosed with diabetes at a young age.

Azhar was diagnosed with Type 1 diabetes when he was 8 while Zikri and Naufal were diagnosed with Type 2 diabetes in their early 20s.

Azhar and Zikri died of diabetes complications in 2006 and 2012 respectively.

“I still remember how hard it was to face reality. I still recall those heart-breaking moments when little Azhar passed out or had seizures while playing due to hypoglycaemia,” says Maisarah.

Managing the disease was a major challenge when the brothers were in their teens.

“They refused to watch their diet or inject insulin especially when they were with their friends because they didn’t want them to know of their illness,” says Maisarah.

“They were rebellious because they didn’t want to be treated differently. They just wanted to lead a normal life,” she says.

“I wish I can make people empathise with youngsters living with diabetes so that they can cope better and live their lives more positively.”
(*Not their real names)

TIPS FOR TEACHERS
Every child with diabetes may have different symptoms of low blood sugar, insulin dependency, food intake, exercise, illness or stress. Remember that the child must eat whenever he feels low on blood sugar. Never leave him alone when he is in such a condition.

Pay close attention to your student’s regular snack time. Find creative ways to remind him of his snack time without drawing unnecessary attention from other students.

Always carry snacks such as crackers or sweets whenever you and your diabetic student leave the classroom or school ground. This is especially important during field trips, fire drills, special presentations or assemblies.

When blood sugar is high, the natural response is to eliminate the extra glucose by urinating. Let the child know that it is okay to go to the bathroom whenever necessary.

Never label a student with diabetes as diabetic. The child needs understanding, acceptance, support and patience, not sympathy.

Source: www.diabetes.org

TIPS FOR PARENTS

Diet
A healthy meal plan for a child with diabetes shouldn’t be different from the rest of the family. Keep in mind that food choices can help prevent or delay side effects of diabetes such as high blood pressure or heart and kidney diseases.

The diet should help prevent or treat very low blood sugar, especially when your child exercises, plays games or falls sick. Prepare extra snacks, or let him bring some sweets to school in case he runs low on blood sugar.

For a child with Type 1 diabetes, the meal plan should help keep his blood sugar level as near as normal as possible. The food should be prepared consistently so that he eats when the insulin is working the hardest.
For a child with Type 2 diabetes, the food should help control his blood sugar level, as well as maintain better blood fat level, normal blood pressure and a healthy weight.

Plan ahead and consult your child’s health care team on how to adjust his medication dosage when he goes to birthday parties, school trips, vacations or is eating out.

Health and lifestyle
Talk to your child. Make sure he understands his condition, and teach him to recognise the warning signs and how to handle it (such as telling the teacher right away if the problem happens at school etc).

Check your child’s blood sugar level frequently and encourage physical activities to help his body use excess glucose.

Taking part in physical activities such as sports can help your child make friends, feel good, and maintain a healthy body weight. However, such activities can affect his blood sugar level especially if he is taking insulin. He needs to have his blood sugar tested before, during and after activities, and may need to adjust his insulin dosage.

Stay positive with your child. Talk about non-diabetes issues as well, such as asking him about his day at school rather than just focusing on his condition.

Talk to the teachers. Tell them about his condition and give them your contact details, in case they have concerns about your child’s health. Besides teachers, work closely with a health care team who is knowledgeable about paediatric diabetes.

Source: www.livestrong.com, www.diabetes.org.my, www.joslin.org, www.fitwatch.com & www.diabetes.ca