Children and Diabetes

Dr Hanan Al Hassan,

Diabetes is a widely prevalent disease locally and internationally. Its symptoms are not fatal, but can lead to fatal complications and even death. Dr Hanan Al Hassan, Paediatric Diabetes Consultant at Mubarak Hospital highlighted that diabetes is a chronic disease caused by high blood glucose levels, due to the lack of insulin secretion, the body’s resistance to insulin, or both. Diabetes can fall under four categories: Type I, Type II, Gestational Diabetes and other types.

Type I diabetes is the most common among children and teenagers; it represents 90% of the cases. Overall around 80000 children are estimated to develop type 1 diabetes worldwide. According to statistics from 2013, Kuwait has one of the highest incidences of type I diabetes with an annual incidence of 41 cases per hundred thousand children between the ages of 0 to 14 years. Since 1999, the incidence rate recorded of children with diabetes was doubled.

There are no current statistics that show the percentages of Type II diabetes among children, but it is likely the numbers are increasing, due to the high prevalence of obesity, change in eating habits, and lifestyle, particularly with children spending more time using electronics and smart devices rather than being active. The average age of Type II diabetes diagnosis in youth is around 13.5 years and is more prevalent among females than males. Other types of diabetes, such as MODY, are rare, and the incidence rate does not exceed 1 to 2%.

Causes of diabetes among children
Type I diabetes is caused by chronic autoimmune destruction of beta cells, the ethology is multifactorial and the exact cause of type 1 remain unknown. In a genetic susceptible individual who have HLA genes DR3-DQ2/DR4 -DQ8, some certain environmental triggers such as viral infections, rapid weaning off breast milk, the intake of bovine milk, early ingestion of gluten, vitamin D deficiency and exposure to toxins, such as nitrosamine, may induce an autoimmune process leading to beta cell destruction of the pancreas However the exact role of these factors in the pathogenesis of diabetes is not known.
Type II diabetes is a chronic disease resulting from resistant of the body’s cells to the effect of insulin and insufficient insulin secretion, leading to relative insulin deficiency. Type II diabetes can be a result of the following:

• Genetics play a major role in developing type II diabetes; 90% of the cases had diabetes in the family history, while in type I, only 10% have positive family history.

• Obesity also plays a key role in the increased risk of developing type II diabetes, in addition to an inactive lifestyle and frequent consumption of fast food.

Other types of diabetes, such as MODY and neonatal diabetes are rare, and the incidence rate does not exceed 1%. Genetics play a major role in the ethology, and these are caused by a defect in the gene responsible for the action of beta cells that secrete insulin. Some of these cases are not treated with insulin injections but through pills that stimulate insulin secretion. These cases of MODY or monogenic diabetes are diagnosed through genetic testing in genetics laboratories.

Symptoms of diabetes in children
Type I: Symptoms may appear within weeks or months, and involve frequent and excessive urination (polyurea) or nocturnal enuresis, excess water drinking, (polydipsia) weight loss with increased hunger, skin, vaginal and urinary tract infections. It could also present as acute cases, such as Diabetic Ketoacidosis, which leads to vomiting, severe abdominal pain, severe dehydration, weight loss, acetone detected in breath, rapid breathing, and affected sensorium or shock. In some cases these symptoms are unfortunately misdiagnosed as UTI or pneumonia or acute abdomen , or GE which leads to delayed diagnosis, especially in children under the age of five.
In Type II: the presentation can vary from a symptomatic diabetes detected during a clinical screening, or the patient exhibits symptoms similar to the symptoms of type I diabetes mentioned earlier.

According to the American Diabetes Association’s (ADA) criteria, the diagnosis of diabetes in children is done by measuring the child’s glucose levels. Diabetes is diagnosed when the fasting blood glucose level is more than 7 mmol / L or exceeds 11.1 mmol / l after two hours of OGTT or HBA1c is more than 6.5%, or in the presence of symptoms when the blood glucose level reaches 11.1 mm / l. In the absence of symptoms, diabetes must be confirmed by re-examination in the laboratory again. After confirmation of the diagnosis, the doctor will review the tests and examine the patient periodically to decide the type of diabetes the patient has.

Treatment methods
Treating children with diabetes is key to their growth and development, and to prevent acute or chronic complications. In the case of type I diabetes, associated autoimmune diseases, such as the hypothyroid or celiac disease will need to be treated, while in the case of type II diabetes, other associated diseases, such as high blood pressure and, dyslipidaemia, obesity will need to be managed properly. Most importantly, treating the disease will allow children to live normally while leading a healthy lifestyle to manage blood glucose levels.

The first step and the corner stone in the treatment of diabetes consists of educating the child and the family about living with diabetes and managing it in cases of hypoglycaemia or hyperglycaemia, or during exercise. Also, introducing the concept of diabetes related complications, and the importance of measuring glucose levels regularly at home. Patients and families are also informed about the function of the insulin hormone, how it works and its different types, how to administer an insulin injection, as well as the importance of organizing sleep and eating times in order keep the glucose levels in the blood under control.

Furthermore, children with type II diabetes are informed about the importance of having a healthy lifestyle, as well as the importance of weight loss through follow-ups with a nutritionist, exercise and adherence to the treatment. Insulin injections are the only treatment available for type I diabetes. The treatment of type II consists sometimes in injecting insulin in children or giving them the metformin tablets as well as treating the cases associated with high blood pressure, and increased fat and obesity. The treatment must also take into account the psychological state of the child and children living with diabetes should be treated like their peers.

By Dr Hanan Al Hassan, Children Diabetes Consultant

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