In a growing organism, all processes occur much faster than in adults, therefore it is very important to recognize and stop the disease at the very beginning. The development of diabetes in children proceeds rapidly, the time from the first pronounced symptoms to diabetic coma takes a few days, and even hours. Often, diabetes is detected in the conditions of the medical facility where the child was taken unconscious.
The statistics of children's diabetes is disappointing: it is diagnosed in 0.2% of children, and the incidence is steadily increasing, an increase of 5% over the year. Among chronic diseases that debuted in childhood, diabetes is ranked 3rd in the frequency of detection. Let's try to figure out what types of diseases are possible in childhood, how to identify them and successfully treat them in time.
Features of type 1 and 2 diabetes in a child
Diabetes mellitus is a complex of metabolic disorders, which is accompanied by an increase in the concentration of glucose in the vessels. The reason for the increase in this becomes either a violation of insulin production, or the weakening of its action. In children, diabetes is the most common endocrine disorder. A child can get sick at any age, but most often violations occur in preschool and teenagers during the period of active hormonal changes.
Diabetes and pressure surges will be a thing of the past
- Sugar normalization -95%
- Elimination of vein thrombosis - 70%
- Elimination of palpitations -90%
- Excessive Blood Pressure - 92%
- Increased vigor during the day, improved sleep at night -97%
Childhood diabetes is usually more severe and more likely to progress than an adult. The need for insulin is constantly changing, parents are often forced to measure blood glucose and recalculate the dose of the hormone, taking into account new conditions. Insulin sensitivity is influenced not only by infectious diseases, but also by the level of activity, hormonal surges, and even bad mood. With constant treatment, medical control and increased attention of parents, the sick child successfully develops and learns.
Diabetes in children is not always possible to compensate for a long time with standard methods; it is usually possible to stabilize glycemia only by the end of puberty.
Causes of diabetes in children
The causes of violations are not fully understood, but their provocateurs are well known. Most often, diabetes in a child is detected after exposure to the following factors:
- Children's infectious diseases - chickenpox, measles, scarlet fever and others. Also, diabetes can be a complication of influenza, pneumonia or severe angina. These risk factors are especially dangerous in babies up to 3 years.
- Active release of hormones during puberty.
- Psychological overstrain, both long and one-time.
- Injuries, predominantly of the head and abdomen.
- High carbohydrate fatty foods that regularly fall on the child’s table, especially when combined with a lack of movement, are the main cause of type 2 disease.
- Irrational use of drugs, especially glucocorticoids and diuretics. There are suspicions that immunomodulators can also be dangerous, which in Russia are usually prescribed for almost every cold.
The cause of the disease in a child can also be decompensated diabetes in his mother. Such children are born larger, they gain weight well, but they are much more likely to get diabetes.
A definite role in the development of a disorder is played by a hereditary factor. If the first child has diabetes, the risk for follow-ups in the family is 5%. With two parents, diabetics, the maximum risk - about 30%. Currently, there are tests that reveal the presence of genetic markers of diabetes. True, these studies do not have any practical use, since preventive measures that ensure guaranteed prevention of the disease are not currently available.
Classification of diabetes
For many years, type 1 diabetes was considered the only possible one in a child. It is now established that it accounts for 98% of all cases. In the past 20 years, the diagnosis increasingly reveals non-classical types of the disease. On the one hand, the frequency of type 2 diabetes has increased significantly, which is associated with unhealthy habits and a sharp increase in weight among the younger generation. On the other hand, the development of medicine made it possible to determine the genetic syndromes causing diabetes mellitus, which were previously considered pure type 1.
The new classification of carbohydrate disorders proposed by WHO includes:
- Type 1, which is divided into autoimmune and idiopathic. It is more common than other types. The cause of the autoimmune is its own immunity, which destroys the cells of the pancreas. Idiopathic diabetes develops in the same way, but there are no signs of an autoimmune process. The cause of these violations is not yet known.
- Type 2 diabetes in a child. It accounts for 40% of all cases that can not be attributed to type 1. The disease begins with puberty in children who are overweight. As a rule, in this case, heredity can be traced: one of the parents also has diabetes.
- Gene mutations that lead to a violation of insulin. First of all, it is Modi-diabetes, subdivided into several types, each of which has its own characteristics of course and methods of treatment. It accounts for about 10% of hyperglycemia, which cannot be attributed to type 1. This group also includes mitochondrial diabetes, which is hereditary and is accompanied by neurological disorders.
- Gene mutations leading to insulin resistance. For example, type A resistance, most often manifested in adolescent girls, and leprechaunism, which is a multiple developmental disorder accompanied by hyperglycemia.
- Steroid diabetes is a disorder caused by the use of drugs (usually glucocorticoids) or other chemicals. Typically, diabetes of this type in children responds well to treatment.
- Secondary diabetes The cause can be diseases and injuries of the pancreatic department, which is responsible for insulin production, as well as endocrine diseases: hypercorticism syndrome, acromegaly, other genetic syndromes that increase the risk of diabetes: Down's, Shereshevsky-Turner, etc. Secondary diabetes in children takes about 20% of carbohydrate disorders not related to type 1.
- Polyglandular insufficiency syndrome is a very rare autoimmune disease that affects the organs of the endocrine system and can destroy insulin-producing cells.
The first signs of diabetes in children
The debut of type 1 diabetes in children goes through several stages. With the onset of beta-cell degeneration, their remaining functions take over. The child is already sick, but there are no symptoms. Blood glucose begins to grow when cells remain critically low and insulin is lacking. At the same time tissues lack energy. To replenish it, the body begins to use fat reserves as fuel. With the breakdown of fat ketones are formed, which affect the child toxic, leading to ketoacidosis, and then coma.
During the period of sugar growth and the onset of ketoacidosis, the disease can be identified by the following characteristic features:
|Thirst, frequent urination.||Excess sugar is eliminated by the kidneys, so the body tends to increase urination. Diabetes mellitus is accompanied in children by an increase in the number of nightly urges. Intense thirst appears in response to the onset of dehydration.|
|Increased appetite.||The reason is fasting tissues. Due to lack of insulin, glucose accumulates in the baby’s vessels and does not reach the cells. The body is trying to get energy in the usual way - from food.|
|Drowsiness after eating.||After eating, glycemia increases dramatically, which worsens health. In a few hours, residual insulin lowers blood sugar and the child becomes more active.|
|Rapid weight loss.||One of the most recent signs of diabetes. It is observed when there are almost no live beta cells left, and fat deposits are used. This symptom is not characteristic of type 2 and some Mody diabetes.|
|Weakness.||This manifestation of diabetes can be caused both by starvation of tissues and toxic effects of ketones.|
|Persistent or recurrent infections, boils, barley.||As a rule, are the result of a smooth onset of diabetes. Both bacterial complications and fungal diseases are possible. In girls, thrush; in infants, intractable diaper rash.|
|The smell of acetone emanating from the skin, mouth, urine. Sweating||Acetone is one of the ketone bodies formed during ketoacidosis. The body seeks to get rid of toxins by all available means: through sweat, urine, exhaled air - the norms of acetone in the urine.|
The first symptoms may be masked by a viral infection, which has become a provocateur of diabetes mellitus. If you do not go to the doctor in time, the child's condition worsens. Diabetes is manifested by vomiting, abdominal pain, impaired consciousness, therefore, when they are admitted to hospital, intestinal infections or appendicitis often become the first diagnoses.
In order to timely detect diabetes in a child, endocrinologists are advised to test for glucose after each serious illness. Make a rapid test using a portable blood glucose meter can be in most laboratories and some pharmacies. With high glycemia, you can detect sugar in the urine with the help of test strips.
In children, 1 type of diabetes prevails, characterized by acute onset and vivid symptoms. For the diagnosis may be enough classic clinical signs and high sugar. The criteria are glycemia on an empty stomach above 7 or at any time of the day greater than 11 mmol / l. Confirm the diagnosis of tests for insulin, C-peptide, antibodies to beta cells. To exclude inflammation in the pancreas ultrasound.
In which cases it is not possible to unambiguously identify 1 type of diabetes:
- if the disease started mildly, the symptoms increased for a long time, there is a possibility of type 2 disease or its modi-forms. Any worn out or atypical symptoms in the presence of hyperglycemia require additional research;
- child less than 6 months. In young children, type 1 occurs in 1% of cases;
- the child has developmental pathologies. An examination is needed to identify gene mutations.
- analysis of C-peptide is normal (> 200) 3 years after the onset of diabetes, glycemia without treatment is higher than 8. In type 1, this happens in no more than 5% of patients. The rest of the children have beta cells completely destroyed;
- the absence of antibodies at the time of diagnosis - reason to suggest idiopathic type 1 or more rare types of diabetes.
How to treat diabetes in children
Diabetes mellitus type one requires compulsory insulin therapy. It begins immediately after the diagnosis of the disease and continues throughout life. Now the replacement of one's own insulin with an artificial one is the only way to save the life of a child with diabetes. A low-carbohydrate diet can significantly reduce glycemia, but cannot compensate for the disease, because glucose enters the blood not only from food, but also from the liver, in which it is produced from non-carbohydrate compounds. Popular methods can be life threatening. With type 1 diabetes, there are no beta cells, insulin is not produced. In such conditions, sugar is not able to keep normal any miracle cure.
Selection of insulin and parental training on glycemic control occurs in the hospital, in the future it is enough dispensary observation. After the start of insulin therapy, the remaining beta cells temporarily resume their work, the need for injections is greatly reduced. This phenomenon is called honeymoon. It can last a week or a year. All this time, the child should receive small doses of insulin. Completely refuse treatment.
After the honeymoon, the child is transferred to an intensive insulin therapy regimen; both short and long hormone are used. Special attention is paid to nutrition; every gram of carbohydrates should be counted in it. For a good compensation for diabetes, you will have to completely eliminate any unrecorded snacks.
Insulin can be administered under the skin in various ways. The syringe is considered an obsolete way and is used very rarely in children. The most commonly used syringe pens, which allow the injection of almost no pain. By school age, the child already knows how to make injections himself, a little later he learns to collect a pen and put the right dose on it. By the age of 14, diabetics with intact intelligence are able to count insulin themselves and can be independent of their parents in this matter.
The most modern method of administration is the insulin pump.. With its help it is possible to achieve the best results of glycemia. Its popularity in the regions of Russia is uneven, somewhere (Samara region) more than half of children transferred to it, somewhere (Ivanovo region) - no more than 5%.
Type 2 disorders are treated according to fundamentally different schemes. Therapy includes:
|Treatment components||Information for parents|
|Diet therapy||Low-carb diet, complete elimination of baking and sweets. Calorie control to ensure gradual weight loss to normal. For the prevention of vascular disorders limit the amount of saturated fat. The basis of nutrition - vegetables and high-protein products.|
|Physical activity||The level of activity is selected individually. At first, these may be medium-intensity loads - long (at least 45 minutes) walks at a fast pace, swimming. At least 3 workouts are required per week. With the improvement of physical condition and weight loss, a child with diabetes can successfully work in any sports section.|
|Sugar-reducing tablets||Of the tablets, children are allowed only metformin, its use is approved from 10 years. The drug is not able to cause hypoglycemia, so it can be used without constant supervision by adults. When taking metformin, additional control of development and puberty is necessary. The starting dose in children is 500 mg, the maximum dose is 2000 mg.|
|Insulin||Appointed quite rarely, usually temporarily, to eliminate decompensation of diabetes. In most cases, basal insulin is sufficient, which is injected up to 2 times per day.|
What should children with disabilities with diabetes
All children with diabetes at an early age have the opportunity to get a disability, they are assigned the category of disabled child without division into groups.
The grounds for disability are set out in the Order of the Ministry of Labor of the Russian Federation 1024n from 12/17/15. This can be either age up to 14 years, or complications of diabetes, its long-term decompensation, the ineffectiveness of the prescribed treatment. With uncomplicated diabetes mellitus, disability is removed at the age of 14, since it is believed that from now on the child is capable of self-control and the help of parents is no longer needed.
Benefits for a disabled child:
- monthly cash payment. Its size is regularly indexed. Now social pension with
- makes 12,5 thousand rubles;
- payment to a non-working parent caring for a disabled person - 5.5 thousand rubles;
- regional payments, both one-time and monthly;
- improvement of living conditions in the order of turn under the social lease agreement for families registered before 2005;
- compensation of 50% of the cost of housing and communal services;
- reception without a queue at the kindergarten;
- free admission to kindergarten;
- the possibility of obtaining education at home;
- free lunch at school;
- special sparing mode EGE;
- quotas for admission to some universities.
As part of the VED list, all diabetics receive the medicines they need. The list includes all types of insulin and consumables. According to the experience of parents, needles, lancets, test strips give out too little, and they have to be bought independently. For people with disabilities, additional drug coverage is provided.
Possible consequences and complications
Compensation of diabetes in the whole country is assessed by endocrinologists as unsatisfactory, the average glycated hemoglobin in children is 9.5%. In large cities, this figure is much better, about 8.5%. In remote locations, the situation is worse due to poor information of parents, insufficient number of endocrinologists, poor hospital equipment, inaccessibility of modern medicines. Naturally, in such conditions, complications of diabetes are quite common.
What threatens the high sugar child: glucose toxicity is the cause of the development of micro- and macroangiopathy, neuropathy. The poor condition of the vessels provokes numerous comorbidities, primarily nephropathy and retinopathy. By the age of 30, renal failure may occur.
Even at a young age, atherosclerosis, hypertension and even heart attack are possible. These undesirable consequences affect the physical development and learning ability of the child, significantly narrowing the list of professions available to him in the future.
Diabetic foot for children is not typical, usually problems with the vessels and leg nerves are limited to symptoms such as numbness and tingling.
Prevention of diabetes is now one of the most pressing problems of medicine. With the prevention of type 2 disease is simple, as it develops under the influence of the environment. It is enough to normalize the weight of the child, balance his diet, add to the daily routine of training, and the risk of diabetes will decrease significantly.
With type 1 diabetes, a change in lifestyle does not play a significant role, and it is still not possible to slow down the autoimmune process and preserve beta cells, despite the enormous funds invested in research. Immunosuppressants, which are used for organ transplants, can slow down the process. Their lifelong use is poorly tolerated, suppresses immunity, and when canceled, the autoimmune process resumes. There are already drugs that can narrowly influence the causes of diabetes, they are being tested. If the properties and safety of new drugs are confirmed, type 1 diabetes can be cured at the very beginning.
Clinical recommendations for the prevention of diabetes (it is worth considering that they all have rather low effectiveness):
- Regular sugar control during pregnancy. Timely start of treatment at the first signs of gestational diabetes.
- There are suggestions that the use of cow's milk and unadapted milk formulas in a child under one year of age increases the risk of diabetes. Breastfeeding is the first measure to prevent disease.
- The same data is available in relation to early feeding with cereals.
- Timely vaccination to prevent infectious diseases.
- Prophylactic vitamin D in children under one year. It is believed that this vitamin reduces the intensity of immunity.
- Regular tests for vitamin D in older children, if deficiency is detected, a course of treatment in therapeutic doses.
- The use of immunostimulants (feronov) only for indications. SARS, even frequent, is not an indication for treatment.
- Elimination of stressful situations. Good relationship of trust with the child.
- Natural good nutrition. Minimum dyes and other additives. Insulin-dependent diabetes is more common in developed countries, which scientists associate with overly refined and repeatedly processed food.
We wish your children good health, and if there is a problem, then you need patience and strength.