Children are not spared from diabetes

By Henrylito D. Tacio

IF you think diabetes happens only among adults, think again. When he was still in kindergarten, Michael used to drink softdrink for breakfast. During lunch time, he ate his favorite pork “adobo” with four plates of rice and gulped orange juice loaded with sugar. “I gorged myself with so much food but I never felt full,” he recalled.

Michael’s parents never took notice of his eating behavior. His weight steadily climbed. By the time he turned 10, Michael weighed 90 kilograms. He was overweight for his age. In the Philippines, 1.8 percent of boys and 0.8 percent of girls between the ages of six and ten are obese.

At one time, when Michael got sick, he was brought to the hospital. His parents were surprised to know that their son was suffering from a debilitating disease called diabetes. “But he is too young to have such kind of disease,” the mother insisted.

“Diabetes is one of the most common chronic diseases of childhood,” reports the Brussels-based International Diabetes Foundation (IDF). “It can strike children of any age, including infants and toddlers. Yet diabetes in children is often diagnosed late, when the child has very high, potentially life-threatening, blood glucose levels. Sometimes, it can be mistaken for something else, such as the flu.”

Currently, there are almost 250 million people with diabetes worldwide. “Within 20 years, this number is expected to grow to 380 million,” IDF predicts. “Diabetes is certain to be one of the most challenging health problems in the twenty-first century,” comments Dr Daniel J. McCarty of the International Diabetes Institute based in Melbourne, Australia.

Unknown to many, diabetes is not a single disease. In his book, ‘The Best Treatment,’ Dr. Isadore Rosenfeld, explains: “Although all diabetes have abnormally high blood sugar, the mechanisms responsible for it are not necessarily one and the same. For example, diabetes appearing in childhood or adolescence requires insulin, is often difficult to regulate, and has a significant impact on the quality and duration of life. By contrast, the adult-onset type usually does not need insulin, sugar levels are generally stable, and the risk to life is much smaller.”

The pancreas, which lies deep in the belly behind the stomach, virtually on your backbone, makes the insulin, which regulates sugar metabolism. In insulin-dependent diabetes mellitus (or type 1 diabetes), which affects mostly children, there is very little insulin around because the special cells that produce it within the pancreas have been destroyed by the body.

The most common form is the non-insulin-dependent diabetes mellitus (type 2 diabetes). Also referred as the “adult-onset diabetes” (it usually develops after age 30), it involves insulin resistance. A person may be making insulin, but his body is not using it properly. This type comes on gradually, making it difficult to detect.

A third type of diabetes develops during some cases of pregnancy. Other rarer types of diabetes also exist. Some children diagnosed with diabetes may have elements of both type 1 and type 2 diabetes. This phenomenon is often referred to as ‘hybrid’, ‘mixed’ or ‘double’ diabetes.
Maturity-onset diabetes of the Young (or MODY) is a rare form of diabetes in children that is caused by a single gene that results in the faulty secretion of insulin. This form of diabetes is thought to account for up to 5% of all cases of diabetes in children. It often goes unrecognized.

There are five common symptoms of diabetes: increased urination, increased thirst, increased appetite, weight loss, and fatigue. Among adults, people with diabetes experience blurred vision, frequent skin and vaginal infections, and poor healing of wounds.

“Type 1 diabetes is growing by 3 percent per year in children and adolescents, and at an alarming 5 percent per year among preschool children,” IDF discloses. Around the world, 70,000 children under 15 develop type 1 diabetes each year or almost 200 children a day.

Untreated or poorly controlled type 1 diabetes results in diabetic ketoacidosis (DKA). This life-threatening consequence occurs because there is low or no insulin available in the body to help the organs and tissues take up glucose for energy. “DKA is the leading cause of death and disability in children with type 1 diabetes around the world,” IDF informs. “If left untreated, it has a 100% death rate.” (Between 60 to 90 percent of all DKA-related deaths are a consequence of cerebral oedema, or swelling of the brain.)

On the other hand, the global incidence of type 2 diabetes in children “looks likely” to increase by up to 50 percent over the next 15 years, according to IDF. This type of diabetes was originally considered a problem exclusive to adults, particularly those older than 40.

However, as more and more children are becoming overweight and inactive, type 2 diabetes is increasingly being diagnosed in young adults and children. The rapid rise of type 2 diabetes is believed to be partly a result of dietary changes.

“Across the globe, more people are consuming high-fat foods that are heavily processed and low in fiber,” IDF notes. “Increasingly, families are eating food prepared outside the home. The majority of children (some 85 percent) with type 2 diabetes are overweight or obese at the time of diagnosis.

It is estimated that one in ten of the world’s children are overweight. This includes 30 to 45 million children and adolescents who are obese and 22 million children under the age of five. All of these children are at increased risk of diabetes.

According to IDF, type 2 diabetes usually develops slowly in children. “It is frequently reported around puberty, when insulin sensitivity may be reduced by as much as 30 percent because of changes in the body,” it explains.

Symptoms for type 2 diabetes are frequently similar to those for type 1 but are often less apparent. Some children and adolescents with type 2 diabetes may show no symptoms at all. This can result in delayed diagnosis, which can have serious consequences.

“Children with diabetes are at high risk of developing complications at a young age,” IDF warns. Despite modern treatment, over 50 percent of children with diabetes develop complications 12 years after diagnosis. Intensive diabetes therapy can control diabetes and allow children to live full and healthy lives. However, it can also result in an increased incidence of low blood sugar levels, which when frequent, may slow down brain development and function in young children.

“At the time of diagnosis, it is not uncommon for young people to have developed multiple risk factors for early cardiovascular disease, including high blood pressure and abnormal blood fat,” IDF points out. — ###

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