Diabetes also affects young children, teens

Nearly all childhood diabetes is DM1, a condition where the body produces insufficient insulin — Paediatrician

KUCHING: Diabetes, a disease common with adults and senior citizens, is also affecting young children and teenagers, said Normah Medical Specialist Centre (NMSC) consultant paediatrician Dr George Ting Hua Sen.He said nearly all childhood diabetes is Type 1 diabetes mellitus (DM1), which is a condition where the body produces insufficient insulin.

“DM1 is usually triggered after a viral infection (such as enteroviruses) in a genetically susceptible child. Their body makes antibodies to attack the virus which also attacks the insulin producing cells in the pancreas.

“This slowly destroys the cells over months and diminishes their insulin producing capacity. When enough cells are destroyed, the body no longer produces adequate insulin and the blood sugar level starts rising,” he said in a statement.

Because of this, he said, the rising sugar level eventually exceeds the reabsorbing ability of the kidneys and the sugar enters the urine.

“The high concentration of sugar in the urine draws more water away from the body into urine. This leads to dehydration. The child now goes into excessive drinking and excessive peeing phase, they may even wake up many times overnight  to  pee  and drink.

“Without insulin, the body cannot use  sugar and has  to  find  alternative fuel source for energy production. It now turns to fat and muscle and breaks them down for energy needs,” he said, adding the by-products of fat metabolism is called ketone bodies and are acidic.

Due to this condition, he said the child becomes acidotic and is tired all the time, triggering heavy and deep breathing as the body tries to get rid of the excess acid by blowing out more carbon dioxide.

He added the ketone bodies also pass into the urine and are detectable in urine tests.

“Protein breakdown occurs in muscles. Consequently, the child loses weight both from muscle loss and dehydration. This state of high sugar, dehydration, acidosis and alternative fuel usage is a medical emergency called Diabetic Ketoacidosis (DKA).

“If not treated urgently, the child will deteriorate rapidly and may even die. Sadly most children are only diagnosed with DM1 after DKA. The rest of DM1 cases are diagnosed by testing blood sugar level,” he said.

On the treatment for DM1, he said this can be done through insulin replacement, which is given via special insulin devices a few times a day into the fat layer beneath the skin.

He said there are many different synthetic insulin types available today, and they differ in speed of onset and duration of action.

The usual insulin therapy is a multiple dose regime tailored to individual needs.

“Two other important components of diabetic management is regular exercise and diet control. Exercise helps by reducing insulin requirement and reducing blood sugar.

“Diet management is important to ensure energy balance both for sugar control and for growth, it is dynamic and needs the guidance of a dietitian,” he said.

He added that DM1 is a lifelong condition and at present, there is no cure.

He stressed that educating caregivers (parents/guardian) to better understand this condition helps the affected child to achieve better control and lessen the chance of diabetic complications.

“DM1 children are most vulnerable in their teenage and pubertal years — their pubertal hormone changes make sugar control difficult.

“Many teenagers may become rebellious and choose to ignore or neglect their condition altogether, ending up with DKA and other complications,” he pointed out.

He also revealed there is yet to be any accurate data for diabetics below the age of 18, although the 2006 National Health and Morbidity Survey (NHMS III) stated that more than one out of 10 adults above 18 has diabetes.

“The number of diabetic sufferers has doubled over a 10-year period in direct proportion to an increase in obesity problems in the population,” he said.

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