Diabetes in children development symptoms treatment

The overwhelming majority (95%) of diabetics Children develop congenital diabetes mellitus type 1, the acquired form, type 2 diabetes, occurs very rarely in children and adolescents.In total, about 3.000 children under 15 years of age affected by diabetes, very often adolescents in puberty. The first signs are a feeling of thirst, frequent urination, fatigue, tiredness, poor performance and poor concentration, as well as cravings.

If the disease is not diagnosed in time, there is a risk of ketoacidosis, a severe metabolic derailment that can develop into a life-threatening diabetic coma without prompt medical attention. Type 1 diabetes is an autoimmune disease in which the pancreas no longer produces insulin; the missing insulin must be replaced with medication for the rest of the patient's life. In Austria, approximately 2.500 to 3.000 children. Adolescents (up to 15 years) suffering from diabetes.500 to 3.000 children and adolescents (up to 15 years of age) with diabetes. 95% of them are type 1 diabetics, which is why this form is also called juvenile diabetes; in contrast, type 2 diabetes is often mistakenly called "adult-onset diabetes" Called.

In Germany, around 300 children are diagnosed with diabetes each year, with boys being affected slightly more frequently than girls. While the number of new cases of type 2 diabetes remains constantly low, there has been a sharp increase in the number of juvenile type 1 diabetics in recent years. Children most frequently develop the disease on the threshold of puberty, with a further peak in the disease occurring between the ages of 3. and 4. Year of life.

Type 2 diabetes in children and adolescents

Since type 2 diabetes is much less common in children and adolescents in Austria (and in Europe), we will only briefly discuss it here. In principle, the number of under-15s suffering from type 2 diabetes is also increasing, but only very slightly, because the number of extremely overweight children and adolescents in this country is also not (yet) increasing as much – severe overweight is the main cause of type 2 diabetes. Like type 1 diabetes, type 2 initially manifests itself in increased thirst, urinary urgency and fatigue, but type 2 in children and adolescents can be easily cured by reducing excess weight through increased exercise and a change in diet. If successful, the disease often disappears on its own. If not, therapy with oral antidiabetics is indicated. Type 1 diabetes mellitus is a chronic metabolic disease. Counts among the so-called autoimmune diseases. The body's immune system attacks the insulin-producing beta cells of the pancreas, and the resulting inflammatory reaction (insulitis) leads over time to the destruction of the beta cells, so that less and less insulin is produced. As a result, the glucose in the blood is less and less efficiently supplied to the body's cells – which need it as an energy source – and remains in the blood.

The reason for this immune system response is not known, but it is clear that genetics appears to play an important role: Children of a parent with type 1 diabetes have twice the risk of developing the disease. If both parents have type 1 diabetes, the likelihood of children developing diabetes is 25%.

The increased incidence of type 1 diabetes in adolescents suggests that other causes, such as obesity, the older age at which women bear children, or excessive hygiene, may also be a factor.

Diabetes in children: symptoms

The first signs that your child may have diabetes are a strong feeling of thirst and increased drinking, frequent urination, weight loss, fatigue, poor performance and concentration, and cravings. Infants sometimes wet the bed again at night and often complain of headaches or abdominal pain.

It becomes dangerous if these symptoms are not very pronounced (which can happen) and the disease is therefore not diagnosed in time. There is then a risk of ketoacidosis, a severe metabolic derailment that can develop into a life-threatening diabetic coma – a state of unconsciousness – without prompt medical attention. The signs are nausea, vomiting, weakness, acetone odor (smells similar to nail polish remover) in the breath, strained breathing and fatigue.

Diabetes in children: Risk of hypoglycemia

Hypoglycemia, or low blood sugar, is the most common complication that can occur in a type 1 diabetic patient. The sugar deficiency occurs when too high a dose of insulin has been injected, which can happen especially during physical activity such as sports – when the body has not been supplied with enough carbohydrates. The low blood sugar level leads to symptoms such as sweating, trembling, food cravings or convulsions. If this occurs, the child should immediately take sugary food or drink (preferably dextrose, fruit juices are also suitable), otherwise there is a risk of unconsciousness and danger to life.

Diagnosis of diabetes in children

In case of suspicion, the sugar concentration in the urine is measured by the doctor. If this is above 180 mg/dl this is a massive indication of diabetes. Then the child should be referred immediately to a specialized diabetes center.

The exact diagnosis is made in the laboratory. The criteria are the same for children and adults; the following blood glucose values must be measured on at least 2 different days:

– Fasting blood glucose from venous blood ≥ 126 mg/dl and/or – Blood glucose ≥ 200 mg/dl 2 hours after eating – HbA1c value above 6.5%

If it is not clear whether the child has type 1 or type 2 diabetes, the so-called C-peptide can also be measured – a part of the hormone precursor proinsulin – which is released by the pancreas at the same rate as insulin. In type 1 children it is almost absent, in type 2 children the C-peptide level is increased due to the overproduction of insulin.

Therapy of diabetes in children

The initial treatment after type 1 diabetes has been diagnosed in a child/adolescent should be carried out on an inpatient basis – on the one hand because of the necessary metabolic adjustment, and on the other hand so that the patients and their parents can receive detailed training on how to deal with the disease. Most centers can only offer this service on an inpatient basis. The length of the stay in the clinic is also based on these criteria.

Subsequently, lifelong insulin substitution is necessary, whereby there are different forms of insulin therapy. Available are conventional insulin therapy (2-3 x tgl. insulin doses, as well as fixed times and amounts of carbohydrates), a more flexible basic bolus therapy (= functional insulin therapy), as well as insulin pump therapy.

The treatment is adapted by experts together with the family to the specific requirements, life circumstances, individual needs and age of the child / adolescent.

Diabetes in children: Tips for parents

The most important thing you as a parent can do for your child is to follow exactly the measures that you have been taught during the training in a diabetes center. Therefore, always discuss your questions or problems with the treating team. This concerns blood glucose testing, which you must do if your child is not old enough to do it himself, recognizing the signs of hypoglycemia, or having sugary drinks or food ready (glucose or juice, ev. fruit or cereal bars), in case your child's blood sugar level drops.

Guide your child to independence so that he or she can soon perform necessary measures such as measuring (and recording in the diabetes passport) blood glucose levels and insulin injections on his or her own. Follow the instructions of the medical experts very carefully. Conscientious – but "don't pack your child in absorbent cotton". Make sure that it is as "normal" as possible Life leads and does not become an outsider among peers.

Apart from this, passing on information is a very important criterion: inform those people who look after and supervise your child – kindergarten teachers, teachers, child minders, etc. – about the diagnosis. – about your child's disease. Private friends and acquaintances should also be familiar with the disease at least to the extent that they can take the right measures in an emergency (especially in the case of hypoglycemia).

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