DIABETES IN CHILDREN :CAUSES AND SOLUTION

DIABETES IN CHILDREN: CAUSES AND SOLUTION 

 By Nwanaga Chinedu

Diabetes is a complex group of disease with a variety of causes. Children with diabetes have high blood glucose, also called high blood sugar or hyperglycemia. It is a disorder of metabolism, the digestive tracts breaks down carbohydrates sugars and starches found in many foods into glucose, a form of sugar that enters the blood stream. Diabetes develops when the body doesn�t make enough insulin or is not able to use insulin effectively, or both. Insulin is made in the pancreas, an organ located behind the stomach.

Diabetes is caused by a lack of insulin due to the destruction of insulin-producing beta cells in the pancreas. In type 1 diabetes -an autoimmune disease -the body�s immune system attacks and destroys the beta cells. Normally, the immune system protects the body from infection by identifying and destroying bacteria, viruses, and other potentially harmful foreign substances. But in autoimmune diseases, the immune system attacks the body�s own cells. In type 1 diabetes, beta cell destruction may take place over several years, but symptoms of the disease usually develop over a short period of time. Type 1 diabetes typically occurs in children and young adults, though it can appear at any age. In the past, type-1diabetes was called juvenile diabetes or insulin-dependent diabetes mellitus. Latent autoimmune diabetes in adults (LADA) may be a slowly developing kind of type 1 diabetes. Diagnosis usually occurs after age 30. In LADA, as in type-1 diabetes, the body�s immune system destroys the beta cells. At the time of diagnosis, people with LADA may still produce their own insulin, but eventually most will need insulin shots or an insulin pump to control blood glucose levels.

Also, heredity plays an important part in determining who is likely to develop type-1 diabetes. Genes are passed down from biological parent to child. Genes carry instructions for making proteins that are needed for the body�s cells to function. Many genes, as well as interactions among genes, are thought to influence susceptibility to and protection from type-1 diabetes. The key genes may vary in different population groups. Variations in genes that affect more than one percent (1%) of a population group are called gene variants. Some other causes of diabetes among children include;

Environmental Factors: Factors such as foods, viruses, and toxins, may play a role in the development of type-1 diabetes, but the exact nature of their role has not been determined. Some theories suggest that environmental factors trigger the autoimmune destruction of beta cells in children with a genetic susceptibility to diabetes. Other theories suggest that environmental factors play an ongoing role in diabetes, even after diagnosis.

Viruses and infections: A virus cannot cause diabetes on its own, but children are sometimes diagnosed with type-1 diabetes during or after a viral infection, suggesting a link between the two. Also, the onset of type-1 diabetes occurs more frequently during the winter when viral infections are more common. Viruses possibly associated with type-1 diabetes include cytomegalovirus, adenovirus, rubella, and mumps. Scientists have described several ways these viruses may damage or destroy beta cells or possibly trigger an autoimmune response in susceptible children . For example, anti-islet antibodies have been found in patients with congenital rubella syndrome, and cytomegalovirus has been associated with significant beta cell damage and acute pancreatitis��inflammation of the pancreas. Scientists are trying to identify a virus that can cause type 1 diabetes so that a vaccine might be developed to prevent the disease.

Infant feeding practices: Some studies have suggested that dietary factors may raise or lower the risk of developing type-1 diabetes. For example, breastfed infants and infants receiving vitamin D supplements may have a reduced risk of developing type 1 diabetes, while early exposure to cow�s milk and cereal proteins may increase risk. More research is needed to clarify how infant nutrition affects the risk for type-1 diabetes.

What causes type-2 diabetes?

Type-2 diabetes- the most common form of diabetes is caused by a combination of factors, including insulin resistance, a condition in which the body�s muscle, fat, and liver cells do not use insulin effectively. Type-2 diabetes develops when the body can no longer produce enough insulin to compensate for the impaired ability to use insulin. Symptoms of type-2 diabetes may develop gradually and can be subtle; some people with type-2 diabetes remain undiagnosed for years. Type-2 diabetes develops most often in middle-aged and older people who are also overweight or obese. The disease, once rare in youth, is now becoming more common in overweight and obese children and adolescents. In fact, scientists think genetic susceptibility and environmental factors are the most likely triggers of type 2 diabetes.

Obesity and Physical Inactivity

Physical inactivity and obesity are strongly associated with the development of type-2 diabetes. People who are genetically susceptible to type-2 diabetes are more vulnerable when these risk factors are present .An imbalance between caloric intake and physical activity can lead to obesity, which causes insulin resistance and is common in people with type-2 diabetes. Central obesity, in which a person has excess abdominal fat, is a major risk factor not only for insulin resistance and type-2 diabetes but also for heart and blood vessel disease, also called cardiovascular disease (CVD). This excess �belly fat� produces hormones and other substances that can cause harmful, chronic effects in the body such as damage to blood vessels. The DPP and other studies show that millions of people can lower their risk for type-2 diabetes by making lifestyle changes and losing weight. The DPP proved that people with pre diabetes- at high risk of developing type-2 diabetes- could sharply lower their risk by losing weight through regular physical activity and a diet low in fat and calories. In 2009, a follow-up study of DPP participants- the Diabetes Prevention Program Outcomes Study (DPPOS) - showed that the benefits of weight loss lasted for at least 10 years after the original study began

Abnormal Glucose Production by the Liver

In some people with diabetes, an abnormal increase in glucose production by the liver also contributes to high blood glucose levels. Normally, the pancreas releases the hormone glucagon when blood glucose and insulin levels are low. Glucagon stimulates the liver to produce glucose and release it into the bloodstream. But when blood glucose and insulin levels are high after a meal, glucagon levels drop, and the liver stores excess glucose for later, when it is needed. For reasons not completely understood, in many people with diabetes, glucagon levels stay higher than needed. High glucagon levels cause the liver to produce unneeded glucose, which contributes to high blood glucose levels. Metformin, the most commonly used drug to treat type-2 diabetes, reduces glucose production by the liver.

Damage to or Removal of the Pancreas

Pancreatitis, cancer, and trauma can all harm the pancreatic beta cells or impair insulin production, thus causing diabetes. If the damaged pancreas is removed, diabetes will occur due to the loss of the beta cells.

Diabetes is a serious and costly disease affecting than ten million adults Nigerians. The chronic complications of diabetes include; accelerated development of cardiovascular disease, end stage renal disease, loss of visual acuity, and limb amputation. And all of these complications contribute to the excess morbidity and mortality in individuals with diabetes. Moreover, the prevalence of diabetes in children is increasing. If the incidence and prevalence of diabetes in children are increasing and if this increase cannot be reversed, our society will face major challenges. That is the burden of diabetes and its complications will affect many more individual than currently anticipated, and the cost of diabetes to our society will cause us to consume enormous resources.

                                                 photo credit :Gettyimages

SOLUTIONS TO DIABETES IN CHILDREN

Available solutions to diabetes in children include the following:

Comprehensive self-management education: The National Standards for Diabetes Self-Management Education is a useful framework for providing this invaluable component of treatment. Self-management education should include teaching self-monitoring of blood glucose (SMBG). SMBG should be performed as needed and during periods of acute illness or when symptoms of hyper- or hypoglycemia occur. Patients on insulin or sulfonylureas should also monitor periodically for asymptomatic hypoglycemia.

Routine blood glucose monitoring should be tailored to individual needs but should probably include a combination of fasting and postprandial glucose measurements. HbA1c should be assayed to monitor glycemic control and the results and their significance shared with the patient and family. Referral to a dietitian with knowledge and experience in nutritional management of children with diabetes is necessary.

Dietary recommendations should be culturally appropriate, sensitive to family resources, and provided to all caregivers. Encouraging healthy eating habits by the entire family is important. Behavior modification strategies for changing lifestyle and decreasing high-caloric high-fat food choices should be discussed.

Exercise can decrease insulin resistance and is an important component of weight management. Decreasing sedentary activity, such as television viewing and computer use, has been shown to be an effective way to increase daily physical activity in children. Involvement of family members can provide positive reinforcement and make overall family health a higher priority.

CONCLUSION

Diabetes is a complex group of diseases with a variety of causes. Scientists believe genes and environmental factors interact to cause diabetes in most cases.

children with diabetes have high blood glucose, also called high blood sugar or hyperglycemia. Diabetes develops when the body doesn�t make enough insulin or is not able to use insulin effectively, or both.

Insulin is a hormone made by beta cells in the pancreas. Insulin helps cells throughout the body absorb and use glucose for energy. If the body does not produce enough insulin or cannot use insulin effectively, glucose builds up in the blood instead of being absorbed by cells in the body, and the body is starved of energy.

Prediabetes is a condition in which blood glucose levels or A1C levels are higher than normal but not high enough to be diagnosed as diabetes. People with prediabetes can substantially reduce their risk of developing diabetes by losing weight and increasing physical activity.

The two main types of diabetes are type-1 diabetes and type-2 diabetes. Gestational diabetes is a third form of diabetes that develops only during pregnancy.