Causes, signs and treatment of diabetes in children
Content:
- Signs and symptoms of diabetes in children
- Causes of diabetes in children
- Treatment of diabetes mellitus in children
- Prevention of diabetes in children
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. Metabolism in a child's body, including carbohydrate, proceeds many times faster than in an adult. Against this background, the state of the not yet formed nervous system affects the concentration of sugar in the blood. The younger the child, the more severe the disease progresses.
Diabetes mellitus is diagnosed in 1-3% of adults. Children get sick in 0.1-0.3% of cases.
The development of diabetes mellitus 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, its length is 12 centimeters, and its 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 mellitus into two types: insulin-dependent diabetes and non-insulin-dependent diabetes (1 and 2, respectively). According to statistics, diabetes mellitus of the first type is more often detected in children. It is for him that a low level of insulin production is characteristic (more: type 1 and type 2 diabetes: what's the difference?).
Signs and symptoms of diabetes in children
Parents should pay attention to some features in the child's behavior in order to see a doctor as soon as possible. Diabetes mellitus develops rapidly, if the necessary manipulations are not carried out in time, diabetic coma can occur.
Main features:
- dry mouth and constant desire to drink;
- frequent urination, while the urine is sticky;
- nausea and vomiting;
- a sharp decrease in vision;
- insatiability in food against the background of weight loss;
- weakness, fatigue and irritability.
The manifestation of one or more signs at a time is the basis for contacting a doctor. He will prescribe the necessary tests, on the basis of which it is possible to establish an accurate diagnosis.
Symptoms of the disease include typical and atypical manifestations. Parents may notice atypical symptoms. These are complaints from the child about constant headaches, reduced academic performance and fatigue.
Typical symptoms:
- polyuria, or urinary incontinence. Parents of young children mistake this symptom for bed-wetting, common at an early age. Therefore, it is important to know the first signs of diabetes;
- polydipsia, accompanied by a painful feeling of thirst. The child can drink up to 10 liters of liquid per day, and the dry mouth will persist;
- sharp 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 excretion increases (more than 2 liters per day). Its color is light. Urinalysis shows a high specific gravity and acetone content. The appearance of sugar in the urine is possible, 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 diabetes mellitus in a child, timely diagnosis and proper 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 mellitus 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 25 years old, and at 50. It is necessary to control blood sugar levels in pregnant women, because the placenta absorbs it well and promotes accumulation in the forming organs and tissues of the fetus;
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viral infections. Modern medical science has proven that rubella, chickenpox, mumps (mumps) and viral hepatitis interfere with the functioning of 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 the insulin cells. But the transferred infection will lead to the development of diabetes mellitus only in the case of burdened 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 inhibited. As a result, antibodies, even if there is no target virus, continue to be produced, destroying their own cells. The pancreas malfunctions, as a result of which the production of insulin decreases.
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Treatment of diabetes mellitus in children
Currently, medicine has not found a method that can completely cure a child from diabetes. The treatment carried out sets as its main goal the normalization of metabolic processes in the body for a long time. Monitoring of the patient's condition by the parents (or independently, depending on the age of the child) is carried out constantly.
Competent treatment, absence of complications and long-term normal state of the child allows predicting favorable conditions for life and further work.
An endocrinologist is engaged in the treatment of diabetes mellitus.
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, because the child receives several drugs during the day. Their intake depends on the time of the meal. The treatment regimen must be strictly followed, 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%. Calculation of carbohydrate food requires special attention. The total amount per day should not exceed 400 grams.
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Drug treatment
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 baseline daily insulin dose, which is then (before each meal) supplemented with short-acting insulin doses calculated from expected carbohydrate intake and measured glucose levels.
The basal dose can be given once a day (sometimes, in younger children, every 12 hours) as an injection of long-acting insulin (glargine or detemir) with additional boluses in the form of separate short-acting insulin injections (usually aspart or lispro). Glargine or detemir injections are usually given at dinner or before bed and should not be mixed with short-acting insulins. Basal bolus is not suitable when there is no proper supervision of the child, in particular when an adult cannot give daytime injections in school or kindergarten.
Insulin, which is used in the treatment of diabetic children, has a short-term effect. This property is possessed by the drugs protafan and aktrapid. The composition is injected subcutaneously using a special pen-syringe. It is convenient and allows the child to learn how to inject the drug at a certain time without assistance (more: instructions for the use of insulin).
In 30% of cases, children develop type 2 diabetes. In this case, metformin is indicated - it 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 a day for 1 week, and is increased weekly by 500 mg for 3-6 weeks until it reaches a maximum dose of 1000 mg orally 2 times a day. The goal of treatment is to reduce glycated hemoglobin (HbA1c) <6.5%.
If this cannot be achieved with metformin, insulin should be started. Unfortunately, about half of adolescents with type 2 diabetes do not respond to metformin monotherapy and ultimately require insulin.
Prevention of diabetes in children
Children who are bottle-fed from the first days of life are more at risk of developing diabetes mellitus. The formulas contain cow's milk protein, which inhibits the functioning of the pancreas. Breast milk is the first preventive measure that will reduce the likelihood of getting sick. Feeding for 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 the regimen of intake. The diet should be balanced and varied, excluding a large amount of fats and carbohydrates. Be sure to eat fruits and vegetables.
On the subject: 16 healthiest foods for diabetes
Preventive measures are reduced to determining the risk group: the presence of diabetes patients in the family, metabolic disorders in the child and obesity. Children with similar symptoms are registered with an endocrinologist and are examined twice a year. If the diagnosis is established, dispensary observation and a monthly examination by the attending physician are prescribed in order to correct the treatment program, timely identify periods of exacerbation and prevent severe 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 mellitus undergo an annual examination by narrow specialists: an ophthalmologist, cardiologist, neuropathologist, nephrologist, surgeon and others. Mandatory studies for them are an electrocardiogram, urinalysis and those activities that will help to identify violations of organs and systems in the early stages
A complete cure for diabetes is impossible. Competent and timely treatment will allow you to achieve remission, and the child will be able to lead a normal life, developing in accordance with age.
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Author of the article: Sokolova Praskovya Fedorovna, pediatrician
