Children also have diabetes

Diabetes is a serious chronic disease, and its incidence has been increasing worldwide over the past few decades. Many people think that diabetes only occurs in adults, but in fact, diabetes in children and adolescents is increasing year by year. Because the onset age is early and the course of the disease is more serious than that of adult diabetes, it is not easy for parents to detect it in time, which can easily lead to various diabetes complications such as renal failure, blindness and amputation, which seriously affect the physical health of children. Diabetes in children and adolescents should receive more attention.

1. What is diabetes?

Diabetes is a metabolic disease caused by a variety of reasons, characterized by absolute or relative insulin deficiency and chronic high blood sugar. Long-term disorders of sugar, fat, and protein can cause damage to multiple systems such as the eyes, kidneys, and nerves, and even cause functional impairment and failure.

2. What are the types of diabetes in children?

There are three main types of diabetes in children and adolescents, namely type 1 diabetes, absolute insulin deficiency (T1DM), type 2 diabetes, relative insulin deficiency (T2DM), and single gene mutation diabetes [1]. Many genetic, environmental, and biological factors can lead to diabetes in children and adolescents, with type 1 diabetes being the most common. However, as obesity among children and adolescents increases, clinical manifestations overlap, so type 2 diabetes is on the rise. Type 2 diabetes in children and adolescents is different from type 2 diabetes in adults. Their pancreatic B cells fail rapidly, which may lead to absolute insulin deficiency in the later stages. At the same time, they are more likely to develop diabetes complications more quickly and develop rapidly.

3. What are the symptoms of diabetes in children and adolescents?

The typical symptoms of diabetes are 3 more and 1 less. Drinking more, drinking several liters of water every day; urinating more, urinating up to several liters every day; eating more, but losing weight. It is not easy to detect polydipsia and polyuria in infants and young children. Many of them suddenly show symptoms such as eating less, nausea, vomiting, abdominal pain, ketone odor in breath, drowsiness, slow reaction, etc. (acute ketoacidosis).

4. What drugs can be used for treatment?

Children with type 1 diabetes have an absolute lack of insulin secretion and need lifelong exogenous insulin replacement to maintain glucose metabolism balance and survival. The initial insulin treatment dose is 0.5-1.0 U/kg per day. Children in remission can take less than 0.5 U/kg per day. Due to nutritional needs in adolescence, a daily dose of 1.2-1.5 U/kg or higher is required to achieve satisfactory glucose metabolism control. The insulin regimen and dose depend on the individual. The doctor will formulate it based on factors such as the child's age, course of disease, lifestyle, and his own experience. Therefore, it is possible to take it twice or three times a day, or use a basal-pre-meal high-dose regimen or insulin pump, or a combination of short-acting insulin, intermediate-acting insulin, or long-acting insulin. The characteristics of commonly used insulin are as follows [2].

Currently, only metformin and insulin are approved for the treatment of type 2 diabetes in children worldwide, and the treatment plan is also individualized. The initial dose is 500 mg/d for 7 days, and then increased by 500 mg/d every week for 3-4 weeks, with a maximum of no more than 2000 mg/d. Metformin alone has basically no risk of hypoglycemia, but because type 2 diabetes is a progressive disease, most children will eventually need insulin treatment [3].

5. What are the precautions when using insulin?

1. Due to the disease, children with diabetes need to learn to inject themselves. Parents should encourage their children to inject themselves. Children over 10 years old can learn to inject themselves. If children are afraid, a needle aid or insulin pump can be used to improve compliance.

(ii) Choose an appropriate insulin injection site based on the child's actual situation and activity arrangements. For example, insulin should be injected into the abdomen before exercise to avoid accelerated insulin absorption due to movement of the upper arms and thighs.

(III) The insulin used can only be injected subcutaneously, and should be done in a fast and slow manner, that is, the needle should be inserted and removed quickly, and the medicine should be injected slowly. After injection, the needle should stay subcutaneously for at least 6 seconds, and the button should be pressed to the bottom until the needle is pulled out. This ensures a correct injection and ensures that as little blood as possible flows back into the needle or pen cartridge.

(IV) When insulin is used for the first time, it can be placed at room temperature for 1-2 hours after being taken out of the refrigerator. Insulin that has been opened and used does not need to be kept in the refrigerator any longer, and can be stored below 25°C away from light and heat.

(V) Relax your mind so that your skin and subcutaneous tissue are also in a relaxed state.

(VI) The insulin injection site should be rotated every day to avoid long-term injection in the same site which may lead to fat atrophy at the injection site.

(vii) Do not reuse needles.

(VIII) Pay attention to hypoglycemia reactions. If hypoglycemia occurs, inform your doctor or pharmacist immediately. Symptoms of hypoglycemia usually occur suddenly and may include cold sweats, pale and clammy skin, fatigue, nervousness or tremors, anxiety, unusual tiredness or weakness, confusion, difficulty concentrating, drowsiness, excessive hunger, vision changes, headache, palpitations and nausea.

6. Can exercise provide treatment? [3]

Exercise is an important treatment method. Exercise can increase muscle utilization of glucose and improve blood sugar regulation. Children with diabetes should adhere to proper exercise every day. Some aerobic exercises that are easy to stick to can be used, such as going up and down stairs, jogging, skipping rope, swimming, playing ball, cycling, mountain climbing, etc. You can also use exercises that combine strength and flexibility, such as training with dumbbells and barbells, and various stretching activities at the same time. Exercise for at least 30 minutes every day. The exercise method and amount should be personalized, with appropriate intensity and done according to one's ability. The intensity of exercise should maintain heart rate (times/min) = (220-age) × (60%~75%) or feel hot and sweaty during exercise, but not sweating profusely. If you eat before doing a lot of exercise, you should prevent the occurrence of hypoglycemia after exercise.

7. How to monitor blood sugar?

1. First, you need to choose a suitable lancing pen for blood collection. In order to prevent cross infection, the lancing pen must be used by one person only. The lancing pen generally consists of three parts: the pen body, the button, and the depth adjustment button. When using it, after the lancing needle is inserted into the pen body, adjust the depth button according to the condition of the child's skin and fingers to control the distance the lancing needle pops out, thereby controlling the depth of the puncture. Finally, the button is used to operate the spring in the pen body to pop out the lancing needle for puncture and blood collection.

2. The most commonly used blood collection sites are recommended to be the fingertips and both sides of the fingertips. These sites have fewer nerve endings and less pain. Note that the sites should be rotated when blood is collected. Long-term blood collection at the same site is prone to hard scabs. When collecting blood, try to let the blood flow out automatically. Do not squeeze the puncture site hard to avoid squeezing out tissue fluid and affecting the monitoring results. Before blood collection, you can massage the blood collection finger appropriately, or gently shake your arm to ensure that blood can be successfully collected in one puncture, and avoid inaccurate test results due to excessive squeezing or small blood collection volume.

3. The common times for monitoring blood sugar are fasting, before meals, 2 hours after meals, before bedtime, and 2 to 3 a.m., usually 4 to 7 times a day. The specific frequency of monitoring depends on personal circumstances. If there are changes in medication, exercise or eating habits, the number of monitoring times also needs to be adjusted.

8. How to have a balanced diet [3]?

There is no one identical diet plan. Under the premise of ensuring the normal development of adolescents, delay and reduce the occurrence and development of diabetes and its complications. Choose foods with a low glycemic index as much as possible, and avoid sugary drinks and sugary foods. Children and adolescents should also take into account the taste of their children and change their food reasonably, and do not force them to eat foods they do not like. Coarse grains have a lower effect on raising blood sugar than refined rice and flour. Therefore, parents can choose more coarse grains as staple food and choose some high-dietary fiber foods. Whole wheat flour, buckwheat, vermicelli, black rice, vegetables, fruits, soy products, and dairy products. In addition, when children's blood sugar is not well controlled or their blood sugar is high after meals, they can choose more coarse grain foods, such as two-grain rice (rice + millet), multi-grain bread, etc.

References

[1] Qu Huiqi, Tian Lifeng, Hakon Hakonarson. Research progress in precision medicine for childhood and adolescent diabetes. Chinese Journal of Diabetes. 2019. 11(4): 234-237.

[2] Chinese Diabetes Society. Guidelines for insulin treatment of type 1 diabetes in China. Chinese Journal of Diabetes. 2016. 8(10): 591-597.

[3] Endocrine Genetics and Metabolism Group, Pediatrics Branch, Chinese Medical Association. Chinese expert consensus on the diagnosis and treatment of type 2 diabetes in children and adolescents. Chinese Journal of Pediatrics. 2017. 55(6): 404-410.

[4] Wang Weiping, ed. Pediatrics 8th edition [M] People's Medical Publishing House, 2013; 437-444

(Chen Guanru, Anhui Children's Hospital)