Overview

Type-1 diabetes is an auto-immune disorder that causes a wide range of symptoms and complications. It can affect people of any age, including children. When children are affected by the condition, managing it effectively is critical as it can affect overall development of the child/person. In this article, we will cover all these and more.

Introduction

Auto-immune disorders are those where the body’s immune system starts attacking an organ, gland or specific tissue in the body, treating it as a foreign body. This damages the organ/gland/tissue and hence affects its functioning. This attack happens automatically, or on its own, without any provocation (hence ‘auto’). There are various auto-immune disorders that affect human beings. One of them is Type-1 diabetes.

In this condition, the body starts attacking the islet cells in the pancreas which produce insulin. Due to the attack, the islet cells get damaged over time. In the process, the pancreas is not able to produce enough insulin, which affects blood-sugar regulation in the person. As a result, the person must take supplementary insulin all of his/her life. While the condition cannot be treated completely, it can be managed well, which helps the person lead a fairly normal life.

Causes and Risk Factors

Type-1 diabetes is seen most often in children; however, adults can also develop the condition. Like other auto-immune disorders, Type-1 diabetes does not have a specific cause, however there are some risk factors.

• Family history: Having a parent or sibling with type-1 diabetes increases the risk slightly.
• Genetics: Certain gene mutations that have happened in a parent, grandparent or the child concerned, indicate a possible risk of type-1 diabetes.
• Race: White Caucasians are more at risk than people of other races.
• Certain viruses: Being infected with various viruses, either once or multiple times, can trigger the condition.

Signs and Symptoms

• Frequent urination: In children, even those who are toilet-trained, this condition can cause bed-wetting.
• Increased thirst, all through the day
• Extreme pangs of hunger even if the person has eaten some time back
• Unexplained weight-loss (without diets or exercise)
• Constant weakness and fatigue
• Moody and irritable behaviours
• Breath that has a fruity smell

Complications

If type-1 diabetes is diagnosed late, or not managed well, sugar-levels in the body remain high all the time. Over time, this can damage many of the internal organs or tissues leading to various secondary ailments.

• Cardiovascular system:Type-1 Diabetes can cause blood-vessels to become narrow as the child grows up. This in turn increases blood-pressure. Constantly high BP can cause heart disease and trigger strokes anytime in the adult life.
• Nervous system: Excess blood-sugar damages the walls of tiny blood-vessels that supply blood to the nerves. Reduced blood-supply damages the nerves. This manifests as pain, burning sensation, tingling sensation and numbness. However, this damage is gradual and happens over a long time.
• Excretory system: Diabetes can damage tiny, blood-vessels in the kidneys that help filter out waste from the child’s blood.
• Sensory organs: Diabetes can damage blood vessels in the retina of the eye, which can lead to impaired vision.
• Skeletomuscular system: Diabetes may cause reduced bone density, leading to porous bones, and an increased risk of osteoporosis in the adult life.

Diagnosis

• Fasting blood-sugar test: The child must fast for 7-8 hours (generally overnight), after which the blood sample is taken. If the sugar levels are 126 mg/dL or higher, then its an indication of Type-1 diabetes.
• Random blood-sugar test: The child must give a blood-sample at a random time (without fasting). If the sugar levels are 200 mg/dL or higher, plus there are symptoms of diabetes, then it indicates Type-1 diabetes.
• A1C or Glycated haemoglobin test: This test will provide the average blood-sugar level of the child, in the last 3 months. An A1C level of 6.5% or higher when the test is done on 2 different occasions, indicates Type-1 diabetes.

Also Read: Kids and Diabetes – A Short Factsheet

Treatment/Management

Since the condition cannot be completely cured, Treatment effectively refers to Managing of the condition so that blood-sugar levels remain healthy at all time. This will require:

1. Taking supplementary insulin
2. Monitoring blood-sugar levels regularly
3. Consuming a healthy diet
4. Exercising regularly

Taking supplementary insulin

The person should take insulin on a regular basis.

Types of Insulin

• Rapid-acting insulin: Starts working within 15 minutes, and effect lasts for 4 hours, with the peak effect occurring at 60 minutes.
• Short-acting insulin: Starts working within 30 minutes, and effect lasts for up to 6 hours, with the peak effect occurring at 90-120 minutes. The most common type in use.
• Intermediate-acting insulin: Starts working between 1-3 hours, and effect lasts for up to 24 hours, with the peak effect occurring between 12-24 hours.
• Long-acting/ultra-long-acting insulin: The effect of this lasts between 14 to 40 hours.

Types of Insulin Delivery mechanisms

• Fine needle and syringe
• Insulin pen with fine needle
• An insulin pump
• Tubeless Insulin pump

Monitoring blood-sugar levels regularly

The child’s blood-sugar must be tested frequently to ensure it stays within safe limits, as often as once in 4 hours. Typically, once before every meal and just before hitting bed. In rare cases, the doctor may even advise checking once in the night. There are 2 mechanisms for this:

• Continuous Glucose Monitoring: Here a sensor is inserted under the skin and a receiver provided to read the sensor. Modern versions offer continuous reading on a smartwatch or smartphone.
• Closed loop system: A high-tech version where the sensor inserted under the skin interacts continuously with an insulin pump so that just the desired amount of insulin is dispersed all the time.

Consuming a healthy diet

A diabetologist working closely with a dietician will design the perfect diet plan for the child. This will factor the needs of the child, and ensure the right mix of carbohydrates, proteins, healthy fats, vitamins and minerals (through fresh fruits and vegetables).

Exercising regularly

Like everybody else, even children with Type-1 diabetes require regular physical activity. This can go up to 1 hour per day. Since exercise alters the blood-sugar levels and its effects last for a long time, the diet plan provided to the child will factor this point.

Coping Strategies

There can be various challenges in the life of a child with diabetes. Both parents/caregivers of the child and the child himself/herself must learn to cope with this over time, else life can be difficult for both. Fortunately, there is a whole lot of information, strategies, guidelines, tips & tricks available in both offline and online forums, created by thousands of such children and their family members, over time. The challenges come from the fact that blood-sugar levels can change randomly and this can affect various aspects of their overall health.

• Fussy eaters: Such children may find finishing the food on plate a challenge in-spite of the food being healthy and tasty. They should be coaxed or disciplined into finishing, as the insulin doses factor the intake accordingly.
• Infection and Illness: Both hormones and blood-sugar levels vary significantly during illness, which alters the insulin requirements frequently. To overcome this, and prevent infection, such children are given regular shots of vaccine for flu, pneumonia and Covid-19.
• Puberty: Since puberty hikes up metabolism due to a surge in hormones, the insulin requirements also start fluctuating. The doctor must be informed about the development so that he/she can make necessary adjustments.
• Sleep: A good night’s sleep can cause a drop in blood-sugar levels during the night. The doctor can notice this through the blood-sugar readings and will accordingly alter the insulin requirements and diet plans slightly.
• Changes in schedules and routines: Schooling, exercise, vacations, new activities and hobbies, all these cause changes in blood-sugar levels constantly. To ensure parents or the child are not taken off-guard, all such activities should be well-planned.
• Regular health check-up: In addition to blood-sugar levels, the doctor will periodically check the BP, cholesterol, thyroid function, kidney function, eye-sight, overall growth and any signs of trouble.
• Regular diabetic health check-up: The doctors will review the child’s blood-sugar variations, insulin requirements, diet-plans and exercise plans. This is integral to diabetes management.
• Managing short-term complications: This includes low and high blood-sugar levels (hypoglycemia and hyperglycemia) and diabetic ketoacidosis (DKA). The doctor will educate the family on signs and symptoms to watch out for, and will take the necessary action when such an eventuality occurs.
• Involving the child in the whole process: Parents of such children should encourage their children to get actively involved in managing his/her diabetes. He/she should take medication, insulin jabs and the right food, on his/her own, with little to no monitoring from the parent. He/she should wear a medical ID tag that mentions the ailment, all the time. He/she should develop a good relationship with the doctors and nurses who are constantly involved in his/her care.
• Schooling: Administrators at the school where the child studies should be informed about the problem, and signs and symptoms to watch out for. They should be given contact numbers of the parents and the doctors who treat the child, in case of an emergency.
• Join the right forums: Coping with the additional burden that comes from all these can be difficult for the parent and the child alike. In recent years, there are various online and offline forums comprising parents of children with type-1 diabetes. The empathy and tips shared, can make a big difference.
• Managing the child’s emotions: A child with type-1 diabetes is still a child only and is vulnerable. It is important to be sensitive to his/her emotions and watch them closely, all the time. Parents should avoid reacting to every change in the mood or emotion of the child.
• Watch out for substance abuse: Such parents should watch out for any signs of substance abuse or wrong habits that the child may get into, in order to cope with his/her hassle. In case they suspect something, they should involve a psychiatrist in the counselling.

Kauvery Hospital is globally known for its multidisciplinary services at all its Centers of Excellence, and for its comprehensive, Avant-Grade technology, especially in diagnostics and remedial care in heart diseases, transplantation, vascular and neurosciences medicine. Located in the heart of Trichy (Tennur, Royal Road and Alexandria Road (Cantonment), Chennai, Hosur, Salem, Tirunelveli and Bengaluru, the hospital also renders adult and pediatric trauma care.

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