Diabetes in children

In this article we will find out:

• what is diabetes;
• what is the typical diabetes of children (type 1 diabetes);
• how frequent is it;
• what are the first symptoms;
• how the diagnosis is made;
• how to cure;
• advice for proper nutrition;
• the consequences;
• new therapeutic perspectives;
• what is therapeutic education

What is diabetes

“Diabetes - or diabetes mellitus - it's a chronic disease characterized by high levels of glucose (sugar) in the blood: a condition called hyperglycemia, "Explains Paolo Fiorina, head of the endocrine diseases and diabetology department of the Asst Fatebenefratelli-Sacco of our city and of the international reference center on type 1 diabetes at the Sacco Hospital.

Hyperglycemia is due to the body's inability to use its main source of energy, that is, glucose itself, and in turn this inability depends on a deficiency (absolute or relative) of insulin, a hormone produced by the pancreas which, by binding in specific places on the surface of cells, allows glucose to pass from the blood into the cell.

"There are two main forms of diabetes"Explains the expert. "The 1 type diabetes, typical of children and characterized by autoimmune processes, and the type 2 diabetes, especially typical of adults and more linked to lifestyle, as it is associated with conditions such as obesity and a sedentary lifestyle ". In recent years, in our country as in the rest of the world, type 2 diabetes has also appeared in children, who have always been free of it: a fact that goes hand in hand with thehigh incidence of overweight and obesity in our children.

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Much rarer is the so-called neonatal diabetes: "It is a genetic form caused by mutations that lead to dysfunction in insulin secretion or failure to develop the cells that produce the hormone, present in a very small percentage of affected children."

Type 1 diabetes: the typical diabetes of children

In the vast majority of cases, children with diabetes have type 1 of the disease, characterized by autoimmune processes. “In practice - explains Fiorina - some cells of the immune system (lymphocytes) begin to attack the cells of the pancreas responsible for the production of insulin, to the point of destroying them completely. This leads to a slow but inexorable reduction in insulin production and, consequently, to an excess of glucose in the blood and urine (glycosuria). "

Why this happens is not yet completely clear: “Surely one enters the field genetic component, which explains why type 1 diabetes is more common in the children of people who have the same disease. At the same time, however, there are known cases of homozygous twins in which only one has diabetes, indicating that the genetic is just a predisposition, to which something else must be added and in particular environmental factors that we do not yet know well. It is possible that they are involved too viral or bacterial infections but at the moment we don't know much more ”.

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How frequent is it

According to the data of the Registry of the Paeseno for type 1 diabetes reported by the Del Paesena Society of Pediatrics, in the country live about 20 thousand children and adolescents with diabetes mellitus. Between 1 and 14 years, the incidence is approximately 8-15 new cases per year for every 100 children and adolescents: this with the exception of Sardinia, where instead there are 33 new cases per 100 thousand children and adolescents.

"In the world, there are two age peaks in which type 1 diabetes occurs more easily: at 2-4 years and at 12-14 years”, Affirms Fiorina, underlining that in Del Paese in particular the second peak is more widespread. "Not only that: in recent years we are also witnessing the phenomenon of the onset of type 1 diabetes - which is an increasingly widespread disease all over the world - even beyond the pediatric age".

Diabetes in children, the first symptoms

Fiorina says that “the opening picture is very typical and is characterized by tiredness and exhaustion (even the child who was no longer sleeping may request an afternoon nap and many refuse classic afternoon activities), a tendency to drink a lot and to pee a lot, even at night (sometimes even wetting the bed), weight decrease even if the child appears to be very hungry. Sometimes fever may be present".

In the presence of these symptoms it is normal that, after a few days, the parents consult the pediatrician, who can directly in the office measure blood sugar levels: "In these conditions they generally occur around 350-500 milligrams per deciliter of blood (they should be under 125). Starting immediately the replacement therapy with insulin, the glycemic picture stabilizes within a couple of days ".

If no action is taken with insulin, in a more advanced - and severe - phase of the disease the child comes to manifest heavy and labored breathing, a breath with the characteristic smell of ripe fruit (alito acetonemico) and even a sleep state and loss of consciousness (diabetic coma).

Acetonemic breath is due to the elimination through the breath of large quantities of substances called ketones, which derive from the metabolism of fats and are toxic to the body. In fact, when the cells are unable to use the glucose which is also in circulation due to the lack of insulin that allows it to enter, they react by obtaining energy from other nutrients such as fats (with the production of an excess of ketones) or proteins.

How to make the diagnosis: the tests to be done and the blood glucose values

Diabetes is diagnosed through simple blood tests which can also be performed in the pediatrician's office using a simple drop of blood or a urine sample. They are paradigmatic of diabetes hyperglycemia - with blood glucose values ​​above 125 mg / dl after an 8-hour fast and / or higher than 200 mg / dl regardless of meals - and the presence of glucose and ketones in the urine (glucosuria and chetonuria).

They may also be helpful in diagnosing the dosage of glycated hemoglobin (HbA1c) which is an indicator of the average blood glucose of the last 2-3 months, or other tests related for example to pancreatic autoimmunity.

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Therapy: how to intervene in the case of pediatric diabetes

La type 1 diabetes therapy it is based on the administration of insulin: the intake of the drug must in any case be combined with a particular one attention to nutrition and physical activity. “Typically insulin has to be given for subcutaneous injection three or four times a day, before meals and before going to sleep ”explains Fiorina. Alternatively, special insulin pumps can be used for continuous H24 infusion.

The amount of insulin to be given varies not only according to the child's age, but also to his general state (whether or not he is sick) and any physical activity. “For this it is It is important for the child to measure his blood glucose levels three or four times a day, again before meals or if, for example, you feel unwell. So he can regulate the amount of insulin to be administered ”recommends the expert. The measurement can be done with standard glucometers (the classic devices that prick the finger to release a drop of blood and measure the glucose level) or with sensors injected under the skin that allow continuous measurement and must be changed periodically ".

Of course all these measurements and administrations may seem problematic and at the beginning it is certainly not easy for the child and his family to adapt to the new routine imposed by the disease, even from a psychological point of view. "But actually children with diabetes soon become aware of their disease and what needs to be done to control it: already around the age of 8-10 they often manage things well ”says Fiorina. "Rather, there may be rejection in adolescence, a time when adherence to therapies can become more problematic ".

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In the rarest case of type 2 diabetes, in addition to lifestyle intervention (diet and physical activity, to reduce overweight and obesity), the therapy includes the administration of drugs that improve glucose metabolism and body sensitivity. to the action of insulin.

Nutrition of the child with diabetes
Whether it be 2 type diabetes (less common in children) or of 1 type diabetes, the power supply must always be followed carefully. This does not mean undergoing extreme or rigid diets: as the Children's Diabetes Guide of the Bambino Gesù Pediatric Hospital of the city reminds us, the modern nutritional recommendations for children and young people with diabetes consist essentially of tips suitable for the general population. Here, in general, are the aspects to which to pay more attention:

Quantification of carbohydrates present in a meal
This is a necessary operation considering that carbohydrates are the nutrients with the greatest impact on blood sugar. We recall in particular that i simple carbohydrates (such as table sugar and honey sugars, candies, sugary drinks, jams) are rapidly absorbed and therefore lead to a rapid rise in blood sugar. THE complex carbohydrates (bread, pasta, rice, potatoes, legumes), on the other hand, are slowly absorbed and lead to a slow increase in blood sugar.

Protein foods
The main indications are to eat only one animal protein per meal, so if you eat meat or egg you should avoid cheese and consume fish and legumes more often (in this case even better if accompanied by whole grains). Animal proteins should always be accompanied by abundant vegetables.

Grassi
In addition to the quantity of fats, attention must be paid to their quality, since a high consumption of animal fats is associated with an increased risk of cardiovascular diseases. To reduce harmful fats it is advisable to prefer extra virgin olive oil to butter, not to use margarine, to reduce the consumption of cheeses (preferring leaner and fresher ones) and cheese; eat few cured meats and very few snacks. Read also: The first thousand days of the child. How much can you influence his future health according to epigenetics

Pediatric diabetes, the consequences

In the short term, possible consequences are hypoglycemia, hyperglycemia and diabetic ketoacidosis.

Hypoglycemia consists of a sudden drop in blood sugar, with blood glucose levels below 70 mg / dl. It can be asymptomatic, but if the blood sugar drops quickly it can cause paleness, sweating, tremor, a sense of hunger, palpitations and, if the condition persists, mental confusion, disorientation and weakness.

“Hypoglycemia results from an imbalance between circulating levels of insulin and carbohydrates, for example if you inject too much insulin or forget to snack before strenuous physical activity. Or, again, if vomiting is present ”explains Fiorina.

In case of hypoglycemia, immediate intervention consists in administration of rapidly absorbed sugars: a couple of sachets of sugar or teaspoons of honey or a fruit juice. If the hypoglycemia is severe and the patient proves to be particularly drowsy and unresponsive (soporous state), it is instead necessary to practice aglucagon injection, another hormone produced by the pancreas and involved in glucose metabolism (in practice it allows the liver sugar reserves to be mobilized).

Hyperglycemia on the other hand, it can occur when the blood sugar level rises due to a too large meal or "wrong" foods, or due to a concomitant illness (such as the flu), or due to errors in the administration of insulin. Symptoms are frequent urination, intense thirst, tiredness, blurred vision, irritability, difficulty concentrating, headache. In these cases, it is important to check the blood sugar and give an extra insulin injection.

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And yet, another possible short-term complication is represented by diabetic ketoacidosis, which occurs when insulin deficiency means that the body's cells, unable to use glucose as an energy source, begin to burn fat with the formation of ketones, which are toxic to the body. This can lead to nausea and vomiting, abdominal pain, acetoneemic breath.

Keeping your blood sugar well under control is very important not only to reduce the risk of these complications, but also to reduce that of long-term complications. “In the long run, in fact, states of chronic hyperglycemia end with the damage various parts of the body, from the eye to the kidney, from the heart to the liver to the blood vessels and more, so much so that we talk about retinopathy, nephropathy, heart disease, diabetic vasculopathy (and so on) ”Fiorina points out. However, underlining that a tight control of the glycemic picture is associated with an important decrease in the risk of these complications.

Can Diabetes Be Cured?

"The current state, if healing means no longer having to inject insulin, the answer to this question is no"Explains Fiorina. "Of course, there may be times when glycemic compensation improves and the pancreas begins to function again - we talk about honeymoon - but they are transitory periods ".

“It is true, however, that they exist innovative technologies and therapies that allow an increasingly accurate control of the glycemic picture, which manages to remain within acceptable blood sugar levels for longer and longer times. These new tools are increasingly widespread, even in our country, especially in the most advanced diabetes centers ". Let's talk about, for example subcutaneous insulin pumps, of glycemic holter that do not need a drop of blood to detect blood glucose or very recent insulin pumps that receive blood glucose data measured in real time and are able to modify the insulin administration on the basis of the data obtained (in this case we speak of artificial pancreases).

And many hopes are placed in the new frontiers of research, which concern in particular the immune system modulation therapies (to block the lymphocytes attacking the insulin-producing cells of the pancreas) and the replacement of any "defective" pancreatic cells with stem cell cell therapies.

Therapeutic education
As the information material on diabetes released by the Del Paesena Society of Pediatricians points out, it is very important that the person with diabetes follows certain simple rules for achieving a good quality of life. Here they are:

- learn as much as possible about this condition and how to best manage it;
- take medications regularly;
- follow a correct diet;
- do physical activity;
- lose weight, if overweight, and try not to gain weight;
- keep blood pressure and cholesterol levels under control;
- carry out annual checks of the target organs of diabetes (eyes, heart, kidneys);
- screen for autoimmune diseases associated with diabetes;
- carry out periodic check-ups at the dentist and pay attention to oral hygiene, because diabetes increases the risk of gum infections;
- often examine the feet, even between the toes, paying attention to the appearance of blisters, small wounds.

Additional sources for this article: The disease of the month: all about diabetes, information material from the Paesena Society of Pediatrics; Children's Diabetes Guide from the Bambino Gesù Children's Hospital in the city.

Updated on 14.11.2022

TAG:

• diabetes
• glycemia
• food