Children develop diabetes because of genetic, environmental factors

In this report by SADE OGUNTOLA, an expert in diabetes in children, Dr Oluwakemi Ashubu, who treats diabetes in children explains why this is the case and how mothers can help their children cope and live successfully with the condition.

THAT children can be diabetes. How true is it?

It is true. People at any age can be diagnosed with diabetes, just that the type of diabetes can vary with age. The commonest in children is Type 1 Diabetes, diagnosed between the ages of four to six years or during puberty, between the ages of 10 and 14 years. Genetics or environmental factors, like exposure to viruses that trigger this autoimmune response, could be responsible.

Part of the environmental factors include stressors that occur around the time of puberty, illnesses and some infections. Insulin helps glucose enter into cells to help provide energy to carry out various activities. Without insulin, glucose builds up in the bloodstream and the cells in the body do not get access to it. Signs and symptoms of diabetes are seen when about 90 per cent of  islet cells in the pancreas are destroyed.

 

What is the incidence of diabetes in children?

Worldwide incidence per year, as of 2019, in age 0-14 years was 98.2 per 1000 children; ages 0 to 19 years was 129 per 1000 children. So, the incidence increases with increasing age. The data in Africa is scanty but incidence per year in ages 0 to 14 years was four per 1000 children, in ages 0 to 19 years, was 10 per 1000 children. Incidences documented in Nigeria have ranged from 8 to 11 cases per 1000 children. This figure is, however, not unified in Nigeria.

 

What are the common symptoms of undiagnosed diabetes in children?

Sometimes, the diagnosis is delayed in babies and young children because symptoms are similar to those of other illnesses. Symptoms include increased thirst, drinking a lot of water, weight loss despite increased eating, increased passage of urine during the day and may extend to nighttime. There may be bedwetting in a child who has been previously toilet-trained. There could be tiredness and fatigue, reduced activity in the child with dwindling school performance. This may actually draw the attention of the parents to the child if they are yet to notice other problems.

 

How early is the onset of diabetes in children that you see at the clinic? Are there children born with diabetes?

Diabetes is a chronic condition that can occur at any age, even in the first year of a child’s life. There are two peak ages of occurrence — ages 4 to 6 years and ages 10 to14 years. Those I have seen commonly in my practice fall into the second age group. This is the time children enter puberty, which is a stressful event. Also, the hormones that are involved in this process promote increased levels of sugar in the blood. Children with genetic predisposition can then go on to develop diabetes.

 

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What do parents need to know about diabetes in children?

Children do not have food restrictions. Since they are growing, we counsel on the quality and quantity of food ensuring the child has a balanced diet, drinks water and exercises daily. They are not prevented from attending parties as this could affect them psychologically, hence we advise on what to eat and how to take their medication, which is insulin to ensure stable blood sugar.

Exercise is important as it helps burn excess glucose in the blood. Thirty minutes of exercise every day will help the insulin to work better in the child. It should not be a strenuous exercise and they should check their blood sugar before and after the exercise. When a child is sick, the management is different as the child may require more monitoring. Such should visit the doctor for appropriate care and counselling.

Parents need to inform at least the school teacher that their child is diabetic. Some parents and even some of the children think that by doing so, they could be treated as outcasts. This may make them miss the timing for their drugs and may have complications that no one understands and help may be too late when they get it.

 

Myths about diabetes.

Diabetes comes from eating too much sugar. This is not true. Type 1 Diabetes, which is common in children, is a result of the body’s immune system destroying its own tissues, and the islet cells of the pancreas which produces insulin is a victim.

Diabetes can be reversed with diet and exercise. While diet and exercise play an important role in how some people manage their type 1 diabetes, there is currently no cure for the condition.

People with Type 1 Diabetes must rely on insulin injection for life.

Kids can grow out of Type 1 diabetes: Diabetes is a lifelong condition, and people of any age can be diagnosed with it.

Children with diabetes cannot have sugar With the right amount of planning, medication, and attention to the amount of carbohydrates they eat, children with diabetes can enjoy all the same foods that children without diabetes can.

Insulin is a cure for diabetes: Insulin is a necessary and life-saving treatment for those with Type 1 Diabetes, but it is not a cure.

Eating bitter things keeps the blood sugar low: A patient once stopped coming to the clinic because she was advised by neighbours to start eating bitter leaf to keep the blood sugar low. However, this only made the situation worse as the blood sugar kept rising.

Diabetes is contagious: It may or may not run in families, but you cannot spread diabetes like you can spread a cold virus.

 

Insulin comes as injectable. Will a child be taught to self-inject?

When they are diagnosed at a younger age, the parents or caregiver may be the one helping with giving, but when they are of age, and they are able to, they can start by checking their blood sugars first, then graduate to self-inject themselves with insulin. Sometimes, a parent may forget, be out of town, and come back late; this does not mean the medication has to be dependent on them which is why with time they are taught to do the blood glucose checks and take insulin.