Children’s Health- Could your little one get diabetes?
Dec 20, 2009
DIABETES, commonly known as sukali, was a disease of adults, but the condition in which the body has trouble regulating blood sugar, is slowly unfolding in children. The World Health Organisation says diabetes is one of the most common chronic childhood d
By Irene Nabusoba
DIABETES, commonly known as sukali, was a disease of adults, but the condition in which the body has trouble regulating blood sugar, is slowly unfolding in children. The World Health Organisation says diabetes is one of the most common chronic childhood diseases with Type 1 diabetes growing by 3% per year in children and adolescents, and 5% per year in preschool children.
According to Dr. Silver Bahendeka, a physician specialising in diabetes at the Doctor’s Plaza, Ugandan children with
diabetes form 7% of the total population of people with the condition. “Among 0–7 years, they account for 30%, another 30% consist of those between seven and 15 years and another 30% among 15–25,†Bahendeka, who is also the chairperson of the International Diabetes Federation Africa Region, says.
He says Type 1 diabetes is the most common form of diabetes in children; 90-95% of under 16s with diabetes have this type. “It is sometimes called insulin-dependent, immunemediated or juvenile-onset diabetes.
“Type 1 diabetes is classified as an auto-immune disease, meaning a condition in which the body’s immune system ‘attacks’ one of the body’s own tissues or organs. In Type 1 diabetes it is the insulin-producing cells in the pancreas that are destroyed,†he says.
Bahendeka says the incidence of Type 1 diabetes in Uganda is increasing mainly due to changes in environmental risk factors. “The condition is neither congenital nor acquired.
The causes are largely still unknown although there is some degree of inheritance of the disease. It probably involves a combination of genes and environmental triggers, but the majority of the children who develop Type 1 do not have a family history of the disease,†he says.
Bahendeka warns that the disease
is ‘sporadic’ with no particular category of child populations. Consequently, prevention is quite difficult, but if properly managed, a child can grow into adulthood without major complications.
Nonetheless, Type 1 diabetes can develop at any age. Although more cases are diagnosed before the patient is 30 years old, it also occurs in older individuals. Generally, a third of the children will have the diagnosis made between 0 to nine years, another third between 10 to 19 years and the rest after 20 years.
Management
Bahendeka says a parent with a child with Type 1 diabetes should learn more about diabetes for easy management of
the disease. “The main treatment for diabetes is to bring the sugar levels down to normal using insulin,†he says.
“Since the sugar levels fluctuate a lot, this should be determined by frequent blood glucose checks at home using a glucose meter. After a three or four-month’s period, the child should go to the health facility and have a long-term glucose check called A1c (Glycosylated Haemoglobin) checked.
This should be less than 6.5% for good control or up to 7.0% for acceptable control,†he advises. Bahendeka says the cost of monitoring glucose at home is about sh5,000 a day, the cost A1c is about sh40,000 every three months, while the cost of insulin by pens, which are suitable for children, is about sh100,000 a month, including needles. Insulin goes for $6 (sh10,000) per doze and this is a life-time drug.
“This is very expensive. It is for this reason that there are the initiatives to help these children,†he says. Bahendeka says insulin treatment, good glucose control and avoidance of ‘hypos’ (low blood glucose attacks) is important. However, for preventive purposes, caretakers are advised to control their children’s diet.
“Foods with high sugar content are not good. Give foods rich in carbohydrates, roughage, proteins and lots of vegetables. Ensure that your child gets physical exercise to regulate weight,†he says.
Challenges
Dr Ruth Katunze, a paediatrician and head of Mulago Hospital’s Mwana Mugimu Unit, says diabetes in children is often misdiagnosed and by the time it is discovered, the sugar levels are too high.
“We ask mothers to watch for symptoms of diabetes in their children and take them for check-ups twice a year,†Katunze says.
Dr Jessica Nsungwa, the principal medical officer child health in the Ministry of Health, says managing diabetes in children and adolescents is difficult because it is hard to restrict their diets. He warns mothers, whose babies weigh 4.5kg and above, to watch out for diabetes.
Last year, the General Assembly of the United Nations passed a resolution recognising diabetes as a debilitating disease. It designated November 14 the World Diabetes Day.
Recent studies in diabetes clinics in Uganda show that the disease is poorly controlled. This is partly due to the fact that the health system was previously designed to deal with acute infectious diseases with little provision for chronic conditions like diabetes.
Consequently, the system has been ill-equipped to deal with the increase in diabetes cases. Good news Bahendeka says Uganda is among the countries that will receive free insulin for children for the next 10 to 25 years through two projects — the Life of a Child programme and Changing Diabetes in Children programme.
St. Raphael of St. Francis Nsambya Hospital is setting up a comprehensive diabetes centre to act as a hub for training health workers, while Wakiso Health Centre IV will act as a model for training rural health workers in managing the disease.
“If well managed, diabetes is compatible with a full good quality of life, whether it affects a child or an adult. What is extremely important is that the family, the community and most important, the patient, understand how to manage the disease,†he says.
Symptoms
BAHENDEKA says the main symptoms are the same as in adults. However, they tend manifest over a few weeks. “Symptoms include abnormal thirst and dry mouth, frequent urination, extreme tiredness/lack of energy, constant hunger, sudden weight loss, slow wound healing, recurrent infections and blurred vision,†he explains.
“There are also symptoms that are more typical for children like complaints of tummy pains, headaches and behaviour problems. Doctors should consider
the possibility of diabetes in any child who has an otherwise unexplained history of illness or tummy pains for a few weeks,†he advises.
“And because Uganda is a malaria endemic country, initial symptoms may be mistaken for malaria. If not treated immediately, the child goes into coma and this can be as dramatic as one or two weeks. Always look out for sugar in urine, fruity odour on breath, laboured breathing, drowsiness and unconsciousness,†he says.
DIABETES, commonly known as sukali, was a disease of adults, but the condition in which the body has trouble regulating blood sugar, is slowly unfolding in children. The World Health Organisation says diabetes is one of the most common chronic childhood diseases with Type 1 diabetes growing by 3% per year in children and adolescents, and 5% per year in preschool children.
According to Dr. Silver Bahendeka, a physician specialising in diabetes at the Doctor’s Plaza, Ugandan children with
diabetes form 7% of the total population of people with the condition. “Among 0–7 years, they account for 30%, another 30% consist of those between seven and 15 years and another 30% among 15–25,†Bahendeka, who is also the chairperson of the International Diabetes Federation Africa Region, says.
He says Type 1 diabetes is the most common form of diabetes in children; 90-95% of under 16s with diabetes have this type. “It is sometimes called insulin-dependent, immunemediated or juvenile-onset diabetes.
“Type 1 diabetes is classified as an auto-immune disease, meaning a condition in which the body’s immune system ‘attacks’ one of the body’s own tissues or organs. In Type 1 diabetes it is the insulin-producing cells in the pancreas that are destroyed,†he says.
Bahendeka says the incidence of Type 1 diabetes in Uganda is increasing mainly due to changes in environmental risk factors. “The condition is neither congenital nor acquired.
The causes are largely still unknown although there is some degree of inheritance of the disease. It probably involves a combination of genes and environmental triggers, but the majority of the children who develop Type 1 do not have a family history of the disease,†he says.
Bahendeka warns that the disease
is ‘sporadic’ with no particular category of child populations. Consequently, prevention is quite difficult, but if properly managed, a child can grow into adulthood without major complications.
Nonetheless, Type 1 diabetes can develop at any age. Although more cases are diagnosed before the patient is 30 years old, it also occurs in older individuals. Generally, a third of the children will have the diagnosis made between 0 to nine years, another third between 10 to 19 years and the rest after 20 years.
Management
Bahendeka says a parent with a child with Type 1 diabetes should learn more about diabetes for easy management of
the disease. “The main treatment for diabetes is to bring the sugar levels down to normal using insulin,†he says.
“Since the sugar levels fluctuate a lot, this should be determined by frequent blood glucose checks at home using a glucose meter. After a three or four-month’s period, the child should go to the health facility and have a long-term glucose check called A1c (Glycosylated Haemoglobin) checked.
This should be less than 6.5% for good control or up to 7.0% for acceptable control,†he advises. Bahendeka says the cost of monitoring glucose at home is about sh5,000 a day, the cost A1c is about sh40,000 every three months, while the cost of insulin by pens, which are suitable for children, is about sh100,000 a month, including needles. Insulin goes for $6 (sh10,000) per doze and this is a life-time drug.
“This is very expensive. It is for this reason that there are the initiatives to help these children,†he says. Bahendeka says insulin treatment, good glucose control and avoidance of ‘hypos’ (low blood glucose attacks) is important. However, for preventive purposes, caretakers are advised to control their children’s diet.
“Foods with high sugar content are not good. Give foods rich in carbohydrates, roughage, proteins and lots of vegetables. Ensure that your child gets physical exercise to regulate weight,†he says.
Challenges
Dr Ruth Katunze, a paediatrician and head of Mulago Hospital’s Mwana Mugimu Unit, says diabetes in children is often misdiagnosed and by the time it is discovered, the sugar levels are too high.
“We ask mothers to watch for symptoms of diabetes in their children and take them for check-ups twice a year,†Katunze says.
Dr Jessica Nsungwa, the principal medical officer child health in the Ministry of Health, says managing diabetes in children and adolescents is difficult because it is hard to restrict their diets. He warns mothers, whose babies weigh 4.5kg and above, to watch out for diabetes.
Last year, the General Assembly of the United Nations passed a resolution recognising diabetes as a debilitating disease. It designated November 14 the World Diabetes Day.
Recent studies in diabetes clinics in Uganda show that the disease is poorly controlled. This is partly due to the fact that the health system was previously designed to deal with acute infectious diseases with little provision for chronic conditions like diabetes.
Consequently, the system has been ill-equipped to deal with the increase in diabetes cases. Good news Bahendeka says Uganda is among the countries that will receive free insulin for children for the next 10 to 25 years through two projects — the Life of a Child programme and Changing Diabetes in Children programme.
St. Raphael of St. Francis Nsambya Hospital is setting up a comprehensive diabetes centre to act as a hub for training health workers, while Wakiso Health Centre IV will act as a model for training rural health workers in managing the disease.
“If well managed, diabetes is compatible with a full good quality of life, whether it affects a child or an adult. What is extremely important is that the family, the community and most important, the patient, understand how to manage the disease,†he says.
Symptoms
BAHENDEKA says the main symptoms are the same as in adults. However, they tend manifest over a few weeks. “Symptoms include abnormal thirst and dry mouth, frequent urination, extreme tiredness/lack of energy, constant hunger, sudden weight loss, slow wound healing, recurrent infections and blurred vision,†he explains.
“There are also symptoms that are more typical for children like complaints of tummy pains, headaches and behaviour problems. Doctors should consider
the possibility of diabetes in any child who has an otherwise unexplained history of illness or tummy pains for a few weeks,†he advises.
“And because Uganda is a malaria endemic country, initial symptoms may be mistaken for malaria. If not treated immediately, the child goes into coma and this can be as dramatic as one or two weeks. Always look out for sugar in urine, fruity odour on breath, laboured breathing, drowsiness and unconsciousness,†he says.