Diabetes and children

‘Diabetes can be mastered and life will go on’

As a parent of a child with diabetes

• Do not over- protect the child…

It can create a problem with other siblings who feel  that too much attention is being given.
The child with diabetes also needs to develop independence to lead a normal life with diabetes.

• Consult a team of doctor, nurse, dietitian, and child psychologist. 

• Create awareness…

Involve  grandparents and siblings, neighbours and school authorities and tell them about the condition, its effect on the child and what they can do  to help or do in  case of emergency.

• Learn…

How to give shots, monitor blood glucose, test for ketonuria, recognize the symptoms of  hypoglycemia and deal with it, food requirements and preparation of nutritious meals that tackle hunger and assist growth and development of the child and also cater to individual needs as well as family food habitswith very small children with diabetes.

• Communicate with the child with diabetes in simple words and be to the point …

Although blood tests and injections hurt, they are an important part of the treatment

Make them understand the reason for the changes in diet, activity and so on.

Set limits on food and activity. 

Praise is a strong motivator for young children.

• Be extra vigilant on sick days…

Increase blood glucose monitoring

Check more often for urinary ketones 

Take weight often to check for weight loss 

Prevent dehydration.

• Encourage independence in older children… 

Encourage children to take more responsibility for their diabetes so that by mid -adolescence they are able to manage on their own most of the time.

• Prepare the child …

To tackle any problems that they might face at play or at school.

• Get the help of teachers…   

To help your child cope with diabetes at school.

In primary school, a child usually has one teacher for almost all activities, but as he or she moves there will be many teachers who will need to know that your child has diabetes and what to do.

Diabetes and infections:

People with diabetes face greater risk of infections because …

• High levels of blood sugar can weaken the immune system that protects the body against invading bacteria, virus and fungi. 
• Some of the bacteria, virus and fungi thrive on the sugar. 

People with diabetes tend to have infections everywhere- mouth and gums, lungs, skin, feet, genitals, or incision areas after surgery.

Other complications of diabetes add to the risk of infection.  A bladder affected by neuropathy makes one unaware of voiding, and can result in bladder infections. If your arms and legs are affected by neuropathy, you may not notice a cut or burn which, if not treated, can get infected.

Legs and feet are prone to infections because loss of sensation makes people unaware of injury which then becomes infected. Slow blood circulation harms the healing process. High blood glucose weakens the white blood cells and lowers ones immunity. An infected area at the bottom of the foot can develop an ulcer. In untreated ulcers, layers of skin and tissue are destroyed by the infection creating a hole which may reach the bone and infect it. If leg and/ or foot infections get worse, the surgeon may have to amputate the part to save the rest of the limb.

Many women with diabetes often get Candidiasis, a vaginal yeast infection because the moist environment and the high blood glucose supplies nourishment to the yeast.The symptoms are a burning, itching sensation in the vaginal area often accompanied by a thick white discharge.  

People with diabetes also develop dental problems such as caries and gingivitis- red swollen gums that bleed easily- which are very often ignored.An annual dental check- up is compulsory.

People with diabetes are also prone to lung infections especially influenza and pneumonia.

Prevention:

Prevent gum disease or periodontitis by brushing and flossing your teeth regularly. 

Go to a dentist to clean your teeth twice a year.

Prevent candidiasis by improving blood glucose control, wearing all- cotton underwear, avoiding tight clothing that restricts the flow of air. 

Check your feet everyday for ulcers, calluses, corns or other problems. Wear good, fitting shoes. Keep weight off affected part, wear special shoes and go to the doctor if you notice swelling in a joint. It is important to keep blood flowing to your feet through exercise and regular walks, keeping high blood pressure and cholesterol down,  and stopping smoking. 

Vaccinate against flu and pneumonia.

Go to your doctor regularly.

CALL YOUR DENTIST IF:

Your gums bleed when you brush your teeth or eat food, gums are red, swollen or tender, gums have pulled away from teeth.

GO TO A DERMATOLOGIST IF :

Redness, swelling, pus or pain of bacterial infection

Athletes foot, vaginal itching, ringworm or other fungal infection

Blisters or bumps on the back of the fingers, hands, toes arms legs or buttocks

Rashes bumps or pits near insulin injection site.

VISIT A PODIATRIST IF YOU HAVE:

An open sore ulcer on your foot

Any infection in a cut or blister

A red tender toe- ingrown nail

Any puncture wound

Pain, tingling, numbness or burning.

Keep a check on blood glucose levels.

Your goal is to help your body use the glucose you take in efficiently. Insulin-users should match blood glucose levels to food intake and exercise .People on oral diabetic medication use a similar technique, but making fine adjustment is more difficult. All people with diabetes should be careful of their carbohydrate intake and get regular physical exercise to help the body move the glucose into the cells where it can be used for energy.

It is not too late to improve blood glucose control if you already have complications, as all complications can be treated and many diabetic complications can be kept from getting worse with good blood glucose control and a healthy living plan – exercise, nutritious food in healthy portions. 

Besides controlling glucose, quit smoking, eat healthy, control blood pressure, and exercise regularly.

HOWEVER, DESPITE YOUR BEST EFFORTS YOU MAY GET COMPLICATIONS THROUGH FACTORS YOU CANNOT CONTROL SUCH AS AGE, RACE, AND GENES .BUT DON’T GIVE UP.

“Make Diabetes fit into your life, don’t fit your life into diabetes”- Phil Knott

Reference: 

1. American Diabetic Association Complete Guide to Diabetes: the ultimate home diabetes reference— 2nded. 

2. Diabetic Complications. Edited by R.David Leslie & Paolo Pozzilli

Diabetes and the kidney

The kidneys work 24 hours a day to remove toxins the body makes or takes in. They are the body’s filtration units, and poisons from the body enter the kidneys through the walls of tiny blood vessels.

When capillaries cannot filter out impurities, it results in nephropathy where waste products remain in the blood and important products like protein and nutrients are lost in the urine.

Symptoms of kidney damage such as fluid retention,sleeplessness, decreased urination, tiredness, vomiting and weakness are absent in the early stages and appear much after the damage is done. However,not all people with diabetes get nephropathy. 

Hypertension also damages the kidneys. Years of high blood pressure can damage the filtering units and the removal is less efficient. 

Prevention: 

Risk of nephropathy can be reduced by :

—Controlling blood glucose level 

—Testing urine regularly to check for presence of small amounts of protein (microalbumiuria)

—Keeping a healthy weight and consuming low salt diet to control blood pressure

—Having medication to control blood pressure

Diabetes and the nervous system :

The nervous system controls every activity of the body. It is the means of communication between the brain and other parts of the body. Too much glucose can damage nerves by upsetting the chemical balance inside nerves or by getting them pinched by the surrounding tissues; or by slowing down or stopping the flow of blood to them so that they do not get sufficient oxygen. When they are damaged, nerves may be unable to send messages, send them at the wrong times or send them too slowly. This condition is called neuropathy.

Neuropathy is usually seen in people who have had diabetes for many years or have poor blood glucose control. 

Nerve damage can cause a range of effects such as pain in the limbs, loss of sensation, weakness in muscles, loss of bladder or bowel control, trouble with digestion, sexual dysfunction or impotency in males.

Types of neuropathy :

If your arms, hands feet or legs on both sides  -

feel numb, have no sensation to  changes in temperature,  feel shooting or stabbing pains,  feel burning tingling or prickling, or show muscle weakness

                - it could be symptoms of   Distal Symmetric Polyneuropathy.

Wear comfortable shoes and check feet daily as you could injure them without knowing it and it can get infected.

If you have 

Lack of sensitivity to touch or pain, or difficulty moving,  a tingling , burning and numbness of  hands,  and you  keep dropping things without being aware of it,

               - It could be symptoms of Focal Neuropathy 

Nerves are damaged either because blood supply has been cut off or because a nerve is pinched.  

Carpal tunnel syndrome  is one such condition that occurs more often in people with diabetes, especially women,   when the median nerve of the forearm is squeezed by the carpal bones in the wrist. The tingling goes away when arms are relaxed at the sides.

This condition is not permanent and usually goes away within 2 weeks to 18 months with good blood glucose control.

If …

—You have frequent attacksof diarrhoea, constipation, nausea or vomiting,  and stomach and gut muscles do not work properly  

—The bladder cannot be emptied fully and you have  frequent   urinary tract infection 

—Sex life is affected by impotency

—Blood pressure fluctuates between low and high -  (You feel light- headed or dizzy when you stand suddenly, or your blood pressure  goes up  when you exercise)

—You have  too much /too little sweating, or dryness of the skin, or excessive facial sweating while eating

 —Your heart rate does not  speed up or slow down with exercise 

—Early symptoms of low blood glucose levels  are lost and you lose consciousness without warning

You may have Autonomic Neuropathy which affects nerves that control parts of the body not moved voluntarily. 

Neuropathy can start diabetes - related problems:

Charcot’s foot in people with long diabetes- A loss of feeling on weight- bearing joints, such as ankles, and thinning of bones can result in   a painless fracture that goes untreated. Muscle shrinking and joint damage add to the damage and can result in deformed foot. 

 Prevention :

Good blood glucose control, healthy blood vessels  which provide constant blood supply for  good functioning of nerves, exercise, no smoking, healthy meals, foods rich in vitamins and minerals, and  minimum  alcohol consumption.

Be Aware of Diabetes Complications

“Whatever I do, I will get diabetes complications.” 

That’s not true. You can help yourself! Blood glucose levels are the main cause of this. So if you can keep it as close to normal as possible, it will stop the complications from occurring, or slow down those that are already present. Even if it is in your genes, controlling blood glucose can delay the onset of complications.

People with diabetes can live long and healthy lives without complications - THE KEY TO THIS IS THE SAME FOR ALL COMPLICATIONS—

CONTROL BLOOD SUGAR LEVELS AND LOOK FOR COMPLICATIONS AT AN EARLY STAGE.

Too much blood glucose can affect the blood vessels and the nerves and this can create problems in other organs. 

Be alert to these signs of diabetic complications:

Vision problems – blurring, spotting or flashes    

Feeling exhausted without a good reason    

Discomfort in the leg after walking   

Numbness or tingling in hands or feet    

  

Having chest pain with exertion    

Cuts or sores that don’t heal fast ,or are infected for a long time

Constant headaches which may be due to high blood pressure 

Diabetic complications usually develop after many years of high blood glucose levels. However, sometimes the signs of Type 2 diabetes are not easily noticeable and a person may develop symptoms of complications before being diagnosed for diabetes. 

Diabetes and the heart 

Most cardio-vascular complications related to diabetes are due to blockages caused by narrowing or clogging of large and small blood vessels or due to slow blood flow.

The blood supply to the heart, brain, tissues and organs is limited. Blood cannot reach parts of the body .This results in circulation problems and leads to eye and kidney disease. 

Too much glucose can speed up the normal process of narrowing of arteries (atherosclerosis). This decreases blood flow to the heart and brain. 

If the blood supply to the heart slows for some time, it can cause a chest pain called angina.( Not a disease but a warning signal).

A complete stoppage of blood to the heart is a heart attack.

When blood flow to the brain is cut off, it can cause a stroke.

Blockages in the arteries of the legs can cause leg pain while walking, a condition known as intermittent claudication.

Hypertension can also play a part in cardio- vascular disease. The heart works harder to pump blood to parts of the body thus damaging lining of arteries. If untreated for long, this can form fatty tissue that narrows or blocks arteries. It is common in Type 2 Diabetes mellitus.

Hypertension in Type 1 diabetes mellitus can be a pointer for kidney disease.

Hypertension by itself can damage the small blood vessels and capillaries especially in the eyes or kidneys. Hypertension and diabetes together increases cardiac and kidney risk considerably.

Prevent  Cardio-vascular Diseases- 

—Control diabetes and bring down lipid levels, lose weight, keep blood glucose levels low, increase physical activity, eat low- fat, high- fiber food; stop smoking, exercise regularly, and avoid high blood pressure. All these keep the blood vessels clear and healthy.

—Monitor blood glucose levels regularly.

Diabetes and the eye 

Uncontrolled diabetes over a period of time can damage the blood vessels that supply blood to the retina of the eye. Retinopathy is a disease of the retina – the light -sensing region of the inner eye that projects images you see. The central portion of the retina, the macula, which helps us to see fine details, swells. Vision is impaired and blindness results. Retinopathy is common among people with Type 1 Diabetes mellitus but people with long term Type 2 Diabetes mellitus can also get it.

Early detection can slow or stop this from interfering with your vision and only a doctor can detect it in the early stages.

There are 2 major forms of retinopathy:

• Non -proliferative - Blood vessels close or weaken and leak blood, fluid, and fat into the eye. Vision is blurred but does not cause blindness unless it leaks into the area near the optic nerve. 

• Proliferative – New blood vessels, which are  fragile and break easily due to hypertension during exercise or when asleep, grow out of control  in the retina. Blood can leak into the fluid filled portion of the eye in front of the retina blocking light and impairing vision. Scar tissue can also form in the retina which shrink and tear the layers of retina apart, damaging vision. Images look as if they are flapping in the breeze.  

(Advanced stage)

Glaucoma or high pressure in the eyes occurs more often in people with diabetes but can be treated if detected early. 

VISIT YOUR OPHTHALMOLOGIST IF YOU NOTICE:

—Visual problems such as spots, floaters, or cobwebs in your field of vision, blurring or distortion, blind spots, eye pain or persistent redness.

—Have trouble reading books or traffic signals or difficulty distinguishing familiar objects.

Prevention:

—Annual eye examination through dilation.

—Keep blood glucose levels low.

 Do not postpone eye tests.