It was previously perceived that all children who are diagnosed with diabetes at a young age have type 1 diabetes. With an increase in childhood obesity rates the case becomes more complex though, and there is now an increase in statistics of children with type 2 Diabetes.
We need to remember that childhood diabetes is very complex because of the family involvement, especially when diagnosed at a very young age. Today we will give you the overall picture of children from toddlers to teenagers living with diabetes
Diagnosis of Diabetes
Most children with type 1 diabetes present with increase urinating, severe thirst, increased appetite, weight loss together with hyperglycemia (increased blood glucose levels), glucose in the urine and ketones in the urine.
Increased blood glucose alone may be a poor indicator as some children with any type of infection might present with increase blood glucose levels.
As type 2 diabetes increases in children, it is very important to differentiate between the two from the day of diagnosis for treatment and management reasons and educational approaches. Maybe the most obvious indicator is the body mass of the child. A slender pre-pubertal can be assumed to be a type 1 diabetic, however in an overweight child, it is difficult to differentiate if the diabetes has been brought on by lifestyle (type 2) or not.
Initial Care
Diabetes in children, regardless of age, can be very complex and therefore the initial treatment is crucial. This initial treatment can be done in or out of hospital, but, many patients who are diagnosed to present with very high blood glucose levels and should be hospitalized for that medical emergency.
Once stabilized, a team of pediatricians, endocrinologists, nurses, dietitians and psychologists will be involved to ensure an optimal treatment plan.
Education and care
- Education should be individualized to the setting of the child including the family, cultural requirements and needs
- Education is not a once-off event at diagnosis. Families and children need ongoing educational support
- Children with diabetes should wear identification at ALL times in case of medical emergencies, especially those who are frequently away from home or taking part in sport
- Meal plans must be individualized for each patient and be revised on an ongoing basis to be current with the child’s physical activity, schedules, eating patterns and preferences.
Aim of Nutrition Interventions
Nutrition interventions are very individualized as previously mentioned. Therefore, it is best to contact a registered dietitian for a modified daily meal plan suitable for your child.
- Maintain a near normal blood glucose level by balancing food intake and medication
- Prevent short and long term complications
- Encourage regular mealtimes with the even spacing of carbohydrates throughout the day
- Recommend low GI foods that are rich in fiber such as beans, vegetables, legumes, oat bran and fruit with skin such as apples.
- Ensure sufficient antioxidant intake from fruit and vegetables
- Optimizing exercise routines
Children < 6 years of age
The relationship between low blood glucose levels (hypoglycemia) and possible neurological or mental impairment is of great concern for parents, Another problem in this age group is the unpredictable intake of food such as fussy eaters.
Therefore, in this age group, management will largely rely on the eating pattern of the child and with the aim of preventing possible hypoglycemic episodes in a very crucial brain developing period of life.
Children 6-12 years of age
In this age group, children will spend a large portion of their day away from home. Those who are dependant on insulin will require intense training and involvement of teachers at school.
Good communication should be established between parents, healthcare workers and teachers to ensure flexibility for the child to eat and inject with assistance and supervision as needed, depending on the abilities and age of the child.
Type 2 Diabetes in children
We all think that type 2 diabetes can only be diagnosed in adults, but, this has been changing over the last few years as the prevalence of obesity among children is increasing both in developed and developing countries. In Europe and the USA it has more than doubled in the last 20 years.
1. Fat Mass in type 2 Diabetes
Together with an increase in body mass, and especially fat mass, insulin resistance, (which is the key in type 2 diabetes) has also increased.
The relationship between insulin sensitivity and body fat is well documented in lean and obese patients, Body fat mass is the most important factor contributing to insulin resistance in obese children. 15-18 % and 7-9% of total body fat is found in the abdominal regions of males and females respectively, which contributes to insulin resistance.
2. Puberty in type 2 Diabetes
It is normal to have a decrease in insulin sensitivity during puberty even in healthy adolescents and those who are at normal weight. Girls, however, appeared to be even more insulin resistant than boys. This decrease in insulin sensitivity can be due to growth hormones or due to an increase in fat mass.
Even type 1 diabetics, who have been diagnosed at a pre-pubertal age, might need adjustment and increase of their normal dose of insulin, due to the decrease in insulin sensitivity.
3. Risk Factors for type 2 Diabetes
3.1 Born at a low birth weight (<2.5 kg)
There is a relation between those who were born at a birth weight < 2.5 kg and glucose tolerance later in life
3.2 Maternal diabetes (mother have diabetes when pregnant with the baby)
Maternal diabetes appears to increase the risk of obesity in the offspring. This obesity accelerates the development of insulin resistance and type 2 diabetes.
We hope that this information can help you and your children. Remember that a diabetic diet is nothing other than a healthy diet and lifestyle that even those without diabetes should follow. Remember that every child is different and that you should seek individual treatment if your child has diabetes or is suspected of having diabetes.
The Good Life Dietitians are here to help. Drop us a mail to guide you to an individual session with a dietitian
Sources
Levy-Marchal C, Czernichow P. Insulin resistance in type 2 diabetes in children. Annales Nestle 2005; 63: 10-16
Silverstein J et al. Care of Children and Adolescents with Type 1 Diabetes. Diabetes care. Vol 28. 2005
It's indeed sad that even the children can be battling with diabetes. It's just great that there are now treatments and medication for this.
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