Sunday November 18, 2007
Managing the big D
By LIM WEY WEN
This year, the theme for World Diabetes Day urges us to tackle the problem of diabetes in our young.
WHEN Penny, a nurse and mother of two boys knew that her youngest son had diabetes, she broke down in tears.
The signs were there. Riley was more thirsty than usual. But her first child had drunk a lot of water when he was in second grade, and when she checked his sugar, it was fine! Riley may have taken after his brother after all.
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Consultant endocrinologist Prof Chan Siew Pheng ... ‘For type 1 diabetes, some children will want to know how they should adjust their insulin according to their activities and their growth.’ |
It was emotionally difficult to accept the fact that Riley had diabetes, but Penny did one thing right, that is to take her child immediately to the doctor once she noticed changes in her child’s drinking patterns.
But isn’t diabetes only common in the middle age and old, the sedentary and the obese?
In fact, it isn’t. Diabetes can affect a person at any time from the moment he’s born until he reaches his elder years.
It is estimated that, worldwide, almost 200 children develop type 1 diabetes (insulin dependent) each day (World Diabetes Day 2007 booklet) and the global incidence of type 2 diabetes (non-insulin dependent) in children looks likely to increase by up to 50% over the next 15 years.
Not surprisingly, Malaysia has also shown similar statistics.
According to recent reports, statistics from the Health Ministry has shown a 56% increase in the admission of children (babies to 19 year-olds) into hospitals due to diabetes from 1999 to 2004.
About 50% of these children were diagnosed with type 2 diabetes, which is associated with obesity and lack of physical activity.
In light of the increasing prevalence, the International Diabetes Foundation (IDF) and World Health Organization (WHO) dedicated the World Diabetes Day this year to children and adolescents, with their theme Diabetes in Children and Adolescents.
Sugar isn’t the main culprit
Diabetes is not exactly due to excess of sugar in our diets! Boy, are we fooled.
It is actually due to obesity (excess of calorie intake), lack of physical activity, and unfortunately, your genes.
Type 1 and type 2 diabetes have strong genetic links, but environmental factors play a big part in bringing forward this disease earlier in a person, said senior consultant endocrinologist Prof Chan Siew Pheng.
“In the old days, when food was scarce, everyone was generally thinner and physically fit as a result of walking around; we didn’t see diabetes in them until they were in their 50s or 60s.”
Now, the younger generation has less physical activity and is gaining more weight on top of having genes that predispose them to diabetes.
“That’s the reason why we are seeing many patients who are young having adult-onset diabetes (type 2 diabetes), which is quite sad,” she lamented.
Type 1 or 2
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According to dietitian Teng Yu Yuet, in children, dietary control of diabetes must be balanced with calories, vitamins and minerals that are essential for their growth. |
People with diabetes have high levels of glucose in their bloodstream, but they could not bring it into their cells where it will be utilised to produce energy or stored as glycogen.
The reason they could not do this is generally because they do not produce enough insulin (type 1 diabetes), or their cells are resistant to the effects of insulin (type 2 diabetes).
Type 1 diabetes (insulin dependent diabetes mellitus) occurs when insulin-producing beta cells in the pancreas are damaged; usually by processes triggered by viruses or our immune system, resulting in the decreased or absence of insulin production.
As this kind of diabetes is often diagnosed in children and adolescents, it also called juvenile-onset diabetes within the medical fraternity.
Type 2 diabetes (non-insulin dependent diabetes mellitus) is the more common type of diabetes. As it commonly affects the middle age and the elderly, it is often called adult-onset diabetes.
It was only in the past couple of decades that type 2 diabetes began to be detected in increasing numbers of younger people, said dietitian, Teng Yu Yuet.
Sweet sirens
Warning signs of diabetes in children differ between type 1 diabetes and type 2 diabetes.
“You can’t miss type 1 diabetes,” said Prof Chan, who went on to explain that in this kind of diabetes, the onset is quick and sudden. Patients usually present with noticeable symptoms between weeks or a few months after the onset of the disease.
This differs from type 2 diabetes, where people having it relatively have no symptoms, feels quite well, and most of the time do not understand why doctors are so upset about good sugar control, Prof Chan quipped. Probably more so when children and adolescents are less articulate about what is happening in their body.
However, it is not too difficult to spot the changes when you look carefully.
The common symptoms during the onset of diabetes (both type 1 and type 2) are: frequent urination, excessive thirst, increased hunger, tiredness and blurry vision.
More serious symptoms include lack of concentration, vomiting and stomach pain (often mistaken as the flu).
So if your child’s teacher has been complaining that your child takes too many toilet breaks, or he wets his bed or drinks more water than he normally does without any change in his activity, it is not too much trouble to drive to the nearest pharmacy for a quick glucose test.
Normal blood glucose levels are between 3.8 mmol/L and 6.1 mmol/L when a person is fasting and should not exceed 7.8 mmol/L two hours after your meal.
With glucose levels, it is not a matter of the lower, the better. If blood glucose gets too low, hypoglycaemia (low blood glucose) can also cause problems such as dizziness, mental confusion and even coma.
Diabetic ketoacidosis
One of the key messages in this year’s World Diabetes Day is that “no child should die of diabetes”.
Diabetic ketoacidosis (DKA) is one of the complications of diabetes that can be fatal.
“DKA occurs spontaneously due to the lack of insulin,” Prof Chan said. When the body lacks insulin, organs and tissues could not take up glucose for energy. Thus, the body turns to another source of energy: our fat stores.
Breaking down fats produces acidic waste products called ketones, which will make our body more acidic and affect the functions of our body.
“If the patient is not given proper management in time, they may die due to the complication.”
Most of the time, only those with type 1 diabetes present with diabetic ketoacidosis (DKA) if warning signs go unheeded. However, it can also happen in severe and uncontrolled diabetes.
“Patients with DKA have very high levels of sugar, and their body becomes acidic. On top of that, they become dehydrated,” Prof Chan explained.
Symptoms to look out for in DKA are rapid breathing, increased heart rate, fruity smelling breath, vomiting and tiredness.
Managing the big D
“Diabetes is like being expected to play the piano with one hand while juggling items with another hand, all the while balancing with deftness and dexterity on a tightrope,” Marlene Less was quoted as saying in 1983.
Marlene’s quote can be found in any blog belonging to diabetes patients worldwide because it describes precisely the dilemma of any person having to deal with diabetes.
Keeping one’s glucose levels from skyrocketing or plummeting is just like walking on a tightrope: it is not as easy, and not as predictable as one may think.
Now, imagine a child, or even a 17-year-old doing that, all the while juggling with school, peer pressure, and the process of growing up. It is certainly not an easy feat.
The good news is, with proper control, people with diabetes can lead a normal life and delay the complications that come with the disease.
“Managing diabetes in a teenager involves more flexibility when we take them through their teenage rebellion years,” said Prof Chan with a knowing smile.
“We may relax the reins a little, but later on when they become adults, we hope that they will be able to understand what are the implications of poor control, and subsequently get them back on track again.”
Living with the diabetes often involves life-changing decisions on lifestyle and diet.
Children and adolescents with type 1 diabetes need insulin to help control their blood glucose levels while those with type 2 diabetes can try lifestyle measures before medications are employed.
“For type 1 diabetes, some children will want to know how they should adjust their insulin according to their activities and their growth,” Prof Chan said.
“Once they have more understanding (of their disease), we will teach them how to adjust to their needs,” she added.
Children and adolescents with type 1 diabetes can learn how to monitor themselves and determine how their activities will affect their sugar level.
Eventually, the patients will become better at controlling themselves because they know what each activity can do to their sugar level.
At the end of the day, doctors who manage diabetic patients will want their patients to be independent and able to take care of their health needs.
“We want the patient to be in the driver’s seat. We do not want to be the one calling the shots all the time,” Prof Chan concluded.
In this process, Prof Chan normally advises parents and the child affected with the disease to take measures so that people around them would be able to help them if needed.
First, they have to make sure that there is always some food with the child in case his/her sugar levels run low.
Second is to inform a few people about the child’s condition, especially those in charge of the child so that they will know how to respond if there is a need.
Last but not least, the child is also advised to tell some of his or her close friends about the condition and inform them about what they can do to help him in times of crisis.
“For type 2 diabetes, the child is normally encouraged to be as active as possible, because we know that activity actually improves insulin action,” Prof Chan elaborated.
Of course, an important part of diabetes management is regular glucose monitoring and dietary control. In children, this diet must be balanced with calories, vitamins and minerals that are essential for their growth, Teng said.
That is why parents who have children with diabetes should work closely with their endocrinologist and dietitian to determine the dietary needs of their children.
Sounds like an uphill battle? Not if you learn how to live with the disease.
“When patients get past the disappointment of having the disease, they can learn survival skills (to avoid the highs and lows of blood glucose levels) and lead successful lives,” said Prof Chan.
Reference:
1. The World Diabetes Day 2007 booklet, http://www.worlddiabetesday.org/assets/documents/0000/0092/WDD_booklet_EN.PDF
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