WHEN CHILDREN ARE DIABETIC

All the pancreas-kidney transplant patients were diagnosed as children and had to inject insulin up to eight times a day. The latest scientific approaches help to make diabetes treatment more bearable for kids
By Ilse Salzwedel

DIABETES among children has increased threefold during the last 30 years. Both type 1 and type 2 diabetes are on the increase but the majority of children suffer from type 1 diabetes where the pancreas doesn’t produce a single drop of insulin.

Alarmingly, type 2 diabetes (caused by being overweight, a lack of physical activity and incorrect eating habits) is also on the increase among children and young adults. But medical experts are still scratching their heads about the increase in type 1 diabetes.“Some children inherit a tendency to develop diabetes but it now seems as if a virus infection could trigger the destruction of the insulin-producing cells in the pancreas.

A major shock could also bring it on sooner,” explains Dr Jacobus van Dyk, a paediatric endocrinologist from Pretoria who heads a clinic for young diabetics.

Although the reason for the increase in type 1 diabetes among children is not clear, doctors agree with Professor Stuart Brink, clinical professor of paediatrics at the University of Boston, that proper control of insulin levels in children is of the utmost importance in order to prevent heart disease, stroke, kidney failure, blindness and amputation at a later stage in their lives.

HOW THIS PARENT DOES IT
Feelings of humiliation and isolation make life difficult for many young diabetics. Children may become rebellious and purposely refuse to test and inject themselves at school.

“They may also start eating prohibited foods on the sly,” says Delene du Toit from Pretoria, mother of Ryno, who was diagnosed with diabetes at three. “If you keep on forbidding certain foods the child is going to eat them in secret and then you won’t have any control over the disease.’’

A diabetes educator suggested that Delene should occasionally allow Ryno to eat something that’s not allowed and simply administer extra insulin. “You won’t believe the difference the odd milkshake or small piece of birthday cake makes.’’

Many moms report that older children often forget to test and inject themselves regularly. They also get irritated if you enquire about it too often. And, of course, no one enjoys those injections.

DO PARENTS NEED TO TAKE EXTRA PRECAUTIONS?
If your child does a lot of exercise he needs more insulin as insulin lowers the blood sugar level. But too much insulin with exercise may also lead to a dramatic drop in blood sugar.

Make sure your child has something sweet at hand. Also give him extra carbohydrates (such as bread or porridge) before he takes part in sport.

Parents of diabetics must always be on the lookout for symptoms such as nausea, a dry mouth, excessive thirst, excessive urination, stomach ache, quick and deep breathing, confusion and breath with a strong odour (not unlike ammonia or nail polish remover).

A common disease such as a cold can make your child’s sugar level resistant to insulin and cause the kidneys to excrete ketones (poisonous waste products) – a condition known as keto-acidosis.

The child can even lose consciousness and will have to be taken to hospital. Test your child’s ketone levels regularly to prevent keto-acidosis. You also need to be extra careful when your child is sick. Even a slight illness can cause complications.

Remember that over-the-counter medicines often contain a lot of sugar and alcohol, which can make a difference if taken regularly or in large quantities. Medicines containing ibuprofen are dangerous if your child has kidney problems.

Diabetic teenagers need to be even more aware than others of the health risks of alcohol because it will make them more susceptible to heart disease, poor circulation and low blood sugar that can lead to a coma. Watch out for signs of depression and eating disorders.

PARENTS’ BEST ADVICE

• Your child’s test kit must accompany him everywhere.


• Build up a support system: experts, friends and family.


• Involve the teachers and keep them informed of your child’s condition.


• Join a diabetes clinic or support group. They often have weekend camps to teach children to be independent and manage their disease by themselves.


• Find a doctor who cares about his patients and is thoroughly informed about diabetes.


• Make sure you have an emergency number for your child’s doctor.


• Involve other children in the family in the life of the diabetic child. It prevents them from feeling left out or neglected and they can also help prevent a crisis situation.

DID YOU KNOW?

• At least one in nine people in South Africa suffers from diabetes.


• Every year about three million people worldwide die of diabetes or diabetes-related causes.


• In Africa many children die of type 1 diabetes without ever being diagnosed.

YOUNG PATIENTS SPEAK OUT
Talk to young diabetics and it soon becomes clear that the disease requires a lot more than just physical adjustments. Children often feel isolated and rejected by their peers

RYNO DU TOIT (6)
FROM PRETORIA
“The worst is that I can’t just eat anything at parties. Special food must always be provided for me.”

MEGAN SWANEPOEL (9)
FROM JOHANNESBURG
“The children tease me,” she tells us, her chest heaving with sobs.

BRANDON SWANEPOEL (12)
HER BROTHER
“Since I started using an insulin pump and don’t need to inject myself so regularly, the other children have started to accept me.”

RACHEL LOMBAARD (11)
FROM DURBAN
“The worst is that I have to inject myself six or eight times a day. The children at school tease me when I feel bad or get nauseous and start shivering.” When she began using a diabetic pump the children tried to grab it from her because they thought it was an iPod.

YOUR GUIDE TO DIABETES

What is diabetes?
Diabetes is a condition in which the pancreas produces no insulin (type 1 diabetes) or does not use the insulin effectively to transform sugar, starch and other foods into energy (type 2 diabetes). Without insulin you will lapse into a coma and die.

The symptoms and tests
Are you always exhausted, do you urinate frequently, remain thirsty and hungry and have trouble focusing your eyes?

If you also start losing weight you may rightly suspect diabetes but tests are required to confirm the diagnosis.

These include a blood test and two kinds of glucose tests. The tests can also indicate whether you’re on your way to developing diabetes. It’s possible for pre-diabetics to prevent type 2 diabetes by losing weight, eating healthily and exercising.

Have your child tested for diabetes if he regularly complains of stomach pains and headache, suddenly and inexplicably starts losing weight, presents behavioural problems or just wants to sleep in the middle of the day.

Also check his eyes: some children’s pupils become enlarged while others develop red circles around their eyes. Sometimes they turn as pale as a sheet, as though all the blood has drained from their face.

The treatment
Diabetes is not a death sentence and can – also in children – be controlled through administering insulin, healthy eating plans and exercise, says Dr Jacobus van Dyk. “It doesn’t mean they have to eat only dull and uninteresting foods but they do have to know how each kind of food will affect their blood sugar so they can adapt their insulin dosage.”

Insulin pumps and pens
New technology, such as insulin pumps and pens, is making it easier to administer insulin. The insulin pump looks like a cellphone and is carried on the body except when you’re swimming or having a bath. A small Teflon catheter is injected into the buttock or stomach, connecting the pump to the body. The pump contains a small computer which automatically releases a specific dose through the catheter into the body each hour in order to maintain a basic insulin level (known as “background insulin”).

When the diabetic wants to eat or needs more insulin to correct his blood sugar level, he simply types his blood glucose level and/or the carbohydrate value of what he has eaten into the computer. It then calculates the amount of insulin required and administers it.

Where moms previously had to drive to school to inject their children, they can now simply note the carbohydrate content on the child’s lunch box. “The child’s blood sugar level is tested before lunch and after break the teacher helps calculate whether any extra insulin is required,” explains Delene du Toit from Pretoria, the mother of a six-year-old diabetic child.

The catheter only needs to be replaced every third day, which means fewer needle pricks a day.

The insulin pen works on the same principle but Dr Jacobus van Dyk warns that these are only aids; the child still has to eat correctly and be aware of his insulin levels. After insulin, correct eating habits are the most important consideration for type 1 diabetics and are also vitally important for the treatment of type 2 diabetics.

The best way to control diabetes in children is by following a holistic approach: after diagnosis young patients and their parents are assisted by a multidisciplinary team consisting of a diabetes educator, dietician, play therapist and psychiatrist.