Increasing physical activity is key to weight loss and control of diabetes
Increasing physical activity is key to weight loss and control of diabetes

Diabetes is one of the most common chronic diseases in children and adolescents. 

With the high numbers of Bermudians living with diabetes it is important for families to recognize the warning signs and symptoms of the disease and be able to identify when their child may be at risk of diabetes and when they should be screened or visit their doctor.

Diabetes can simply be defined as having too much sugar in the blood and this is due to different disorders in the body, which cause different types of diabetes. 

Type 1 diabetes is caused by a defect in the immune system, which leads to the destruction of the insulin producing cells of the pancreas. 

Insulin is the hormone that allows sugar from the food we eat to be transported into cells.  

Type 1 diabetes used to be called juvenile-onset diabetes and was classically considered to be the only type of diabetes to occur in children but over the last two decades there has been an increasing frequency in the incidence of type 2 diabetes (formerly known as adult-onset diabetes) among young people. It still accounts for a higher percentage of cases of diabetes diagnosed in children.

Type 1 diabetes is five times more common than meningitis but often it is not recognised until the child presents with vomiting, abdominal pain and rapid breathing.  

Parents are advised to take their child to a doctor if they notice any symptoms associated with type 1 diabetes such as excessive thirst, frequent urination, bed wetting, weight loss, hunger, blurred vision, abdominal pain, vomiting, thrush and lethargy. 

Bed wetting (nocturnal enuresis) in a previously dry child can be one of the first symptoms in 90 per cent of children over the age of four. Recurrent infections and oral or genital thrush may also be present.

Challenge

Diagnosis is confirmed with blood tests and it is usual to be admitted to hospital for close medical monitoring and education on managing diabetes: a child diagnosed with type 1 diabetes will need to take injections of insulin for life either via syringe, insulin pen or insulin pump. 

Careful monitoring and learning to balance food, insulin and physical activity is the key to managing type 1 diabetes, and although it is a challenge for most families there is nothing that a young person with type 1 diabetes cannot do or achieve. 

As with any chronic illness seeking support and frequent follow up with the diabetes medical team is vital to prevent further illness or diabetes complications.

Type 2 diabetes in children is often more difficult to detect or classify.  As is the case with adults it can often go undiagnosed for a long period with children exhibiting no symptoms or only mild symptoms at the time of diagnosis. 

Diagnosis of type 2 diabetes in children again can only be confirmed with a blood test so knowing if your child is at risk and when to take a child for screening is important.

Type 2 diabetes begins when the body develops a resistance to the insulin, which it is producing and the body can no longer use insulin properly. 

Type 2 diabetes has a strong genetic component with generations passing down a genetic susceptibility to insulin resistance. 

Obesity is another significant factor and this combined with a low level of physical activity among young people has resulted in an increase of type 2 diabetes in children and adolescents. 

Obesity and inactivity can result in excessive amounts of insulin being produced to compensate for insulin resistance.

Only children who have risk factors for type 2 diabetes need to be screened.

Should my child be screened for type 2 diabetes?

If age or weight match one of these criteria:

Age

-Children older than 10 years

-At the onset of puberty, if puberty occurs earlier

Weight

-Children whose body mass index (BMI) is greater than the 85th percentile for age and sex.

-Children whose weight is greater than 120 per cent of ideal for height.

AND if any two of the following risk factors are present:

-Family history of type 2 diabetes in first or second degree relative (parent or grandparent)

-Ethnic background of African American, Hispanic, American Indian, Asian or Pacific Islander origin

-Presence of conditions associated with insulin resistance:

eg acanthosis nigricans (darkening of skin in patches), polycystic ovary syndrome, high blood pressure, blood fat disorders, high cholesterol or triglyceride levels.

Screening for children at risk for type 2 diabetes should be carried out every two years and involve a fasting blood sugar ordered by your family physician.

Treatment for young people diagnosed with type 2 diabetes is complex but as with type 1 diabetes the goal is to keep blood sugar levels as close to normal as possible.

Management of type 2 diabetes may or may not be with insulin injections or oral medications but should always involve nutrition education and meal planning for the whole family to make healthy lifestyle changes. 

Increasing physical activity is key to weight loss and control of type 2 diabetes in children.

As a community, early intervention and strategies to raise awareness of the connection between healthy lifestyle choices, exercise and the prevention of type 2 diabetes among not just adults but our children must continue in order to prevent the epidemic from increasing.  

Type 1 diabetes is not preventable with lifestyle intervention but in both cases recognizing symptoms and early detection is important in preventing complications later on.

 

For further information on diabetes please contact the Bermuda Diabetes Association at 297-8427.