DIABETES

Diabetes is considered a rapidly escalating public health threat to the American population.  There are different types of diabetes which affect children and adults, alike.  Type I diabetes is more commonly referred to as insulin dependent diabetes (juvenile onset).  This type of diabetes is multi-factorial in origin, with a genetic predisposition towards its development.  Generally, children with type I diabetes have a deficiency in insulin production by cells in the pancreas.  Type II diabetes (adult onset) develops as a result of insulin resistance or the body’s decreased sensitivity to insulin.   The incidence of diabetes, particularly type II diabetes, in the pediatric population is very low.  However, certain aspects, such as diminished physical activity and the rising incidence of obesity in children, are risk factors that develop and evolve during early childhood.

Parents often question me regarding their child’s risk of developing diabetes.  The level of fear far outweighs the overall incidence of diabetes.  Recently, a patient of mine was diagnosed with type I diabetes.  Having a relative with diabetes, his mother urged me to “test” him for diabetes, despite any symptoms.  With some hesitation, we checked his urine which demonstrated the presence of sugar.  A subsequent blood glucose was obtained, and the child was, in fact, diabetic.  The following questions are among the most frequently raised by parents.

What causes diabetes?  Although the causes have not been fully elucidated, it is believed that, with type I diabetes, the body’s own immune system attacks and destroys the insulin-producing cells in the pancreas.  A genetic predisposition and, perhaps, environmental and/or infectious etiologies may also play a role.  People with type I diabetes must regularly give themselves insulin.   In type II diabetes, the pancreas still produces insulin, but the body’s tissues are partially resistant to its effects.  Treatment includes dietary modification, exercise, monitoring of blood glucose, and glucose-lowering medications, including insulin.

My child’s grandfather had diabetes.  Should we “test” her?  There are no strict guidelines in answering this question.  While there is a genetic predisposition towards the development of both types of diabetes, it would not be warranted to perform bloodwork in the absence of clinical symptoms—for type I diabetes—and in the absence of obesity or other markers—for type II diabetes.  Additionally, the vast majority (upwards of 90%) of type I diabetics have no identified relative with diabetes.  Often, pediatricians perform a urinalysis which should demonstrate the absence of glucose.  This should allay much of the parent’s concern.

How do I know if my child has diabetes?  What are the symptoms?  The symptoms may occur gradually or suddenly, and include thirst, frequent urination, drowsiness, increased appetite, and weight loss.  In severe acute cases (diabetic ketoacidosis), a fruity odor to the breath may be present, as well as labored breathing, lethargy, and/or loss of consciousness.  A high sugar diet in an otherwise healthy youngster is not likely to contribute to the development of diabetes, except (perhaps) in the presence of obesity. 

My child has type I diabetes.  What foods should he eat/avoid?  The diet of a type I diabetic need not be overly restricted.  Eating less fat and smaller more frequent portions of nutritious foods is the primary objective.  Fat restriction is very important for those with type 1 diabetes because high cholesterol and diabetes are two of the four major risk factors for developing heart disease.  Avoiding refined sugar, or limiting its use, is also important.  Additionally, a lower-salt diet (which can benefit blood-pressure) is also recommended.

Will there ever be a cure?  The focus of diabetes research is currently on prevention.  For type II diabetes, this means avoiding a sedentary lifestyle and obesity.  For type I diabetes, there is ongoing research to find ways of controlling the immune system’s destruction of insulin-producing cells in the pancreas.   Currently, the main goal of newer therapies is to improve delivery of insulin in a manner that more closely resembles what happens naturally; thereby making organs less subject to fluctuations in glucose levels.  In addition to these therapies, some patients have undergone transplantation of the insulin-producing cells in the pancreas. 

While no one can prevent diabetes (specifically, type I diabetes), the risk of developing type II diabetes can be greatly diminished, if not eliminated, by reduction of excess weight gain and maintenance of an active lifestyle, including regular exercise.  Many people, including those with the disease, remain unaware of how devastating it can be.  Simple measures can be taken to minimize complications.  As a pediatrician and a parent, I would love to see more kids playing outside and to hear less about Nintendo, X-Box, Playstation 3, and Wii.