Juvenile Diabetes

A peep into a pediatric endocrinologist’s clinic would give you an opportunity to have a glance at the varied spectrum of children with Diabetes waiting for their turn to get their health concerns addressed by the doctor. The commonest and the most peculiar of them would be the child newly diagnosed with antibody-positive type 1 Diabetes mellitus, whose effect would reflect his state of mind. The child & his parents sitting anxiously with a kit full of insulin pens, needles, lancets, a glucometer and a heart full of anxiety about the child’s next needle prick. The other end of the waiting room has an overweight child with type 2 Diabetes who is lovingly referred to as a “healthy” child by the grandmother. Ignorance is truly bliss as this child is just glad about the lack of needle pricks in his life at the moment as he fails to thank the pancreas for the ample insulin it produces.

The rising incidence of pediatric obesity has increased concomitantly the incidence of type 2 Diabetes in children and adolescents. The role of genetic predisposition in type 2 Diabetes mellitus amongst families and the adverse environmental effects on the already unfavorable genes cannot be overemphasized. Advances in genetic research help confirm a rare single gene mediated etiology of early onset diabetes known as monogenic diabetes of the young which typically runs across generations. Physicians caring for children must be aware of prescription drugs being incriminated as causative for diabetes mellitus.

Type 1 Diabetes comprises nearly 85-90% of all cases of pediatric Diabetes. As astonishing as it seems, the incidence of type 1 Diabetes mellitus, has increased over the last 2 decades at a rate of 3 to 5% per annum. The global incidence of type 1 Diabetes would be to the tune of just below 15 new cases per 1 lakh. But as the saying goes about statistics–what it reveals is suggestive, but what it hides is vital.

Sadly but truly, as the pancreatic beta cell reserve of the young type 1 Diabetic child progressively fails, the child manifests with symptoms of excess urination, excess thirst, and weight loss. Lack of awareness amongst the society in general & the denial to accept the diagnosis guilt amongst parents opens the doors to several myths and misguidances, which are in the form of false promises made by people who might be ignorant to the medical field themselves, thus increasing the incidence of Diabetes-related complications, and occasionally at times a fatal outcome.

Some of the commonest myths that you come across would be that “insulin injections are habit forming”, or “a certain oral medication cures type 1 Diabetes”. The treatment of a child with type 1 Diabetes involves insulin replacement, appropriately designed to suit the needs of an individual patient under the care of a pediatric endocrinologist.

The care of a child with type 1 Diabetes should be a team effort, led by the pediatric endocrinologist, along with vital roles played by Diabetes educators, counselors, pediatric nutritionists and support groups. Recent advances in insulin therapy provide opportunities for delivering exogenous insulin in ways which mimic the insulin secretion patterns of the human body. The contemporary standard of care, basal-bolus insulin regime provides basal insulin cover throughout the day with intermittent injections of short-acting insulin to cover meal timings. The intensive insulin therapy reduces the rate of complications due to Diabetes providing life expectancy to match that of the reference population.

Thanks to the advancing technology, the invention of insulin pumps have improved the quality of life of type 1 Diabetics providing relative freedom from needle pricks, flexibility in their daily routines, opportunities to enjoy the freedom of physical exercise and intermittent snacking with timely insulin doses. Insulin pumps are currently the most physiologic modality of intensive insulin therapy administration. Increasing advances in research provide opportunities to explore newer technologic modalities to provide better health care with promising outcomes and in turn improve the lives of children with type 1 Diabetes mellitus. A silver lining will always continue to exist in the gloomiest of corridors of the medical field, in an endeavor to provide the best to these ‘sweet’ children.

Dr. Abhishek Kulkarni | Consultant Paediatric Endocrinology | SRCC Children’s Hospital, Mumbai