The diabetic child

diabetes mellitus or type I diabetes is a metabolic or endocrine disease. It is a chronic disease and is caused by a lack of insulin that causes an increase in sugar in the blood (hyperglycemia) and in the urine (glucosuria).

It is the most common endocrine disease in childhood. It affects two children out of every thousand, especially from the age of 10.

There is another type of diabetes called type II that occurs mainly in obese adults and children and is characterized by resistance to the action of insulin, not a production deficit.

Causes

diabetes is caused by a destruction of the beta cells of the pancreas, responsible for making insulin. The destruction is due to an autoimmune process (the immune system recognizes pancreatic cells as foreign and destroys them) in a child with a genetic predisposition.

Insulin allows blood glucose to enter the body's cells: muscles, liver so that these cells can use it as a fuel or source of energy.

Diabetic children cannot properly store and use glucose from the food they eat, so this sugar stays in the blood, increasing normal levels and altering the child's metabolism.

Symptoms

As the cells of the diabetic child lack the main source of energy for their body, glucose, one of the first symptoms is fatigue or asthenia. The child feels an excessive urge to eat (polyphagia). By not being able to use glucose, energy is obtained from the metabolism of fats, so that the diabetic child presents a progressive loss of weight and visibly loses weight.

The kidney arrives at a time when it cannot retain all the excess glucose that circulates in the blood and this escapes through the urine; This causes the child to urinate more than normal (polyuria) and feel thirsty and need to drink frequently (polydipsia).

In the diabetic child, sustained hyperglycemia and the metabolism of fats for energy causes an increase in ketone bodies (popularly called acetone). If the levels of these substances are very high, a serious metabolic state called ketoacidosis occurs, which requires prompt treatment in the hospital. The symptoms of ketoacidosis are: severe light-headedness, shortness of breath, apple-smelling breath, dehydration, vomiting, severe abdominal pain, blurred vision, and in the most extreme cases, coma.

Treatment

Children have type I diabetes, that is, the pancreas is unable to produce insulin, it is what is called insulin-dependent diabetes. The treatment of this type of diabetes is to administer the insulin that is missing to the child through injections several times a day.

These children and their families should be educated about what diabetes is and how to administer insulin. The treatment is for life and the child must be aware of the problem and take responsibility for the controls that must be done as they grow.

diabetes can be controlled but not cured. Insulin treatment aims to prevent or reduce long-term complications of diabetes and to help the child grow and develop properly. Insulin, physical exercise, and a proper diet help maintain correct blood glucose levels.

To achieve all this, capillary blood samples (from the fingertip) have to be taken during the day and insulin doses adjusted.

Insulin needs are individualized, based on each child's metabolism, age, diet, and physical activity.

There are different types of insulin:

• Ultrafast: its effect begins 15 minutes after its administration and its peak of action is reached after 30-60 minutes.
• Rapid: it begins to act within 30 minutes and the peak of action occurs between 1 and 3 hours after the injection
• Intermediate (NPH) or slow: the onset of action is one hour and its maximum effect occurs between 3 and 6 hours.

Normally the child has to be pricked more than once a day with a mixture of different insulins (intermediate and rapid).

The nutrition of the diabetic child must be a balanced diet similar to that of any child of his age.

What has to be taken into account is that the schedules should be fixed in the meals, supplementing the basic meals with a small snack at mid-morning, snack and midnight. Foods rich in fast-absorbing sugars should be avoided: soft drinks, sweets, sweets. They should drink a sufficient amount of water to maintain proper hydration, especially in case of hyperglycemia.

Physical exercise is very important for the child with diabetes. You must be physically active on a daily basis. Physical exercise helps maintain correct blood sugar levels. The only precautions to be taken are to decrease the insulin dose or eat an extra meal beforehand. It is advisable for the child to carry glucose tablets in case they have a drop in glucose during exercise.

Other benefits of sport in diabetic children is the social integration of the child with their peers.

Treatment complications

• Hypoglycemia: it is the most common complication in children with diabetes. It is a state where blood sugar levels drop below normal. It can appear as a consequence of not taking the adequate amount of food, exceeding the amount of insulin or doing an excess of physical exercise. The symptoms are: feeling of hunger, cold sweat, pale skin, weakness, blurred vision and in the most severe cases seizures or coma. The treatment of hypoglycemia, if the child is conscious and stable, is the administration of sugar (fruit juice, glucose). If the child is unconscious or has a seizure, nothing should be offered by mouth and must be transferred to a hospital.
• Hyperglycemia: it is the increase in blood sugar and its cause can be due to an excess of food, lack of physical activity or a lower dose of insulin than necessary. When the child is sick, hyperglycemia can also appear. Symptoms are increased thirst, the need to urinate, weakness, and tiredness. In the most severe cases, it can lead to ketoacidosis, which can be serious.