Treatment of diabetes in children

Diabetes is a chronic disease in which the body is unable to produce or use insulin effectively. Insulin is a hormone that transfers sugar (glucose) from food to cells to be used as energy.

In children, the most common type of diabetes is type 1 diabetes, which is an autoimmune disease. However, with the increase in obesity in children, the cases of type 2 diabetes are also increasing.

Diagnosing diabetes in children can come as a shock to families, but with proper management by professionals, diabetic children can lead healthy and productive lives. Treatment of diabetes in children is a complex and multifaceted process that requires a team approach and close cooperation with the family.

Type 1 diabetes in children

Type 1 diabetes (formerly called insulin-dependent diabetes or juvenile diabetes) is an autoimmune disease. In this condition, the body's immune system mistakenly attacks and destroys the insulin-producing cells in the pancreas (Islets of Langerhans). As a result, the body no longer produces insulin.

Symptoms of type 1 diabetes in children usually appear quickly and suddenly and include:

Extreme thirst and drinking a lot of fluids
Frequency of urination and nocturia in a child who already had urinary control
Unwanted weight loss despite high appetite
fatigue and lethargy
Increased appetite (sometimes)
Blurred vision
fruity breath odor (caused by ketones in cases of diabetic ketoacidosis)
Abdominal pain, nausea or vomiting (which can be a sign of diabetic ketoacidosis and is a medical emergency).

Diagnosis of type 1 diabetes is done by fasting blood glucose test, glucose tolerance test, and measurement of glycosylated hemoglobin (HbA1c). In some cases, type 1 diabetes antibodies are also tested to confirm the diagnosis.

Type 2 diabetes in children

Type 2 diabetes (formerly called adult-onset diabetes) occurs when the body does not produce enough insulin or cells become resistant to insulin (insulin resistance). This type of diabetes is increasing in children, especially in teenagers and in connection with obesity and inactivity.

Symptoms of type 2 diabetes in children may be less specific and include:

Thirst and frequent urination (similar to type 1, but usually milder).
Weight gain or obesity.
Darkness of the skin in the folded areas of the body (such as the neck, armpits) which is called acanthosis nigricans.
Fatigue.
Blurred vision.

The role of specialists in the treatment of children's diabetes

Treatment of diabetes in children, especially type 1 diabetes, is a complex and lifelong process that requires a team of specialists and close family cooperation. Pediatric endocrinologist is the center of this treatment team and other members include:

Nutritionist (diabetes): for teaching carbohydrate counting and food planning.
Diabetes Educator: for comprehensive training in daily diabetes management.
Child/adolescent psychologist: to help cope with the psychological challenges of diabetes.
Ophthalmologist and nephrologist: to check and manage possible complications in the future.

Treatment principles of type 1 diabetes in children

Treatment of type 1 diabetes in children mainly focuses on insulin replacement and lifestyle management:

Insulin therapy

The only way to treat type 1 diabetes is insulin injection. Since the body no longer produces insulin, it must be provided externally.

Types of insulin: rapid-acting (for before meals), short-acting, medium-acting and long-acting (basic) insulins are prescribed according to the child's needs and lifestyle.

Injection methods:

Injection with a syringe or insulin pen: the most common method, which is done several times a day (usually 4-6 times). Careful education of parents and child (at the appropriate age) is vital for correct injection.

Insulin pump: a small device that delivers insulin to the body continuously and with very precise and programmed doses. This method provides more flexibility in managing diet and activities and can help control blood sugar better.

Regular monitoring of blood sugar

Measuring blood sugar with a glucometer: several times a day (before meals, before sleep and if necessary). This information is necessary to adjust the dose of insulin.

Continuous blood glucose monitoring (CGM) systems: Devices that continuously measure sugar levels in the interstitial fluid (under the skin) and transmit the information wirelessly to a receiver or smartphone. These systems provide a more comprehensive view of blood sugar fluctuations and can help prevent extreme sugar spikes.

Nutrition and carbohydrate counting

Meal planning: The dietitian teaches the family how to count the carbohydrates in foods. This skill is necessary to match the dose of insulin with the amount of carbohydrates consumed.

Balanced diet: emphasizing the consumption of whole foods, fruits, vegetables and proteins.

Meal time management: Keeping the timing of meals and snacks consistent can help stabilize blood sugar levels.

Physical activity

The importance of exercise: Regular physical activity helps manage blood sugar, maintain a healthy weight, and improve overall health.

Insulin regulation: During physical activity, the need for insulin may decrease. Parents and child should learn how to adjust insulin dose and take extra snacks to avoid hypoglycemia.

Management of low blood sugar (hypoglycemia)

Recognition of symptoms: tremors, sweating, confusion, extreme hunger, moodiness, headache.

Quick treatment: quick consumption of sugar sources such as juice, chocolate, or glucose tablets.

Family and school education: Everyone in contact with the child should know the symptoms and how to deal with hypoglycemia.

Monitoring and prevention of complications

Regular examinations: ophthalmology, kidney function check, and foot examination for early detection of complications.

Accurate control of blood sugar: the best way to prevent long-term complications such as kidney, nerve, eye and cardiovascular diseases.

Treatment principles of type 2 diabetes in children

Treatment of type 2 diabetes in children first focuses on lifestyle changes and then drug therapy is added if needed:

Lifestyle changes

Healthy diet: reducing consumption of simple sugars, saturated fats and processed foods. Focus on fruits, vegetables, whole grains and lean proteins.

Increasing physical activity: at least 60 minutes of moderate to intense physical activity on most days of the week.

Weight loss: Even a slight weight loss can help improve insulin resistance.

Drug therapy

Metformin: the first line of treatment is a drug that reduces insulin resistance.

Insulin: In some cases, especially in the early stages or if there is no control with metformin, insulin may be needed temporarily or permanently.

Other newer drugs used for adults are currently less recommended for children, but research is ongoing.

Regular monitoring of blood sugar: with a glucometer or CGM.

The role of family and school

The role of the family in the management of childhood diabetes is very vital. Parents have important responsibilities including:

Learning to inject insulin and monitor blood sugar.
Carbohydrate counting and food planning.
Management of blood sugar fluctuations.
Emotional support of the child.
Cooperation with the school to train the school staff about child diabetes and how to help in emergency situations.

Summary

Diabetes in children, both type 1 and type 2, is a chronic disease that requires careful and continuous management. However, with the guidance of pediatric endocrinology specialist in Tehran and a team of specialists, and the active cooperation of the family, diabetic children can control their blood sugar well, prevent serious complications and live a completely normal, active and successful life. has made it easier and has increased the hope for a brighter future for diabetic children.

Tags Child diabetes type 1 diabetes type 2 diabetes