Down the bumpy road with a diabetic toddler

May 22, 2011

AT the mention of diabetes, thoughts of your ageing relatives may come to mind, but children too develop diabetes. <br>Diabetes mellitus is a chronic disease caused by lack of, or impaired function of the insulin hormone, leading to impaired utilisation of carbohydrates and increased utilisation of

By Vicky Wandawa
AT the mention of diabetes, thoughts of your ageing relatives may come to mind, but children too develop diabetes.
Diabetes mellitus is a chronic disease caused by lack of, or impaired function of the insulin hormone, leading to impaired utilisation of carbohydrates and increased utilisation of fats and proteins for energy.

Leonard Tutaryebwa, a paediatrician at Seven Hills Hospital in Ntinda, says: “Diabetes is classified as either Type 1 diabetes mellitus or Type 2 diabetes mellitus,” he notes.

How glucose is absorbed
After a meal, the body breaks down food into glucose and other nutrients. When the glucose level in the body rises, the pancreas releases insulin into the bloodstream.

However, in cases of diabetes, the body fails to respond to the insulin or does not release any at all. Yet without insulin, the glucose cannot be absorbed into the cells, thus staying in the blood stream, making the sugar levels in the blood higher than normal and offsetting health problems.

Type 1 diabetes
This type, which is also mostly diagnosed in children, is where the body is not able to produce insulin at all.
According to James Sekajugo, the health ministry’s principal medical officer for non-communicable diseases, more children in Uganda are being diagnosed with type one diabetes.

Type 1 is caused by insufficient production of insulin, usually due to an immune attack against one’s own insulin-producing beta cells in the pancreas. “This has been linked to genetic factors and in some cases viral infections.”

Type 2 diabetes
This type is more common in adults. This is where the pancreas is capable of releasing insulin, but the body is not able to process the insulin and convert it into energy. The condition can be inherited, but is also caused by obesity and inherited disorders of insulin release, among others.

According to Sekajugo, Type 1 is more common in children than Type 2 because the latter is commonly associated to obesity. Type 2 used to be uncommon in children, but is now on the increase due to a growing number of obese children. Most children with Type 2 are those in puberty, as they are more likely to be obese.

Diagnosis
Diabetes in children can be diagnosed at any age, but most commonly between four and six years and during adolescence.

How do you tell that your child might be diabetic?
Tutaryebwa says excessive thirst, increased appetite not followed by weight gain, excessive urination and blurred vision in some cases, may point to diabetes.

“This also includes recurrence of bed-wetting in a child who had stopped wetting the bed and also increased urination at night.”

Furthermore, others may get a life-threatening complication called diabetic ketoacidosis in which they develop a sweet-smell in their breath, altered consciousness, deep and slow breathing, severe dehydration, abdominal pain and fever.

Tutaryebwa says with Type 1 diabetes, there is more rapid development of these symptoms. Nonetheless, there are those that do not show any symptoms.

However, Sekajugo adds that many of the children suffering from diabetes are dying because the symptoms are vague. They are more like those of malaria.

Who is prone?
Tutaryebwa says children with family members that have inheritable forms of diabetes mellitus are more likely to develop diabetes.

Obese adolescents, children with Down Syndrome and those who have suffered severe malnutrition early in life, also risk developing the condition.
As soon as a child is diagnosed with diabetes, they need to start treatment right away, and will need insulin injections for life. The doses are tailored to each patient, and vary with the level of control of blood sugar and type of insulin used.

Tutaryebwa says the medication needs to be adjusted in times of stress, illness, or when insulin causes dose-related side effects.

Children with Type 2 may need to use oral drugs and insulin. Early detection based on detecting suspicious symptoms also helps prevent complications and death.

Prevention
Type 1 is difficult to prevent since the cause may be a result of unavoidable conditions. Upon diagnosis, blood sugar is controlled with insulin injections and diet modification.

“Although most children will need to have injections of insulin and frequent blood sugar checks, the other aspects of their life can be as normal as those of non-diabetic children if blood sugar is controlled.

More children diagnosed
According to Sekajugo, more children in Uganda are being diagnosed with Type 1 diabetes. This is basically because there is now more capability of health centres to detect the condition in children.

However, the statistics of children with the condition are scanty because of poor public awareness about diabetes in children.

Unfortunately, many of these children are dying because the symptoms are similar to those of malaria. “Health workers keep treating malaria using chloroqine as the child’s blood sugar is going down, before long they are in coma and die,” Sekajugo adds.

Furthermore, health centres do not have sufficient numbers of adequately trained health workers to diagnose diabetes in children.

What is more, even if these health workers suspected a child of having developed diabetes, there is insufficient equipment to make the diagnosis, and insufficient supply of insulin for treatment.

Way forward
The health sector strategic plan of 2011 to 2016 includes plans to establish a specialised care unit for children with diabetes. However, because of the enormous expenses, the Government has solicited support to strengthen its initiatives towards addressing the burden of Type 1 diabetes, especially children.

On March 3, 2011, the health ministry and a firm known as Novo Nordisk signed a memorandum of understanding under The Changing Diabetes in Children programme.

Novo Nordisk is implementing a five-year initiative to address the burden of Type 1 diabetes in children in developing countries, including Uganda.

Plans are also underway to improve infrastructure and supply medical and laboratory equipment and train healthcare professional in Type 1 diabetes, provide insulin and blood glucose monitoring equipment as well as free supplies.

According to Dr. Edirisa Mutebi, the head of the endocrinology and metabolic unit at Mulago Hospital, the hospital has a clinic for diabetic patients that runs every Wednesday. Within it is a separate clinic for children.

However, there is need for more specialist paediatricians for diabetes. Currently, the unit has about 200 registered child patients.

Basic treatment for a child with diabetes is about sh100,000 a month and in case of complications, such as cardiac problems like hypertension, the costs are much more.

Head teachers who were contacted about how they handle diabetic children said they had not registered any.

Howto handle a diabetic child
Even with treatment, the child’s lifestyle should be altered to suit their diabetic condition. The diet should be balanced and every type of food eaten in moderation.

Regular follow-up by clinicians and dieticians is important.

Adopt a low sugar and fat-free diet and take more legumes, vegetables and cereals. Whole fruit and fresh fruit juice have less sugar than processed juices.

Increase physical activity. Increased duration of exclusive breastfeeding also helps prevent obesity.

Caretakers should get as much information about the disease and explain to the affected child.

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