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The disease manifests itself at different ages. Diabetes also occurs in newborns. It is congenital in nature, but the frequency of its occurrence is low. The disease is more common among children 6-12 years old. The metabolism in the body of a child, including carbohydrate metabolism, proceeds many times faster than in an adult. The state of the not yet formed nervous system against this background affects the concentration of sugar in the blood. The younger the child, the more severe the disease.
The development of diabetes in children is similar to the disease in adults. Features of the disease in childhood are associated with the state of the pancreas. Its dimensions are small: by the age of 12, the length is 12 centimeters, and the weight is about 50 grams. The mechanism of insulin production is getting better by the age of 5, so the period from 5-6 to 11-12 years is critical for the manifestation of diabetes.
In medicine, it is customary to divide diabetes into two types: insulin-dependent diabetes and non-insulin-dependent diabetes (1 and 2, respectively). According to statistics, children are more likely to be diagnosed with type 1 diabetes. It is he who is characterized by a low level of insulin production (for more details: type 2 and type XNUMX diabetes: what’s the difference?).
Signs and symptoms of diabetes in children
Parents should pay attention to some features in the behavior of the child in order to see a doctor as soon as possible. Diabetes mellitus develops rapidly, if the necessary manipulations are not carried out in time, a diabetic coma may occur.
Main features:
dry mouth and constant desire to drink;
frequent urination, urine is sticky;
nausea and vomiting;
a sharp decline in vision;
insatiability in food against the background of weight loss;
weakness, fatigue and irritability.
Symptoms of the disease include typical and atypical manifestations. Atypical symptoms may be noticed by parents. These are complaints from the child to constant headaches, reduced academic performance and fatigue.
Typical symptoms:
polyuria, or urinary incontinence. Parents of young children mistake this sign for bedwetting common at an early age. Therefore, it is important to know the first signs of diabetes;
polydipsia, accompanied by a painful feeling of thirst. A child can drink up to 10 liters of fluid per day, and dry mouth will persist;
sudden weight loss against the background of increased appetite, or polyphagia;
the appearance of itching on the skin, pustular formations. The skin becomes dry;
after urination, itching appears in the genital area;
urine output increases (more than 2 liters per day). Its color is light. Urinalysis shows high specific gravity and acetone content. Perhaps the appearance of sugar in the urine, normally it should not be;
a fasting blood test reveals an increase in blood sugar of more than 5,5 mmol / l.
If you suspect a child with diabetes mellitus, timely diagnosis and competent treatment are extremely important.
Causes of diabetes in children
There are many causes of diabetes in children. The main ones are:
heredity. The disease is very common in relatives. Parents with diabetes are 100% likely to have children who will sooner or later receive the same diagnosis. The disease can manifest itself in the neonatal period, and at the age of 25, and at 50. It is necessary to control the blood sugar level in pregnant women, because. the placenta absorbs it well and promotes accumulation in the developing organs and tissues of the fetus;
viral infections. Modern medical science has proven that rubella, chicken pox, viral mumps (mumps) and viral hepatitis disrupt the pancreas. In such a situation, the mechanism of the development of the disease is presented in such a way that the cells of the human immune system simply destroy insulin cells. But the transferred infection will lead to the development of diabetes mellitus only in the case of aggravated heredity;
persistent colds. The immune system, faced with an infection, begins to actively produce antibodies to fight it. If such situations are repeated often, then the system wears out, and the immune system is depressed. As a result, antibodies, even if there is no target virus, continue to be produced, destroying their own cells. There is a malfunction in the pancreas, as a result of which the production of insulin decreases.
Treatment of diabetes in children
Currently, medicine has not found a method that can completely cure a child of diabetes. The main goal of the treatment is to normalize the metabolic processes in the body for a long time. Monitoring the patient’s condition by the parents (or independently, depending on the age of the child) is carried out constantly.
Competent treatment, the absence of complications and the long-term normal condition of the child make it possible to predict favorable conditions for life and further work.
Diabetes is treated by an endocrinologist.
The initial stage of the disease can be corrected in a hospital setting.
Diet
In children, treatment begins with the selection of the optimal diet, agreed with the doctor and adjusted depending on the severity of the disease. Compliance with the diet is required, tk. the child receives several drugs during the day. Their intake depends on the time of the meal. The treatment regimen must be strictly observed, otherwise the effectiveness of drugs will be significantly reduced.
The calorie content of food is calculated in the following ratio: – breakfast – 30%, – lunch – 40%, afternoon tea – 10%, dinner – 20%. The calculation of carbohydrate food requires special attention. The total amount per day should not exceed 400 grams.
Medication
Since more than 70% of all cases of diabetes in children are type 1 diabetes, drug treatment is reduced to calculating the carbohydrates eaten by the child, and the use of insulin. In this regimen, children receive a daily basal dose of insulin, which is then (before each meal) supplemented with short-acting insulin doses based on expected carbohydrate intake and measured glucose levels.
The basal dose may be given once a day (sometimes every 1 hours in younger children) as a long-acting insulin injection (glargine or detemir) with additional boluses of short-acting insulin (usually aspart or lispro) as separate injections. Injections of glargine or detemir are usually given at dinner or at bedtime and should not be mixed with short-acting insulins. The basal bolus regimen is not appropriate when there is no adequate supervision of the child, in particular when an adult cannot give daily injections at school or kindergarten.
Insulin, which is used in the treatment of diabetic children, has a short-term effect. Protafan and actrapid preparations have this property. The composition is administered subcutaneously using a special syringe pen. This is convenient and allows the child to learn how to administer the drug at a certain time without outside help.
In 30% of cases, children develop type 2 diabetes. In this case, metformin is indicated – this is the only oral antihyperglycemic drug approved for patients under 18 years of age. Metformin should be started at a low dose and taken with food to prevent nausea and abdominal pain. The usual starting dose is 500 mg once/day for 1 week, increasing weekly by 1 mg for 500 to 3 weeks until a maximum dose of 6 mg orally twice a day is reached. The goal of treatment is to reduce glycated hemoglobin (HbA1000c) < 2%.
If this cannot be achieved with metformin, insulin must be started. Unfortunately, about half of adolescents with type 2 diabetes do not respond to metformin monotherapy and eventually require insulin.
Prevention of diabetes in children
Children, from the first days of life, who are bottle-fed, are more at risk of developing diabetes. The mixtures contain cow’s milk protein, which inhibits the work of the pancreas. Breast milk is the first preventive measure that will reduce the likelihood of getting the disease. Feeding up to a year or more will strengthen the child’s immunity and protect against infectious diseases that can trigger the development of diabetes.
In the case of older children, it is necessary to monitor the nutrition, its composition and intake regimen. The diet should be balanced and varied, exclude a large amount of fats and carbohydrates. Be sure to eat fruits and vegetables.
Preventive measures are reduced to the definition of a risk group: the presence in the family of patients with diabetes, metabolic disorders in the child and obesity. Children with similar signs are registered with an endocrinologist and are examined twice a year. If the diagnosis is established, a dispensary observation and a monthly examination by the attending physician are prescribed in order to correct the treatment program, timely detect periods of exacerbation and prevent serious complications in the course of the disease.
The frequency and methods of examination methods are determined depending on the stage of the disease.
Patients with diabetes undergo an annual examination by narrow specialists: an oculist, a cardiologist, a neuropathologist, a nephrologist, a surgeon, and others. Mandatory studies for them are an electrocardiogram, urinalysis and those activities that will help in the early stages to identify violations of organs and systems
A complete cure for diabetes is impossible. Competent and timely treatment will achieve remission, and the child will be able to lead a normal life, developing in accordance with age.
Author of the article: Sokolova Praskovya Fedorovna, pediatrician