DIABETES MELLITUS IN CHILDHOOD
Diabetes mellitus is one of the most common chronic diseases of childhood, and its prevalence is gradually increasing in recent years. Type 1 Diabetes is the most common form of the disease in children, and it occurs due to the deficiency of insulin secretion in pancreas. Although the real cause is unknown, genetic and environmental factors have a great role in development of the disease.
Due to a recent increase in prevalence of obesity, prevalence of Type 2 diabetes mellitus, which is adult-onset type, is also rising in children. In this type of diabetes, there is resistance to insulin hormone. Although underlying pathogenetic mechanisms are different, metabolic consequences are the same in both forms. Sugar (glucose) cannot be moved from the blood into the cells, where it is converted to energy, and ultimately, blood glucose level increases.
Patients are admitted with the complaints of dry mouth, frequent voiding, polyuria, polydipsia, tiredness, fatigue, hyperphagia, involuntary weight loss, blurred vision, and loss of sense, numbness, and tingling on feet and hands. Symptoms develop so fast that some patients claim they don’t have any complaints before the diagnosis of diabetes. On the other hand, some other patients are admitted to hospitals, with the findings of “diabetic ketoacidosis” including deep and frequent breathing, dry skin and mouth, redness on face, halitosis, nausea, vomiting, frequent voiding, abdominal pain, stomach ache, confusion and loss of cosciousness resulted because of rapid increase of blood glucose level.
Diagnosis of diabetes is made in a child with suspected findings for diabetes if blood glucose level measured at any time of day is ≥200 mg/dL, fasting blood glucose ≥126 mg/dL and HbA1c ≥ 6.5 %.
Children diagnosed to have diabetes mellitus should be followed up by a pediatric endocrinologist together with a team including diabetes nurse, an experienced dietician, and a social service expert, if available. Since insulin hormone is not synthesized or very poorly synthesized, Type 1 diabetic patients should receive injection of insulin hormone lifelong. Moreover, a good diet and exercise program should be planned, while lifestyle should be modified accordingly.
For insufficiently treated cases, long-standing high blood glucose level (hyperglycemia) leads to diabetic problems. Hyperglycemia may cause ocular, neural and renal damages and lead to heart attack and stroke by damaging heart and blood vessels. For this reason, regulating blood glucose level at or very close to normal ranges reduces risk of these complications.
DIABETIC NEPHROPATHY (RENAL DAMAGE)
billions of small capillary vessels, kidneys may get damaged over
time in diabetic patients. Diabetic
nephropathy develops in 15-20 % of patients 15-25 years after
diabetes is first diagnosed. Over a period
of 10 years, 15-20 % of these patients may develop progressive renal
damage and progress to end-stage kidney disease, which requires
dialysis or kidney transplantation.
The early manifestation of diabetic nephropathy is the increased albumin level in urine and it can be analyzed with "microalbuminuria test". Microalbuminuria is most reliably examined in 24-hour urine specimen. Excretrion of albumin between 30 and 300 mg/day at least in 2 or 3 samples or albumin/creatinine ratio between 30-300 mg/g at spot urine sample is considered as microalbuminuria.
At the time of diagnosis, the size of kidneys are usually mildly increased and filter excessive amount of urine in 1/3 or 1/2 of patients. In this period, a transient microalbuminuria may occur, but since there is no permanent renal damage yet, it can be reversed or at least progression can be slowed down if blood glucose level can be controlled.
Along a silent period of 2-5 years after diagnosis, some permanent changes occur slowly, and microalbuminuria develops in 1/3 of patients after 7-10 years. Moreover, in 15-20 % of patients, obvious nephropathy develops in approximately 15-25 years after diagnosis and urinary protein excretion rapidly progresses. Renal functions deteriorate in time and blood pressure may increase. Other complications, such as retinopathy, can also be observed at this period. If sufficient preventive measures are not taken, patients progress to end-stage renal disease in 5-10 years, and they lose chance of survival without dialysis or renal transplantation.
In development and progression of diabetic nephropathy, some risk factors play significant role. Most important of them are blood glucose control level, time elapsed from diagnosis, puberty, age of patient at diagnosis, hypertension, hyperlipidemia, familial history of diabetic complications and genetic factors. Elimination of some risk factors is impossible. However, good blood glucose control and blood pressure regulation are the best preventive measures. Additionally, early diagnosis of diabetic nephropathy is necessary for planning a successful preventive management. For this purpose, all patients with Type 1 DM (diabetes mellitus) for over 5 years should have annual microalbuminuria screening, since it is the sign and earliest finding of evident diabetic nephropathy.
As a result, diabetes mellitus has been increased in recent years and became an important problem of childhood. If it is not followed up and treated properly at early stage, it leads to life-threatening complications, such as diabetic nephropathy, which also decreases the life quality. Therefore, it is of vital importance for families to learn about symptoms of diabetes in order to start management at early stage, after necessary examinations are performed. Children diagnosed as diabetes, should be closely followed by an experienced team. Good regulation of blood sugar and blood pressure should be obtained, together with an appropriate exercise program and necessary lifestyle modifications. If preventive measures are taken and necessary examinations are made regularly, end-stage kidney disease that is caused by diabetic nephropathy can be prevented.
-Diabetes Mellitus is also an important problem in childhood.
-Excessive thirst, urinary frequency, weight loss, blurred vision, numbness in hands and feet can be signs of diabetes in children.
-Diabetic nephropathy may develop and progress to end-stage renal disease, if diabetic patient is not early and sufficiently treated.
-Good blood sugar and blood pressure control may prevent serious complications.