How to care for children with diabetes

Master Johnson was having constant and recurring fever over a period of time while also passing large volume of urine.

Worried by the development, his mother Mrs Jane took him to the hospital for examination and he was diagnosed of diabetes.

Prof. Alphonsus Onyiriuka, a Consultant Paediatrician and Paediatric Endocrinologist at the Department of Child Health, University of Benin Teaching Hospital, (UBTH), described diabetes in children as a condition in which blood sugar level is high for a long time due to lack of or ineffective insulin.

 He said, “Insulin is a chemical substance produced by the body that lowers the blood glucose, so if it is absent or ineffective, blood glucose would be very high.

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“In children, majority of diabetes is due to destruction or damage of pancreas which is the organ responsible for insulin production, and when there is damage to this organ, insulin production would be deficient and diabetes may occur.

“But there are three other factors that may influence diabetes which are genetic factors, family history, that is if there is diabetes history in the family the chances of diabetes is also increased in children, as well as environmental factors.

“For instance, infection may trigger damage to the pancreas leading to diabetes. Also, some drugs like steroids can also cause diabetes because they make insulin less infective.

According to him, there is no known cause for diabetes melitus, but the damage to the pancreas can occur any time in any body. “There are various types of diabetes but this one that I have described is most common in babies and about 90 per cent of babies with diabetes have type one,” he said.

He explained that type one diabetes is as a result of damage to the pancreas but that for the other ones, like type two diabetes, there is relative deficiency of insulin or insulin resistance and these occur in people who are overweight or obese. And also people who are on drugs like steroids or anti-cancer drugs.

Prof Onyiriuka said there are three classical symptoms of diabetes in children. They are passage of large volumes of urine, drinking plenty water and weight loss.

“Other symptoms include gathering of ants at the place where the person passes urine, somebody who has achieved dryness at night suddenly starts wetting the bed, and they may also feel weak,” he added.

The consultant paediatrician said the diagnosis is based on the presence of the classical symptoms

He said, “So, when we have these classical symptoms and we measure the blood glucose, and if it is greater than or equal to 126 milligrams per deciliter of fasting blood glucose , or if you have a random blood glucose which is the sample taken at any time, and it is more than 200 miligrams per deciliter plus the classical symptoms, then we make the diagnosis of diabetes mellitus.”

 For prevention, Prof Onyiriuka, said , “Mothers  that are overweight and obese are likely to have babies that are obese and overweight; and new born babies whose birth weight are above 4 kilogram  are at a higher risk of developing diabetes melitus.

 “So, by avoiding obesity in children, we would also prevent diabetes in children because children who are obese are prone to develop diabetes, particularly type 2. And then drugs, we only give drugs that are necessary for a period. For example like steroids, there is no need to give steroid when they are not necessary and if the patient is on the drug it should be monitored so that if there are problems we can identify it.”

He explained that the treatment for type I diabetes in children involves the administration of insulin because it is the damage of the organ that produces insulin that results to diabetes.

“So, since insulin is deficient, the correct treatment is the supply of insulin that is deficient. In children 90% of diabetes is as a result of lack of insulin”.

 He advised mothers to monitor their children diagnosed of diabetes because it is the monitoring that would help to adjust the dose of insulin to be given.

 “They also need to measure the blood glucose before breakfast in the morning because that would tell us how the night insulin is doing. Also they need to measure it two hours after meal and that would tell how the patient is doing with it.’’

 He added that on no account should insulin be stopped in children with diabetes unless if it is recommended by a doctor.

 They should also let their school teachers and friends know that the child has diabetes because he is on insulin and can have hypocalcemia (A low level of calcium in your blood), as having knowledge of it would let them know what to do.

He said it is not in the best interest of the child to hide the status because low blood glucose is a threat to life, adding that parents should contact a doctor if the child falls sick, has high glucose or has diarrhoea.