This disease impairs the body's ability to metabolize glucose, the blood sugar which is the primary energy source for all body cells. The form of diabetes that usually afflicts children is known as juvenile onset, Type I, or insulin-dependent diabetes. It is most likely to develop between the ages of five and seven and during puberty.
HOW DOES INSULIN-DEPENDENT DIABETES DEVELOP?
The basic defect in insulin-dependent diabetes is a malfunction of cells in the pancreas that produce the hormone insulin, which is required to convert glucose into energy. Insulin also controls the rate at which glucose is consumed by body cells.
In juvenile diabetes, the body's immune system, in a so-called autoimmune reaction, destroys the insulin-producing cells of the pancreas. Consequently, the blood retains abnormally high levels of glucose, and the body cells have no energy source.
It is now that the two factors must come into play in order for a child to develop diabetes. First, the child must have a genetic "predisposition" to diabetes. That means that somewhere in the child's genes there is a program for becoming diabetic. But that program does not get turned on unless there is a trigger—the second factor. The trigger may be a viral infection or some other stress to the system.
WHEN SHOULD I SUSPECT THAT MY CHILD HAS INSULIN-DEPENDENT DIABETES?
Symptoms do not appear until most of the insulin-producing cells in the pancreas have been destroyed. Look for the following signs:
• Abnormal thirst
• Excessive urination
• Increased appetite
• Sudden weight loss
• Severe fatigue following light activity
• Irritability
• Nausea and vomiting
IS MEDICAL ATTENTION NECESSARY?
Yes. Immediate diagnosis and treatment are essential. By the time nausea and vomiting appear, the child may already have dangerously high blood-glucose levels and severe acidosis due to the burning of fat by the body because glucose is not being utilized for energy.
If there is a family history of diabetes, a test for the antibodies that signal an autoimmune attack can identify a child at risk before symptoms appear; it may even be possible to predict when the disease will develop. A few hospitals have undertaken a new research program that treats at-risk children with immunosuppresive drugs in the hopes of halting the autoimmune attack.
HOW CAN THE PEDIATRICIAN TELL IF MY CHILD HAS INSULIN-DEPENDENT DIABETES?
Diagnosis requires only simple blood and urine tests. Most children who develop diabetes are hospitalized for a few days to regulate their insulin and diet and to learn about the disease. The length of the initial hospitalization will depend on the child's age, the availability of self-care training in your community and the degree of glucose elevation.
WHAT TREATMENTS ARE AVAILABLE?
Insulin therapy, in the form of daily injections, is the basic treatment. During the first week of insulin therapy, your physician will carefully monitor the child's response to determine the optimal daily dosage. Blood-glucose monitoring and daily injections of insulin will be necessary throughout the child's life. Even young children can learn to measure their own blood-glucose levels.
You should contact your doctor if your child develops any other illness. Even a cold or flu can mandate changes in the youngster's insulin dosage.
MAINTAINING SAFE BLOOD SUGAR LEVELS
A central goal of diabetes management is prevention of high blood-glucose levels. An acutely high glucose level carries the risk of a diabetic coma. In addition, a chronically elevated glucose level (even if only slightly elevated) seems to contribute to the evolution of complications such as eye and kidney damage and high blood pressure.
Conversely, low blood sugar is just as dangerous. If the child exercises strenuously and does not compensate by taking less insulin or eating extra carbohydrates or sugar, the glucose-insulin balance will be thrown off, producing a condition called insulin shock, which untreated, and result in a potentially fatal coma. Treatment for low blood sugar is simple: Have the child consume sugar in a rapidly digestible form, such as orange juice, a hard candy or a sugar cube. Be alert for the symptoms of low blood glucose, which include:
• Tingling throughout the body
• A cold or clammy feeling
• Pallor
• Sweating
• Faintness
• Apprehension
• Headache
• Hunger
• Drowsiness
• Abdominal Pain
• Mental confusion
• Mood changes (such as irritability)
• Rapid heartbeat
• Seizures
• Trembling
CARING FOR A CHILD WITH DIABETES
Learning the basic techniques to manage juvenile diabetes is only the first step in the child's therapy. It is also essential to accept the disease and the necessary adjustments in daily routine. Special clinics, clubs and/or camps for children with diabetes offer children the opportunity to learn the elements of self-care among their peers. They also provide a source of emotional support to help children confront and surmount the emotional issues associated with the disease.
CARING FOR A CHILD WITH INSULIN-DEPENDENT DIABETES
The key to caring for a child with diabetes is to maintain a stable balance of insulin, diet and activity to normalize glucose levels. Components of a management plan include:
• Daily insulin therapy, usually given in one or two injections (depending on individual needs)
• A diet low in sugar and fat and high in complex carbohydrates and fiber to help control blood sugar and cholestorol levels
• Regularly scheduled meals to regulate blood sugar levels; stable dietary intake is crucial to the safety and effectiveness of the prescribed insulin dosage
• Regular exercise to allow a minimum dosage of injected insulin
• Checking blood sugar levels several times a day using a simple finger-stick device
