DIABETES in children most commonly presents between ages five and seven years, and at puberty. It is a chronic illness that occurs when the body does not utilise glucose normally. The amount of glucose in the body is controlled by different hormones; insulin is the one involved in diabetes.

There are two types of diabetes: Type 1, which is most commonly seen in children and is due to the body not producing enough insulin to control sugar levels; and Type 2, which is most commonly seen in adults, but can be seen in adolescents, and occurs when the body does not respond to insulin.

Warning signs

Signs of diabetes include weight loss, generalised weakness, increased thirst, increased hunger, increase in the amount of urine passed, and bed-wetting in a previously toilet-trained child. In severe cases, vomiting, dehydration, fast breathing, and unresponsiveness occur. Adolescent girls can also present with yeast infections.

Managing your child’s diabetes

Several people, including the doctor, dietician, diabetic educator, psychologist or counsellor, and social worker, are involved in the management of the patient with diabetes. However, the most important people in the process are the parent and child.

It is vital that parents and children understand this illness so complications can be avoided. Once diagnosed with Type1 diabetes, insulin injections will start. Insulin is stored in the fridge and administered as prescribed by your doctor. It can be injected at different sites, such as the shoulder, thighs and abdomen. It is important that the sites are rotated during each administration to prevent damage to the skin.

Glucose monitoring with a glucometer before meals is also done, as this will give an idea of control.

Low sugar levels

Although we aim to decrease glucose levels, we also need to monitor for extremely low levels. Symptoms of low sugar levels include excessive sweating, anxiousness, hunger, fatigue, headaches, dizziness, confusion, seizures, and loss of consciousness. Seek medical attention if this occurs.

Nutrition

The doctor will make adjustments to insulin based on the child’s activity level, if they have an illness or infection, and diet intake. Nutritional requirements of the child are based on age, sex, weight, level of activity, and food preferences. With the help of the dietician, children and their families will learn the appropriate calories, and the appropriate food and quantifying sugar content in foods that they eat. If you are involved in preparing meals for diabetic children, consult a dietician for relevant advice.

Adolescents diagnosed with Type 2 diabetes will be treated initially with diet adjustment and exercise. If glucose levels are not controlled on this method then medication would be added.

Coping with diabetes

Children might have difficulty coping with this illness which has no cure. They might be teased at school, have adjustment issues and can develop depression. Coping strategies are very important because without them diabetes will be poorly controlled. Children and their families might need counselling in these circumstances.

Some of the long-term complications of diabetes include damage to the eyes leading to blindness, kidney failure, nerve damage, growth impairment and can affect intellectual functioning. Compliance from the child and family is vital to avoid these complications.

Diabetes education is an ongoing process between the child, family and members of the team managing the illness. Every opportunity to learn, such as medical visits, meeting other diabetic children and their families, and diabetic camps, will be beneficial for the child.

Dr Michelle Williams is a paediatrician at Kidz Klinik. She may be contacted at dr.michelle.williams2014@ gmail.com