The face of diabetes is changing with more children being diagnosed with type 2 diabetes. This is due to changes in lifestyle that tend towards obesity, according to Dr Mahmoud Al Zyoud, consultant at the Pediatrics Endocrine and Diabetes section at Hamad Medical Corporation.
"Before, almost 90 percent of diagnosed cases of diabetes in children involved type 1 diabetes. Nowadays, about 30 percent of diagnosed cases in children involve type 2 diabetes," said Dr Al Zyoud. The number of children diagnosed with diabetes is also increasing yearly.
Diabetes, currently one of the most common chronic diseases, is broadly divided into two types, type 1 or insulin-dependent diabetes, and type 2 which can be managed initially without insulin. According to Dr Al Zyoud, type 2 diabetes previously affected mostly adults. However, this type of diabetes is becoming more common in children due to the increasing prevalence of obesity, a risk factor in this disease.
"Obesity is increasing as children are less active than they used to be. With the present availability of electronic games, computers and cable television, children spend more time indoors and are getting less exercise," explained Dr Al Zyoud.
Eating habits have also changed. Children previously tended to eat more healthy foods, but now with the wide availability of high-calorie, fatty foods and softdrinks in fast food restaurants and supermarkets, children tend to consume more carbohydrates and fats.
"Healthy eating habits and physical exercise are important in preventing obesity. If we can prevent obesity, then we can prevent type 2 diabetes," said Al Zyoud.
Dr Al Zyoud cautioned parents to watch out for the warning signs of diabetes in children, which include increased thirst and appetite, frequent urination or bedwetting, weight loss and general weakness. If children are not diagnosed at this stage, they can proceed to a more dangerous stage called diabetic ketoacidosis, which is characterized by vomiting, abdominal pain and dehydration, and may lead to a state of coma.
"If the parents notice that the child is drinking too much water, wakes often during the night to go to the bathroom, or unexplainably loses weight, it is very important to check the blood sugar immediately. They can do this at home with a glucose meter, or through their doctor or health center," said Al Zyoud. Parents are advised not to wait as early diagnosis is important to prevent the disease's progression to a more dangerous stage.
Dr Al Zyoud noted that the number of children diagnosed early has increased due to greater media focus on diabetes prevention and care, as well as the efforts of the Qatar Diabetes Association towards educating healthcare staff, including school nurses, and the public. With early diagnosis, the number of patients with ketoacidosis has decreased.
"In the schools, we ensure that the teachers and school nurses are informed if a child has diabetes and needs special care. Children with diabetes should have the right to have their blood sugar checked in school, have their regular meals and take sweets, even in the classroom, to increase their blood sugar level," said Al Zyoud.
A child with diabetes will need to be monitored for complications such as the blood sugar becoming too low or too high. It is also important not to misinterpret symptoms that might affect school performance, such as drowsiness or lack of attention in class, and frequent visits to the toilet.
Complications of diabetes can be classified into acute and chronic complications. Acute complications include hypoglycemia or low blood sugar, which can be mild or severe. Mild symptoms include feeling hungry, headache, sweating, shaking or general weakness. These symptoms can be managed by giving simple sugar or orange juice to the child.
When the symptoms are severe, where the child can have convulsions or become comatose, a glucagon injection is given which will increase the blood sugar and help the child to regain consciousness. "We supply every diabetic patient with this injection, and we educate the parents on how to use it and when to use it. It is seldom needed, but it has to be ready in case of unexpected complications," Dr Al Zyoud explained.
Diabetes can also cause chronic complications wherein it can affect the eyes, the kidney, the heart or the blood vessels.
Children with diabetes can still fast during Ramadan. However, precautions must be taken such as taking plenty of fluids without sugar, having Suhoor as late as possible or near dawn, and checking their blood sugar frequently, as they would need to break their fast if their blood sugar is too low or too high. Diabetics should also avoid too much exercise in the afternoon when the blood sugar tends to be lower.
Those with type 1 diabetes should take their insulin as modified by the doctor. Fortunately, the use of insulin pump therapy in the management of type 1 diabetes has enabled people to gain better control of their illness. Insulin pumps are designed to mimic the normal secretion of the pancreas, hence it allows for a more natural and flexible way of managing diabetes than insulin injections.