Dealing with type 1 diabetes in children


  • Children
  • Thursday, 06 Aug 2020

A diabetic child’s blood sugar levels need to be constantly monitored to ensure that it remains within the target range. — Positive Parenting

The mention of diabetes usually refers to type 2 diabetes (T2D) – a worryingly common chronic illness among Malaysians.

Type 1 diabetes (T1D) is lesser known, but its impact on life is equally serious.

T1D (previously known as juvenile or insulin-dependent diabetes) is a chronic condition that comes about because the pancreas stops or only produces a little insulin.

Insulin is a hormone that helps control sugar (glucose) levels in the blood and allows our cells to use sugar from food for energy.

The lack of insulin causes sugar to accumulate in the bloodstream, leading to the many symptoms and complications of diabetes.

One possible cause of T1D is an autoimmune reaction that mistakenly destroys the insulin-producing beta cells in the pancreas.

Exposure to certain triggers in the environment, such as a virus, is also linked to T1D.

A major point that differentiates T1D from T2D is that T1D is not caused by lifestyle factors such as unhealthy eating habits or lack of physical activity.

It commonly occurs during childhood and adolescence, and is relatively rare, affecting around 5% of all diabetes patients.

Symptoms and complications

Unlike T2D, the symptoms of T1D may appear suddenly.

Early diagnosis is important to avoid serious complications such as diabetic ketoacidosis (DKA), but misdiagnosis as acute gastroenteritis or urinary tract infection can happen and should be avoided.

Common symptoms include:

  • Increased thirst and frequent urination
  • Extreme hunger
  • Unintended weight loss
  • Blurred vision
  • Fatigue and weakness
The complications of T1D can be divided into acute and chronic.

Acute complications include:

> Hypoglycaemia

This is when blood sugar levels become too low due to high insulin levels when a T1D child delays a meal/snack, does not eat enough or exercises too much after her insulin has been administered.

It happens quickly and needs immediate treatment.

Symptoms include shaking, nausea, sweating and fatigue.

> DKA

The body breaks down fat cells when it cannot get enough glucose for fuel, resulting in chemicals called ketones.

This happens when the child misses his insulin injections or during inappropriate management of sick days.

The combination of high glucose, dehydration and ketone build-up leads to ketoacidosis, which can be fatal.

If it occurs, DKA must be treated as an emergency.

In Malaysia, about 70% of T1D patients are diagnosed with the condition after first going to the clinic or hospital with DKA symptoms, which includes vomiting, abdominal pain, rapid breathing and loss of consciousness.

Meanwhile, chronic complications of T1D include:

> Cardiovascular disease

The risk of cardiovascular problems, such as heart attack, stroke, atherosclerosis, high blood pressure and coronary artery disease, increases with diabetes.

> Organ damage

Blood vessels in organs like the eyes and kidneys can be damaged due to diabetes, causing kidney failure and serious eye conditions like cataract, glaucoma or blindness.

> Nerve damage

It starts with tingling, numbness or a burning sensation in the feet, and gradually spreads upward.

Over time, it can lead to total loss of sensation, and even loss of limbs.

Nerve damage also affects the gastrointestinal tract.

If a diabetic child starts a new physical activity, e.g. badminton or another sport, his or her insulin dose and meal plan needs to be adjusted to take into account their new energy expenditure. — FilepicIf a diabetic child starts a new physical activity, e.g. badminton or another sport, his or her insulin dose and meal plan needs to be adjusted to take into account their new energy expenditure. — Filepic

Management

While there is no cure for T1D, there are ways to manage it so that the patient can live a regular life.

These include:

> Insulin administration

A child with T1D needs lifelong insulin therapy to control her blood sugar levels.

It can be administered via multiple daily injections or an insulin pump.

There are short-acting, rapid-acting and long-acting insulin.

Following a proper schedule for daily insulin administration is key to managing T1D.

> Blood sugar monitoring

Careful and regular monitoring of the patient’s blood sugar level is important to ensure that it remains within the target range.

Blood sugar levels need to be checked before and after eating, sleeping, exercising, driving, or when low blood sugar is suspected.

Self-monitoring with a chemically-treated paper strip is the standard way of measuring blood sugar, while intermittent and real-time continuous glucose monitoring systems are more advanced.

> Healthy eating

The child and his family needs to understand how different foods affect his blood sugar.

A dietician can propose a suitable diet plan focusing on whole grains, veggies and fruits.

Insulin doses should be tailored to the amount of carbohydrates taken, so the child and his caretakers need to learn to count the carbohydrate content in his food and drinks.

There is no specific diet restriction for T1D patients, but healthy eating is mandatory!

> Physical activity

Regular exercise is still necessary, but the child needs to know it can lower her blood sugar level.

Thus, her blood sugar needs to be monitored more frequently when starting a new activity to observe any effects.

Her meal plan or insulin doses may need to be modified to suit the new activity.

Being diagnosed with T1D can be a huge challenge for a child and his family.

Apart from the need for cautious management, T1D is also a costly disease – while insulin is free at government hospitals, other medications, equipment and overhead costs can strain a family’s finances as diabetes is a long-term condition.

However, T1D can be managed successfully.

With the right help and support, especially from parents, family members and a good healthcare team, a T1D child can cope with his condition and live a regular, healthy life.

Associate Professor Dr Muhammad Yazid Jalaludin is a consultant paediatrician and paediatric endocrinologist. This article is courtesy of the Malaysian Paediatric Association’s Positive Parenting programme in collaboration with expert partners. For further information, please email starhealth@thestar.com.my. The information provided is for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.

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