Judy van Bergen was on holiday with her family in December 2009 when her then 11-year-old son, Dian, suddenly became drained of energy and started drinking lots of fluids. "I remember how tired he was after an hour’s swim. He would rest for two hours, which was not in his nature at all. He also lost a lot of weight, about 5kg in two months," Judy recalls.
When Judy finally took Dian to the doctor and he was diagnosed with type 1 diabetes, it felt like her whole world had collapsed. "We both had no idea what to expect and just sat there crying."
These days more and more children around the country are receiving the same news. According to the South African Diabetes Research Group, type 1 diabetes is growing by 3% a year in children and adolescents; among preschool children this figure climbs to 5%.
Experts are also disturbed by the increase in type 2 diabetes; a disease usually associated with an unhealthy lifestyle in older adults. A study conducted in Ohio, America, showed that the incidence of type 2 diabetes among adolescents rose tenfold between 1982 and 1994.
Whereas the increase in type 2 diabetes can be explained by the global obesity crisis, the reason for the sharp rise in type 1 diabetes among children at an increasingly younger age is still unclear.
"There is a very real phenomenon of type 1 diabetes arising at an earlier age," says Dr Michelle Carrihill, a Cape Town paediatric endocrinologist. "Preteens are being diagnosed where in the past they would have manifested as teenagers; and more and more preschoolers are being diagnosed, where previously they would have presented only in the school-going years."
The rise in type 1 diabetes may be partly explained by the fact that doctors have become more conscious of the disease in children and are testing for it earlier.
"Doctors looking after children are becoming more aware that a child, even a very young one, might have diabetes, so they test for it," Carrihill explains. "Clinic sisters are also taught to check the urine of sick children, so they will pick up glucose in a child’s urine, alerting them to the diagnosis. In this way children that might have gone undiagnosed, and could have died from ‘shock’ in the past, will now be diagnosed and treated appropriately."
Balancing blood sugar
In a healthy person insulin is produced by the pancreas and used to convert glucose into energy. But in some people the pancreas doesn’t produce any insulin (type 1 diabetes) or the body isn’t able to use the insulin properly (type 2 diabetes). The result is that glucose builds up in the blood, where it can clog blood vessels and damage tissue. Diabetes is a serious disease with devastating consequences (including heart disease, stroke, kidney failure, blindness and amputation) if left unchecked.
Being diagnosed with a lifelong disease in childhood can be distressing. Fortunately, advances in medicine mean that diabetes can be managed more effectively these days.
Foremost is the use of insulin, which helps to control blood injections. As Dian is scared of injections and it’s hard to monitor insulin injections while he is at school, Judy and her husband Etienne chose an insulin pump for their son. This small device is about the size of a cellphone and is clipped to a piece of the child’s clothing. It has a tiny computer that automatically injects insulin via a catheter into the body as needed. The insulin pump can be programmed according to the child’s insulin needs. If your child does a lot of exercise, for example, he will need more insulin.
It is important to note, though, that blood sugar levels need to be monitored regularly irrespective of the insulin delivery method, especially whenever the child eats or drinks, so that the pump or injections can be adjusted accordingly.
Says Dr Carrihill: "Testing blood sugar regularly by finger-pricking is essential to determine the dose of insulin required, as well as the effect of the given insulin. Self monitoring is also important to prevent acute and chronic diabetes complications, and to monitor for low blood sugars (hypoglycaemia)."
Finding out that your child has been diagnosed with diabetes can be overwhelming at first. But children are extremely adaptable and they can lead normal childhoods with the correct preparation and understanding.
Judy acknowledges that it was a huge challenge to come to terms with the diagnosis. Her family eventually managed to adjust to the new routine, thanks to their strong faith and excellent support network. "We have a fantastic specialist who is on top of the latest research and technology, and Dian’s teachers are also extremely supportive."
According to Dr Carrihill, a team approach centred around the child is the best way of managing diabetes. The team that is involved should include a doctor experienced in looking after children with diabetes, a diabetes nurse educator, and a dietician to give advice on a well balanced diet. Additional support may be helpful from a counsellor, and teachers are often very willing partners in looking after the school-going child with diabetes.
"As the child matures, the focus can shift from their caregivers to more self-performed monitoring, and then injecting. However, at all times during childhood, a diabetic child should have the guidance and support of their parents or guardians."
Dr Carrihill advises involving the whole family to help the child settle into diabetes management without making them feel excluded from normal life.
"Older siblings can be encouraging and help perform and record the blood glucose test, as well as help remind when doses are due. Adult family members can assist by applying normal discipline and routines and allowing the child to partake in all the usual aspects of life as a growing, developing child. Active play, exercise and sport should be encouraged."
Judy agrees: "Believe in your child and encourage him in everything he does. And be there on the days that he feels despondent about his diabetes. We don’t always realise what our children go through and it is important for them to have a sounding board."
Today Dian’s condition is managed very well and he leads an active lifestyle with school, sports and many other extramural activities keeping him busy. When you see him with his friends, he is just another teenager with a bright future ahead of him.
(Birgit Ottermann, Health24, August 2012)
(Photo of three smiling children from Shutterstock)
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