Paediatric Diabetes: How To Manage Type 1 And Type 2 Diabetes In Children? - Dr Srinath Aswathiah

The past generation has witnessed a surge in the number of children with Diabetes. It is important to know two types of diabetes that are more common in children Type 1 Diabetes (T1DM) and Type 2 Diabetes (T2DM) although there are other variants, they are less common.

In T1DM here is complete deficiency of Insulin is more common in early age & carries a high genetic cause whereas in T2DM there is relative insulin deficiency encountered in child’s later years due to a combination of genetic cause & obesity encountered due to poor lifestyle practices.

In most cases with T2DM, illness begins with excess weight gain, can pose challenges to insulin and cholesterol metabolism. One can vary from having mild glucose elevations to severe glucose values what is being defined as impaired glucose tolerance to true Diabetes where there are elevated levels of fasting and or post meal glucose elevations.

In T1DM the illness is picked up very early since they are more symptomatic like poor growth, significant weight loss, increased thirst & passing urine more frequently since it is an autoimmune reaction where body attacks its own cells. Concerns are with T2DM, especially in children, wherein alarming symptoms are not seen initially until the condition progresses to a more serious situation.

Many times, it is picked up when a child presents to a doctor with some other problem & blood or urine tests show elevated glucose levels. So, it is very necessary to screen high risk children early in life. In either case, young people who develop Diabetes, have a higher risk of health challenges throughout their life.

If we focus on T2DM here, since it is a condition where reversible causes can be worked with, recent studies delineate risk factors for the development of T2DM in children and young adults. Incidence rates of T2DM increase with age, as puberty is associated with a challenge in insulin production.

Emerging evidence suggests that lifestyle intervention and ideal medical intervention may reduce the rates of development of type 2 diabetes in subjects at highest risk which mainly include obesity, strong diabetes history in family, diabetes affecting mother during pregnancy, ethnicity like we as Asians have increased risk, low birth weight & most importantly dietary factors like excess caloric intake, low fibre diet, high trans-fatty acids and saturated fat which increases risk and reduced intake of fibre & polyunsaturated fat and long-chain n-3 fatty acids which may have a protective role.

The American Diabetes Association recommends risk-based screening for type 2 diabetes after onset of puberty or age 10 years in children who are overweight, or obese and have one or more additional risk factors as mentioned earlier. In high children screening is recommended every 3 years and if tests are normal to recheck more frequently if BMI increases. The definitions of diabetes in children and adolescents are the same as in adults.

Screening for children with risk factors and who do not have symptoms of Diabetes a single fasting blood test which tests glucose levels (FBG) and an average glucose over 3 months what we call HbA1c is sufficient and if abnormal levels doctors do check a 2 hours glucose challenge test to confirm Diabetes.

Management of Diabetes varies between T1DM & T2DM. For T2DM preventive and treatment of diabetes, a structured management plan is recommended with provision of extensive education on promoting self-management skills and establishing individualised plans for self-monitoring of glucose.

Lifestyle interventions aimed to achieve desired weight loss which includes improving diet standards with special importance given to nutrition and increase physical activity are often recommended. Role of medications in children with T2DM options are limited which includes an oral antidiabetic medications and Insulin. Other injectable options aimed at weight and glycose control are being tried.

In T1DM, the answer is only Insulin, since the body cannot produce Insulin. Management is straight forward to administer Insulin. Here 2 types are insulin are commonly used by doctors, one type of insulin for meals which are short-acting only for meals & another insulin as background cover which should last round the clock meaning a long-acting Insulin. Room for oral medications usually doesn’t exist unless the child is obese, which is less common with T1DM.

In T2DM, management can be challenging as there are limited oral medication used in children. If that fails, only options remains to administer Insulin. Here more importance is being laid on lifestyle measure like encouraging physical activities & to have a good balanced diet.