‘Babies can have diabetes ’

In marking the World Diabetes Day, Dr Adetokunbo Jarrett, the Secretary-General, Society for Paediatrics and Adolescent Endocrinologists in Nigeria, warns in an interview by SADE OGUNTOLA, that children also fall prey to this disease that many assume only affects adults. (Type 1 Diabetes)

 

What is the incidence of diabetes in children?

We have a lot of cases of diabetes in children, and the commonest is type 1 diabetes. This is a type of diabetes in which the body is not producing insulin.

By the time, a child comes down with symptoms of diabetes; they would have lost at least 90 per cent of the beta cells of the pancreas where insulin is produced. Type 1 diabetes is an autoimmune disease in which the body is fighting itself due to so many factors.

However, type 2 diabetes that is mostly found in adults occurs when insulin is not enough or the body is not sensitive to the insulin that is produced.

In Nigeria, we do not have exact incidence of type 1 diabetes. But we do have about 400 children in our diabetes register. The data is from centres where you have paediatric endocrinologist. There is dearth of data because we have only 30 paediatric endocrinologists in Nigeria.

In Ghana, there are over 500 children with type 1 diabetes. Sudan and South Africa also have over 1,000 children with the condition. However, we know that the number of children with diabetes is increasing.

 

What causes type 1 diabetes?

It is multi-factorial; some children are genetically predisposed. Children born to families with history of diabetes stand a higher risk of developing the disease because of their genetic makeup. Some environmental factors, including viral infections, specific antigens in some food items like milk, and exposure to endocrine destructive agents can also predispose to Type 1 diabetes.

Cow milk, for instance, had been implicated because it contains a protein which bears similarity with some cells in the body that could trigger an autoimmune reaction. However, no particular food item or thing can be said to cause type 1 diabetes.

Also, children with some medical conditions like asthma, infections involving the pancreas, and congenital abnormalities such as Down Syndrome stand a higher risk of developing type 1 diabetes.

 

Can bad or junk diet predispose a child to type 1 diabetes?

Generally, a balanced diet will not predispose to diabetes. But it is established that bad or junk diet will lead to obesity. Of course, obesity can lead to so many other things, including type 2 diabetes in children.

However, we are recording increasing cases of childhood obesity even inNigeria. We have children that are merely six years old that are obese. In fact, my colleagues in Lagos now take care of obesed children with type 2 diabetes.

The more the fat accumulates, the lesser sensitive or responsive the body to insulin and as such, the individual may end up developing diabetes.

 

What are the common symptoms of type 1 diabetes in children?

A child with diabetes will increasingly become weak, less active, and may start eating excessively. Such may also be thirsty always and so end up rinking lots of water.

A mother of a one-and-half-year-old patient said he could finish the food of five adults. Even after eating everything, he is still complaining of hunger.

Also, some that were dry before may just start to bed wet. They pass lot of urine due to the accumulation of sugar in their blood stream and which needs to be washed away. Insulin is the key that opens the cells of the body so that glucose can get in.

In spite of eating a lot, the patient keeps losing weight because the body is breaking down the cells to provide the energy.  That is why they become increasingly tired, overeat, overdrink and go to the toilet often.

Unfortunately, if nothing is done, the child moves to the next stage.  He or she becomes dehydrated and ketone, a toxic, accumulates in the body.  So, such children  may end up being unconscious.

If you do not have a high index of suspicion, when the such a patient comes into the hospital unconscious, you will think it is a case of meningitis or malaria.  Unfortunately, many times, blood sugar of many patients are not checked on arrival at the hospital.

Basically, doctors and nurses ought to check the blood sugar of a sick child that is brought into the hospital alongside other basic checks like blood pressure and temperature. If you see a lot of glucose in the urine, then you can think of diabetes.

 

Can we say therefore that incontinence in a child that was formerly dry could be a red flag for diabetes?

Yes. also, weakness in a child that was very active before or sudden loss of weight for no just reason can also raise a suspicion of diabetes.

For instance, there should be a suspicion of a problem if, for instance, an adolescent that was very chubby, all of a sudden, starts to lose weight, without dieting.

Teachers also can play a role in helping to detect children that may have this challenge early. That is why we also go to schools to talk about diabetes.

 

Common myths and misconceptions on diabetes in children

One, is the fact that children cannot have diabetes, this is not true. Children do come down with diabetes; even some babies are born with diabetes. This is called neonatal diabetes. It is purely genetics and about 50 per cent of these cases in newborns progress to full blown diabetes.

Second, it is also a misconception that type 1 diabetes can be treated with oral drugs. The only thing that works is insulin injections. And the patient is taught how to give the injection. The oral drugs are for type 2 diabetes.

Third, some say that diabetes is contagious. Diabetes is not like HIV. It is not a disease that spreads from one person to another through contact or sexual intercourse.

 

Is type 1 diabetes preventable?

You cannot prevent it. One can only prolong its preclinical state.  In the past, they had tried many things to ensure this like immunotherapy, but none had succeeded.

The idea is that if you have a family member with type  diabetes, you can screen the siblings and commence them on things to prolong the lives of the beta cells in their pancreas. This does not prevent type 1 diabetes, it only delays its onset.

But there are new advancements in diabetes management. We now have artificial pancreas, insulin pumps and so on, to further help in the control of blood sugar.

 

Challenges faced in type 1 diabetes treatment

A major constraint is funding for research on non communicable diseases, including diabetes, even though NCDs kill more people than diseases like malaria, HIV and Tuberculosis that are presently receiving attention.

A lot of people are coming down with diabetes more than we know. Type 1 diabetes will manifest immediately and within one month, you will see the symptoms. Children are dying every day from type 1 diabetes and we have testimonies of these.

 

Access to free insulin

International Federation of Diabetes (IDF) has been supporting by giving free insulin. But they stopped at a particular time because they were asked to pay heavy duty on it.

Now, they are resuming with much plea. We made efforts to get a waiver from the government for this insulin to cover 600 children. This is yet to come, but we are hopeful. Meanwhile, the association had devised pledge cards to get people to support this.