Diabetes mellitus in children

Diabetes mellitus (DM) is a common, chronic,  metabolic disease characterised by hyperglycemia as a cardinal biochemical feature. DM is a very serious metabolic disorder that prevents the normal breakdown and use of food, especially sugars by the body. It can damage  the heart, blood vessels, kidneys and neurological system and can cause a progressive loss of vision over many years.

Our bodies break down the foods we eat into glucose and other nutrients we need which are then absorbed into the blood stream from the gastrointestinal tract. The glucose level in the blood rises after a meal and triggers the pancreas to make the hormone insulin and it stays into the bloodstream. But in diabetes, the body either can’t respond to insulin properly.

Insulin works like a key that opens the door to cells and lets the glucose in. Without insulin, glucose can’t get into the cells that is the door are locked and there is no key. And It stays in The bloodstream. As a result, the level of sugar in the blood remain higher than normal. High blood sugar levels are a problem because they can cause a number of health problems

Types of diabetes in children

1. Type 1 diabetes
2. Type 2 diabetes
3. Neonatal diabetes

Type 1 Diabetes:

Until recently, the common type of diabetes in children and teens was type  1. It was also javenil diabetes or formerly called insulin-dependent diabetis

In Type – 1 diabetes pancreas loses its ability to make insulin because the body’s immune system attacks and destroys the cell that produce insulin. No one know exactly why this happens but it has something to do with genes.

Type 1 diabetes can’t be prevented and there is no real way to predict  who will get it. Nothing that either a parent or the child did caused the disease.

Type 1 Diabetes is characterized by low or absent level of endogenously produced insulin and by dependence on exogenous insulin to prevent development of kitoacidosis, as acute life threatening complication of Type 1 Diabetes. The onset occurs predominantly in childhood with the median ages 7- 15 years but it only presents at any age.

Symptoms of Type 1 Diabetes

The most common symptoms of Type 1 Diabetes in children include:

– increased thirst

– increased urination

– bedwetting

– hunger

– weight loss

– fatigue

– irritability or behaviour changes

– fruity smell On the breath

– Blurred vision

– tingling, pain or numbness in the hand/ feet

– cut or injuries that are slow to heal

 Complication of Type 1 Diabetes Mellitus includes

– heart and blood basal disease

– nerve damage

– kidney damage (kidney diseases)

– eye damage

– osteoporosis

– diabetes ketoacidosis

– gastroenteritis

– Stomatitis

Type 2 diabetes

Children and adolescents with this type of diabetes are usually obese but are not insulin-dependent and intreguently develop ketosis, some subject with type 2 diabetes may present or develop ketosis during severe infections or other stresses and may then need insulin for correction of symptomatic hyperglyacemia. This category includes the most prevalent form of diabetes in adults, which is characterized by insulin resistance and often a progressive defect in insulin secretion. This type of diabetes was formerly known as adult onset diabetes mellitus or non-insulin-dependent diabetes mellitus.

In the past, type 2 Diabetes mellitus was considered a disease of of adults and older individuals not a paediatric condition. Over the last decade however in the world there has been a disturbing trend of increasing cases of type 2 diabetes in children, mirroring increasing rates of obesity. The risk factors for paediatric type 2 diabetes are obesity, increased body mass index, family history of type 2 diabetes, membership of ethnic minority, puberty female gender feature of syndrome x. The common link among these risk factors is insulin resistance which plays a pivotal role in the pathophysiology of type 2 diabetes. Risk factor impact on insulin sensitivity and insulin generation in childhood ultimately leading to type 2 diabetes.

Type 2 diabetes in children is an emotionally charged issue and an emerging public health problem. Type 2 Diabetes mellitus is emerging as a new clinical problem within paediatric practice. Recent increasing prevalence of type 2 diabetes mellitus in children and adolescents around the world even if the prevalence of obesity is not increasing anymore. The majority of young people diagnosed with type 2 Diabetes mellitus.

Symptoms of type 2 diabetes

The most common symptoms of type 2 diabetes in children and adolescents

– urination more often especially at night

– increased thirst

– tiredness

– itching around the genital

– slow healing of cuts or wounds

– blurred vision

– dark velvety patches on skin

– pcos/ pcod

– kidney disease

– eye disease

– high blood pressure

Neonatal Diabetes mellitus (NDM)

Neonatal Diabetes mellitus (NDM) also termed as congenital diabetes or Diabetes of infancy. It is a disease that affects on infant and their body’s ability to produce or use insulin. It is a monogenic (controlled by single gene) form of diabetes that occurs in the first months of life. Infants do not produce enough insulin, leading to increase in glucose accumulation.

Types of neonatal diabetes

There are two kinds of neonatal diabetes

1. Transient neonatal diabetes mellitus
2. Permanent neonatal diabetes mellitus

1. Transient neonatal diabetes mellitus

It is so called because it usually disappears within years of birth but can come back again typical during adolescence.

2. Permanent neonatal diabetes mellitus

Once diagnosed stays for the rest of life or pursists throughout the lifespan. This form of diabetes is characterized by high blood sugar levels i.e. hyperglycemia resulting from shortage of the hormone insulin.

Complication of neonatal Diabetes mellitus

1. 1. Developmental delay such as muscle weakness
   2. Learning disabilities
   3. Diabetic ketoacidosis
   4. Low birth weight
   5. Epilepsy
   6. Macroalossia – a larger than the normal tongue