Type 1 Diabetes Mellitus in Children A quick fact file.

As astonishing as it seems, the incidence of type 1 diabetes mellitus, the commonest form of diabetes in children 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 a 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 type 1 diabetes is nothing but insulin replacement appropriately designed to suit the needs of individual patients under the care of an endocrinologist.

The care of a diabetic child should be a team effort, led by the pediatric endocrinologist, along with vital roles played by diabetes educators, counselors, pediatric nutritionists, and support groups. Yes, it is a daunting task on the part of the medical and paramedical individuals, but it is not all gloomy out there.

Recent advances in insulin therapy provide opportunities for delivering exogenous insulin in ways which mimic insulin secretion patterns of the human body. The contemporary standard of care, the basal-bolus regime provides basal insulin cover throughout the day with intermittent injections of short-acting insulin covering meal timings. This not only reduces the rate of complications due to diabetes but also prolongs the life expectancy to match that of the reference population.

Thanks to 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. Intensive insulin therapy either through multiple daily dose injections or continuous subcutaneous insulin infusion through the insulin pump is associated with a significant reduction in diabetes-related complications.

More and more advances in research provide opportunities to explore and device modalities to provide better health care with promising outcomes to improve the lives of type 1 diabetic children. A silver lining will continue to exist in the gloomiest of corridors of the medical field.

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

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