Diabetes in children

Diabetes in children: description

By far the most common form of diabetes in infants, children and adolescents is the Type 1 diabetes, In Germany currently suffer from about 30,000 to 32,000 minors, experts estimate. Every year, about 2,300 new cases are added. According to forecasts, these numbers will increase in the next few years. Type 1 diabetics have to give their body the hypoglycemic hormone insulin for life, because in their case the insulin-producing cells are destroyed by the immune system.

More and more often (in addition to type 1 diabetes) in children and adolescents and the Type 2 diabetes detected. This usually occurs after the age of 40 years. However, today many offspring have the typical risk profile of this disease: lack of exercise, obesity and a very sugary and fatty diet. That’s why an estimated 200 children between the ages of 12 and 19 are diagnosed with type 2 diabetes every year – with an upward trend.

Occur in some children and adolescents rare forms of diabetes on. These include, for example, MODY (Maturity-Onset Diabetes in the Young). There is little data on the incidence of such rare forms of diabetes in children, adolescents and even adults.

Diabetes in children: symptoms

One Type 1 diabetes in children often only shows symptoms when more than 80 percent of the insulin-producing beta cells in the pancreas have already been destroyed. Before the insulin residual amount is sufficient to prevent a complete derailment of the sugar metabolism.

However, the symptoms of type 1 diabetes in children may develop within a few weeks. This includes:

• large urine volumes, nocturnal urination or wetting
• extreme thirst and drinking of several liters per day
• Dullness and poor performance
• Weight loss with constant cravings (children with type 1 diabetes are usually slim)
• severe abdominal pain
• In the advanced stage a typical acetone smell (like “nail polish remover”) of the exhaled air

The symptoms of the much rarer Type 2 diabetes in children on the other hand, they develop slowly. They are similar to type 1 diabetes. However, these diabetes children usually have a clear overweight (obesity = obesity).

Diabetes in children: causes and risk factors

The causes of diabetes in children (and adults) depend on the form of diabetes.

Type 1 diabetes in children

Type 1 diabetes is one Autoimmune disease, Here antibodies attack the insulin-producing beta cells in the pancreas and destroy them. The body can not produce enough insulin (absolute insulin deficiency).

Meanwhile, several such autoantibodies that are found in type 1 diabetes are known. These include, for example, autoantibodies against cytoplasmic islet cell components (ICA) and against insulin (IAA).

Why the patient’s immune system works against its own tissue is unclear. Genetic factors seem to play a role in this because type 1 diabetes sometimes occurs in several members of a family. Researchers have identified several gene alterations that appear to be associated with type 1 diabetes.

In addition, other factors are suspected of being involved in the development of the autoimmune form of diabetes. These include, for example infections like mumps, measles and rubella. Scientists are also discussing a possible influence of one to short breastfeeding after the birth or one to early intake of cow’s milk and gluten-containing food to children. These suspected relationships are still being explored.

By the way: Often type 1 diabetes occurs together with other autoimmune diseases, such as celiac disease or Addison’s disease.

Type 2 diabetes in children

Type 2 diabetes develops over years: Body cells are increasingly insensitive to the blood sugar-lowering hormone insulin. These insulin resistance leads to one relative insulin deficiency: The patient’s body usually initially produces sufficient insulin, but does not diminish its effectiveness on the cells. To compensate, the pancreas increases insulin production. At some point, however, she is exhausted due to the overload. Then the insulin production decreases. In advanced stages of the disease an absolute insulin deficiency can occur.

The exact causes of type 2 diabetes are unknown. However, an unhealthy lifestyle can be used – both in children and adults high-energy diet, lack of exercise and overweight promote the development of insulin resistance. Join in genetic factorswho are involved in the development of the disease.

Special forms of diabetes in children

The term MODY (Maturity Onset Diabetes of the Young) includes various forms of adult diabetes that occur in minors. They all rely on genetic defects of the insulin-producing cells in the pancreas. MODY is also referred to as Type 3a diabetes.

There are still some other rare forms of diabetes with different causes (chemicals, medicines, viruses etc.).

Diabetes in children: examinations and diagnosis

The right contact person for the suspected diabetes in children is a pediatrician or a specialist in internal medicine and endocrinology. He may ask you the following questions in the first interview:

• Has your child been remarkably tired lately?
• Does it often need to water or wet at night?
• Does it drink more often lately or do you often complain of thirst?
• Is it complaining about abdominal pain?
• Did you notice a fruity smell (like “nail polish remover”) of the breath?
• Is another family member suffering from diabetes?

Physical examination and fasting blood sugar

Subsequently, the doctor will examine the child and usually arrange another appointment for (morning) blood sampling. For these, the child must be sober, so have eaten at least eight hours nothing more and have not consumed any sugary drinks. Only then can the fasting blood glucose value be reliably determined. A single measurement is not sufficient for the diagnosis “diabetes in children”. To rule out measurement errors and fluctuations, repeated measurements of fasting blood glucose are necessary (at least twice). If the result is more than 126 mg / dl several times, this indicates diabetes.

Long-term blood glucose (HbA1c)

The HbA1c value indicates how high the blood glucose level has been on average in the last two to three months: If the blood glucose values ​​are repeated or persistently too high, circulating sugar molecules accumulate in the blood on the red blood pigment (hemoglobin) – ” sugared “(glycosylated) hemoglobin. Its proportion of total hemoglobin can be determined in the laboratory and expressed as HbA1c in percent. If he is more than 6.5 percent, there is a high probability of diabetes.

In case of suspected type 1 diabetes in children and adolescents, the determination of HbA1c is usually only performed in cases of doubt.

By the way: The HbA1c value is also important for already known diabetes disease. It is regularly measured to check the success of diabetes treatment.

Antibody screening test

If diabetes in children can not be clearly assigned to type 1, antibody screening test brings clarity. A blood sample from the patient is screened for autoantibodies typical of type 1 diabetes. In Type 2 diabetes, no such autoantibodies can be detected.

An antibody screening test allows a very early diagnosis of type 1 diabetes in children and adolescents. The autoantibodies can be found in the blood years before the onset of the disease. Diabetes type 1 only becomes noticeable with symptoms when around 80 percent of beta cells have already been destroyed.

Oral Glucose Tolerance Test (oGTT)

The oral glucose tolerance test (oGTT) is also called sugar stress test. He checks how well the body can use sugar. For this purpose, the fasting blood sugar is determined first. Then the patient drinks a defined sugar solution (75 grams of dissolved sugar). After one and every two hours, the blood sugar level is measured again. If fasting blood sugar and the two blood glucose levels exceed certain limits one and two hours after drinking the sugar solution, this indicates a diabetes disorder.

For the diagnosis of type 1 diabetes in children, the oGTT is usually only performed in cases of doubt. In case of suspected type 2 diabetes, however, it is part of routine diagnostics. For a secured result, he is usually performed twice.

Urinalysis

To clarify diabetes in children, a urine test for sugar (glucose) is also useful. Normally, certain cells in the renal medulla transport the sugars into the urine precursor (primary urine) back into the blood. In healthy urine, no / hardly any sugar can be detected. But if the blood sugar rises significantly above the normal values, the kidney can no longer afford this reabsorption. Then the body excretes more and more sugar with the urine (glucosuria) – an indication of a disturbed glucose tolerance or manifest diabetes.

For many years there have been special test strips for the home and simple practice use, with which a glucosuria can be detected. It only takes a few minutes.

In the case of persistently high blood sugar levels, the sugar molecules can damage the kidney tissue (diabetic nephropathy). An indication of this is a specific protein in the urine, the albumin. This so-called albuminuria can also be detected with a urine test strip.

Other investigations

If type 2 diabetes is found in children and adolescents, further investigations are necessary. They are intended to detect any comorbidities, for example, high blood pressure, dyslipidemia (such as increased cholesterol) or diabetes-related eye disease (diabetic retinopathy). At the time of the diagnosis of type 2 diabetes, the increased blood sugar has already caused such secondary damage in many patients.

Diabetes in children: treatment

Immediately after diagnosis of diabetes, the children and their parents should receive special diabetes education. You will learn more about the disease, its development, course and treatment options. Among other things, the training will teach you which amount of carbohydrates are in different foods and how much insulin the body needs at what time of the day for which foods. Proper management of possible complications of diabetes (such as over- and under-sucking) is also taught in the training.

Treatment of type 1 diabetes in children

Type 1 diabetes requires lifelong injections of insulin (usually with an insulin pen) because the pancreas itself can no longer produce insulin. As a rule, insulin is now administered as part of an intensified insulin therapy. Many children and adolescents, however, also an insulin pump is used, which can be controlled flexibly and quickly.

When the body needs how much insulin, type 1 diabetes kids learn in the training. Dose and time are very important to prevent life-threatening hypoglycaemia (hypoglycemia) or high blood sugar levels (hyperglycemia). The diabetes training also shows patients how to administer insulin injections properly and what to look for. Who should receive an insulin pump, is specially trained in their handling.

The type of diabetes therapy and the therapeutic goals (such as the level of blood sugar and HbA1c value) are determined individually. For example, HbA1c tends to target values ​​below 7.5 percent.

Intensified insulin therapy (basic bolus principle)

Here, patients inject a long-acting insulin once or twice daily to make up for the basic insulin requirement (basis). Before each meal, the diabetes children measure the current blood sugar level and then inject another normal or short-acting insulin (bolus). The amount of bolus needed depends on the time of day and the composition of the planned meal.

insulin Pump

The insulin pump is particularly suitable for children to maintain the quality of life despite diabetes. A fine needle is implanted in the abdominal fat, which is connected to the insulin pump via a small tube. It is a small, programmable, battery powered device with an insulin reservoir. The pump can be attached to the belt or in a small pocket under the shirt around the neck and is therefore not visible from the outside.

The insulin pump releases certain quantities of insulin into the fatty tissue throughout the day, where it reaches the entire body via minute blood vessels. This amount of insulin covers the basic needs. At mealtimes, the patient can administer additional insulin at the touch of a button to ensure that the planned meals are used.

The affected person is given a lot of freedom by the insulin pump. In addition, it relieves the children with diabetes significantly, because the daily painful insulin injections are eliminated. The insulin pump can always be worn, even while playing sports or playing games. If necessary – for swimming, for example – the pump can be disconnected for a short time.

The insulin pump is individually adjusted in a specialized diabetes practice or clinic. The insulin reservoir (cartridge) is replaced or refilled regularly.

Treatment of type 2 diabetes in children

As with type 1 diabetes, the treatment plan and treatment goals are set individually.

Form the basis of the treatment regular physical activity and sports as well as one dietary changes (varied, balanced food with lots of blends, fruits and vegetables). This helps patients lose excess kilos and lower their high blood sugar. It also reduces risk factors for concomitant and consequential diseases (cardiovascular disease, hypertension, etc.). In the diabetes training, the diabetes children and adolescents receive tips and help with their exercise program and individual nutritional advice.

More exercise, the diabetes diet and resulting weight loss are enough for some patients to get a grip on type 2 diabetes. However, one has to keep an eye on blood glucose levels, as the tendency to diabetes persists.

If the lifestyle change can not reduce blood sugar sufficiently or if the young patient can not be motivated to exercise more and eat healthier, the doctor prescribes additionally Diabetes medications (antidiabetics), First, it is tried with an oral antidiabetic (mostly metformin tablets). If they do not bring about the desired success after three to six months, the patient gets insulin.

Existing concomitant and secondary diseases of diabetes must also be treated.

Diabetes in children: disease course and prognosis

At the Type 2 diabetes The course of the disease depends crucially on whether patients change their lifestyle. More exercise, personalized diet and weight loss can sometimes make type 2 diabetes completely disappear in children and adolescents.

In contrast, the Type 1 Diabetes not curable in children, adolescents and adults. A regular refresher course and medical supervision are therefore indispensable. The main goal is to use insulin therapy to achieve blood glucose levels that are as constant as possible in order to avoid secondary diseases. In principle, the younger the patients are at the beginning of the illness, the higher the risk of consequential damage occurring in the course of life.

Acute complicationshypoglycaemia and hypoglycaemia (hypoglycaemia), which can occur in varying degrees in type 1 and type 2 diabetes, are hypoglycemic. Among other things, the latter can lead to diabetic ketoacidosis (especially in type 1 diabetes) in severe cases.

hypoglycemia

Hypoglycaemia (hypoglycemia) is one of the most common and at the same time most dangerous acute complications that diabetes can cause in children undergoing insulin therapy. It is often caused by the patient accidentally injecting too much insulin. Even an unusually strong physical stress / too much exercise can lead to a low sugar while the insulin dose remains the same.

Other possible causes include, for example, overdose of hypoglycemic tablets (in type 2 diabetes), omission of a planned meal with a constant insulin or tablet dose and excessive alcohol consumption (especially in connection with exercise or other physical activity).

Possible Symptoms of low sugar For example, sweating, dizziness, trembling hands, palpitations and a pronounced weakness. In severe cases, concentration and vision disorders, cramps, as well as impaired consciousness or even unconsciousness are added.

Especially insulin-requiring diabetics should always have some glucose in order to raise their blood sugar quickly in case of mild hypoglycaemia. Heavier cases usually require medical treatment.

Diabetic ketoacidosis

The absolute insulin deficiency in diabetes type 1 children means that sugar (glucose) can no longer be absorbed from the blood into the cells. When the body from the outside too little or no insulin is added, the blood sugar continues to rise. Such hypoglycemia often develops in insulin-dependent diabetics, even during acute illness infection like pneumonia or urinary tract infection. The body then needs more insulin than normal, even if the patient may eat little. The normal insulin dose is then insufficient, and the blood sugar increases in the episode over.

While there is clearly too much glucose in a blood glucose, there is a lack of glucose in the cells and thus an energy shortage. Especially in the brain, this has a fatal effect, as it requires a lot of energy and is dependent on energy production by glucose. To compensate for the energy deficit, the body begins to reduce fat. This produces so-called ketone bodies. They acidify the blood (Diabetic ketoacidosis).

Typical symptoms are the fruity acetone odor the exhaled air and a very deep breathing (Kussmaul breathing). The body tries to reduce its high blood sugar level by excreting sugar together with plenty of liquid. That leads to a increased urine output and subsequently too dehydration (Dehydration). The patients will tired and weak and can in extreme cases fall into a comatose state (ketoacidotic coma). This coma means danger to life! It must be the instant emergency doctor (under 112) – the patient must be treated in an intensive care unit.

By the way: In a mild form, diabetic ketoacidosis can also occur in type 2 diabetes.

sequelae

The most common complications of diabetes mellitus (regardless of type) include, for example, kidney disease (diabetic nephropathy), retinal disease (diabetic retinopathy) and nerve damage (diabetic polyneuropathy). The nerve damage, along with vascular damage, which is also caused by high blood sugar, can cause diabetic foot syndrome.

Also heart attack and stroke are possible late effects of a poorly adjusted or untreated Diabetes in children, Adolescents and adults.