Diabetes in children

definition

In addition to the much more commonly known type 2 diabetes mellitus (also Age or affluence diabetes called) there are among others also another form of diabetes mellitus, which is usually diagnosed in early childhood. We are talking about diabetes mellitus "Type 1" (also juvenile diabetes called, Dm1). In the case of Dm1, a reaction of the own immune system (Autoimmune reaction) against the body's own, insulin-producing cells (so-called. Beta cells in the islets of Langerhans) in the pancreas to its destruction. Insulin is the body's own messenger substance that controls blood sugar. As soon as approx. 80% of these insulin-producing cells are destroyed, the body loses the function of self-regulating the blood sugar content and blood sugar rises unchecked after a meal. This can have far-reaching consequences for those affected.

causes

Type 1 diabetes is most often associated with one autoimmune cause underlying. This means a reaction of the body's own immune system that is directed against its own body cells. This reaction takes place in the pancreas. There are the Langerhans Islands. These include, among others the so-called beta cells. Beta cells are insulin-producing cells. If these are destroyed, this leads to an absolute lack of insulin. So no insulin or only an insufficient amount is produced. As a result, the body loses the function of effectively lowering the blood sugar level, especially after a meal. This reaction can be idiopathic, i. occur for no significant reason. Nevertheless, researchers have found that around 90% of children affected by Dm1 have a so-called HLA association exhibit. These are certain genes that are inherited and which increase the risk of developing diabetes. If parents are affected, a special human genetic test can be used to determine the probability of the risk of recurrence if they wish to have children. In addition to the causes mentioned above, it is often found that there are associations with other autoimmune diseases. This means that with simultaneous illness with other autoimmune diseases (e.g. Addison's disease, type A gastritis, Hashimoto's thyroiditis, celiac disease) the risk of developing diabetes is increased.

diagnosis

Several examination methods are suitable for diagnosis. The safest and also the simplest is to examine the sugar in the blood itself. It is not always necessary to take a venous blood sample. Usually a small drop from your finger is enough. If there is a well-founded suspicion of diabetes, there are several options. On the one hand, you can measure long-term blood sugar (HbA1c value). Another method that is often used is the determination of the fasting blood sugar value. If the fasting blood sugar value is> 126 mg / dl, the diagnosis of diabetes is considered confirmed. Even with an occasional blood sugar of> 200 mg / dl and typical symptoms, diabetes is considered certain. You can also have one oral glucose tolerance test (oGTT) carry out.
Your doctor will discuss the most suitable method for you.

How can I spot the signs?

Diabates often occurs for the first time with unspecific symptoms. Initially, these are usually not interpreted as a metabolic disease. The most common symptoms in children are Polyuria and Polydipsia. Polyuria in technical jargon means more frequent urination than usual. This can be shown by wetting. "Dry" children who start wetting the bed again are noticeable. Polydipsia describes a pathologically increased thirst. This is then often associated with polyuria.

Read more on the topic: How do I recognize diabetes?

More symptoms

In addition to the most common symptoms mentioned above, unwanted weight loss is often observed in around half of the children affected. Unreasonable tiredness (lethargy) can be observed in some children.

The increased loss of fluid can lead to hardening of the stool and then to constipation (medical: Constipation) to lead. This can include show by abdominal pain. Children also complain of more frequent headaches. Vomiting is also observed as an accompanying symptom in some affected children. Another, not uncommon symptom, are fungal infections. If these occur in the mouth, one speaks of the so-called. Oral thrush (oral thrush, often through Candida albicans). A vaginal fungal infection in girls / young women can also be observed.

Vomit

Vomiting in the context of diabetes is often a sign of a high blood sugar level that has persisted for a long time. This metabolic derailment is called Ketoacidosis. Those affected are very thirsty and have an acetone odor in their breath. This is reminiscent of nail polish remover, for example. Vomiting is only one of several symptoms that can occur. More symptoms of the Ketoacidosis are: Polyuria, lethargy and nausea.

treatment

Unlike the treatment of type 2 diabetes, type 1 can only be treated with insulin therapy. The reason for this is that the two types have a different cause. While conservative treatment approaches (weight reduction, change in diet, exercise, medication, etc.) may also be an option for type 2 diabetics, these are ineffective for patients with type 1 diabetes. Only the insulin therapy helps the children and later the affected adult to lead a "normal" life. This therapy can be implemented through the conventional injection of insulin with syringes or through the application of an insulin pump, which is more common in children. With both procedures, children and, in the beginning, parents in particular, have to undergo special training. There they learn to calculate insulin doses among many other things. These can change significantly not only through the planned meals, but also through school stress, sport and other activities. The prerequisite for this is always regular blood sugar measurements. The doses and frequency of administration depend on the particular insulin regimen. One differentiates here Conventional insulin therapy of the Intensified insulin therapy.

How do I feed a child with diabetes?

As already mentioned in the treatment section, the diet of a patient suffering from type 1 diabetes has no effect on the therapy. This means that a child suffering from type 1 diabetes can theoretically eat anything they want. No diabetic foods are necessary, and sugar must not be avoided. However, this is not a free ticket to an uncontrolled, unhealthy diet. Ultimately, the same dietary recommendations apply as for a healthy person who does not suffer from diabetes. Nevertheless, diet and insulin therapy must be perfectly coordinated in a diabetic. This is to prevent unintentionally high or low blood sugar levels from reaching. Warning: Otherwise there is a danger to life. Training for parents and children is therefore essential.

Can diabetes in children be curable?

Type 1 diabetes is still an incurable disease today. However, researchers are trying to develop new therapies that can bring about a cure. Research is also being carried out into “vaccines”. However, it is currently important to recognize diabetes at an early stage so that the residual function of the insulin-producing cells in the pancreas that have not yet been destroyed by autoimmune factors remains high. This has an impact on the intensity of the insulin therapy, which is the most important point of the therapy. A well-adjusted patient with type 1 diabetes can lead a normal life with no impaired quality of life.

Influence on the school

The influence on the school is not a problem with the appropriate organization. First of all, it is important to inform the school or kindergarten about the child's illness. This ensures that teachers or educators can react correctly in an emergency. In addition, through the appropriate education of classmates, teachers and educators, fears and prejudices can be reduced. This can prevent children from having problems if they have to measure blood sugar or inject insulin during school time. In most cases, an outpatient care service can also take on these tasks if the children are too young or the teachers cannot / do not / are not allowed to take on this task.

The sick child can of course take part in excursions, school trips or sports lessons. Since these activities may lead to a change in the insulin therapy, an exchange between parents and those responsible should always take place before participation.

Application for a severely handicapped ID card

In order to obtain a handicapped ID card, you have to meet special criteria. The most important criteria are the amount of therapy required and the impairment in everyday life caused by the disease. In order to obtain an ID, you have to achieve a certain number of points on the “Degree of Disability” (GdB) scale. The scale goes from 0-100. In order to obtain a severely disabled ID card as a diabetic, you have to achieve at least 50 points. A score of 50 is achieved if the criteria - "minimum 4 insulin injections per day, independently adjusted dose and serious lifestyle restrictions." The increased effort, for example when measuring blood sugar and injecting insulin at school, is usually not enough.

Life expectancy

Unfortunately, it still has to be said that the average life expectancy of a patient with type 1 diabetes is lower than that of a healthy person. A Scottish study has shown that women with type 1 diabetes live around 13 years and men around 11 years shorter than healthy people. The reason is often the secondary complications (also called long-term complications) caused by the underlying disease. Still there is hope. Various studies have shown in recent years that the life expectancy of type 1 diabetics can be extended through consistent therapy and improved treatment options. It is important that there are no late complications such as kidney damage during the course. It has also been shown that the life expectancy of insulin pump users is extended.

Gestational diabetes, what are the consequences for my child?

The occurrence of gestational diabetes (SSD) during pregnancy can have far-reaching consequences for the child. If the SSD occurs early, it can lead to heart defects and malformations in the gastrointestinal tract. Malformations of the lower spine are also rarely observed (caudal regression).

Also the technically called "Diabetic fetopathy“Is a complication that is not infrequently observed in an SSD that is treated too late or inadequately. With "Fetopathia diabetica" This means that the children weigh much more and are taller in the womb than children of unaffected mothers. In addition, more red blood cells are formed, so that the oxygen requirement of babies in the womb is higher than average. It can also lead to breathing problems after the birth. This is justified by the reduced production of the so-called "Surfactant“In the lungs. In addition, the accumulation of glycogen in the heart muscle in the womb can lead to heart problems. Furthermore, the mother's increased blood sugar level passes through the umbilical cord into the blood of the unborn child. As a result, the unborn child's pancreas produces a lot of insulin in order to lower the increased blood sugar again. After birth, blood sugar levels drop rapidly because the child is no longer connected to the mother by the umbilical cord. Since the child's insulin levels are broken down more slowly than blood sugar and still have an effect, these children can fall into hypoglycaemia (blood sugar too low) more frequently after birth. This is potentially life threatening.

Because of these complications, it is important that diabetes is recognized and treated early in pregnancy to protect the unborn child!