Childhood Diabetes: Treatment and Incidence
Diabetes is a disease in which the body does not produce and/or properly use insulin. Insulin is needed to covert foods into energy. In type one diabetes the body fails to produce enough insulin; in type 2 the body fails to properly use insulin plus there may be a relative insulin deficiency. At greatest risk in the United States are African American children, Hispanic Americans, and Native Americans.
There is an interesting variation of childhood diabetes worldwide with Finland having 43 cases per 100,000, Scotland 25, England and Wales 17 and Japan only 3 per 100,000.
Symptoms of diabetes for all ages may include thirst, weight loss, tiredness, and frequent urination. In addition, children may experience stomachaches, headaches, and behavior problems.
Type 1 diabetes is treated with insulin management, nutrition management, physical activity, blood sugar testing, and avoidance of hypoglycemia, or low blood sugar. Type 2 is treated with oral medication and/or insulin. The only oral medication approved for children is metformin. Type 2 is also treated with nutrition management, increased physical activity and glucose testing.
Acceptable levels of blood glucose levels are different for children than they are for adults and different for different ages. The “normal” range before eating is 70 to 100 mg/dl. For infants and toddlers the readings should be around 100 to 180 before meals and 110 to 200 before bedtime. School age children should have levels at around 90 to 130 180 before meals and 100 to 180 at bedtime. Children from the ages of 13 through 18 should have before meals readings of 90 to 130 and bedtime levels of 90 to 150. Usually, fast acting insulin is used during the day and slow acting at night. Glucose should always be available in case the child has an episode of hypoglycemia.
There is no “diabetic” diet anymore. The whole family should eat the same foods as the child eats. The foods should include plenty of complex carbohydrates and fiber as these break down more slowly leading to a slower release of glucose into the bloodstream. Complex carbohydrates are found in whole grains, fruits, and vegetables. Unlike in the past, children may have sweets in moderation. Food intake should consist by calorie of 50 to 60% mostly complex carbohydrates, 10 to 20% protein and less than 30% fat. The child should consume from 20 to 30 grams of fiber per day. There should be three main meals and two to three snacks a day.
One of the goals in childhood diabetes is that the child take increased responsibility for her own diabetes management. Self testing can begin from 5 to 7 years of age; counting carbohydrates from 7 to 9 and giving self insulin shots from 8 to 12 with the parent overseeing dose calculation and drawing up of insulin.
Childhood diabetes is no walk in the park but, with support from parents and others, the child can learn to manage her diabetes and lead a full, happy life.
Childhood diabetes has shown a dramatic increase in the last fifteen or so years. The main reason for the growth of childhood diabetes is the increase of type two diabetes that used to be seen mainly in adults. In 1990 only 4% of childhood diabetes was type two but now it is 8 to 45% depending on the group studied and the racial/ethnic mix of the group. 85% of the children with type two diabetes are obese. There has also been an unexplained increase in type 1 childhood diabetes.
