Childhood diabetes: causes, what symptoms in children?

Diabetes is a condition that will cause an abnormal rise in blood sugar, affecting nearly 250 million people worldwide. Number of young diabetics has experienced annual growth of 4% in France since 2010. Childhood diabetes is characterized by certain specific signs that make it possible to establish the diagnosis. What are the symptoms diabetes in children? What are the causes childhood diabetes? And the treatments?

Definition: what is childhood diabetes?

There are two forms of diabetes. “Type 1 diabetes, or insulin-dependent, is an autoimmune disease: the auto-antibodies will destroy the cells of the pancreas synthesizing insulin (beta cells)“, explains Professor Fabrice Bonnet, diabetologist and endocrinologist in Paris. This will lead to a defect in the synthesis of the hormone allowing the sugar to “enter” into the cells. The majority of diabetic children are affected by type 1 diabetes Or insulin-dependent, which sometimes starts very young. Type 2 diabetes is insulin resistant diabetes, which does not allow sugar to “enter” into the cells. It is caused by overweight and age, which is why it rarely affects children. “But we see more and more young teenagers suffering from it. They are often disadvantaged young people who have a very poor diet“, he specifies.

What are the symptoms of childhood diabetes?

Type 1 or insulin-dependent diabetes will cause too high blood sugar, which is called hyperglycemia. Certain signs make it possible to suspect type 1 diabetes in children: “If the child drinks a lot, urinates a lot (polyuria), loses weight despite a preserved appetite and is tired, these are signs that should lead to consultation”, explains the diabetologist. In effect, type 1 diabetes must be taken care of quickly : more than 30% of children who are hospitalized for diabetes already have ketoacidosis (dehydration, vomiting, abdominal pain, malaise, etc.), a major complication of the disease. The signs of this are abdominal pain, nausea and vomiting, rapid breathing, cramps and anorexia. “It is therefore necessary to treat the child quickly, since these symptoms can progress to an ketoacidotic coma and sometimes even lead to death.“, warns the doctor.

What causes childhood diabetes?

The causes of type 1 diabetes in children are unknown. A few hypotheses are put forward in an attempt to explain these figures, such as the presence ofmaternal obesity during pregnancy, even if she does not have diabetes or even type 1 diabetes in the mother, thus tripling the risk by 3 in her baby. Other theories are put forward, such as a less struggling immune system against germs due to an increasingly sanitized environment.

Some clinical signs exist, although diabetes is a silent disease at first:

• a feeling of thirst very important,
• of the more frequent urinationsometimes going so far as to wet the bed.

Different tests can confirm the presence of diabetes: capillary blood sugar showing too large and a urine dipstick, which highlights the presence of sugar in the urine (glycosuria). If these 2 tests are positive, a more in-depth blood test will be carried out and hospitalization for several days for confirmation of the diagnosis. “Subsequently, the child and his parents will have to change their lifestyle to adapt to diabetes“, explains the doctor.

What are the treatments for childhood diabetes?

The treatment involves several steps: First, the family must be initiated to the essential hygiene and dietary rules to a good balance of diabetes. Then she has to adapt to multiple insulin injections by pen, to be done several times a day. “This can disturb the child in his daily life, which is why, in young children, it is advisable to do an external pump treatment, which allows insulin to be delivered continuously without having to take out an injectionexplains the doctor. So there is no need to ask a nurse at school to do it“. The type of insulin (slow, intermediate or rapid), as well as the dosage, are determined by the doctor. Long-acting insulins have a fairly long onset of action, rapid-acting insulins act quickly. In the case of regimens with injections, the strict blood sugar monitoring is important. Indeed, the dosages of insulin are adapted according to the blood sugar levels observed. Blood sugar levels must therefore be measured several times a day, using a specific device (also called a “dextro”). Measurements must be retained. Finally, parents should know the evocative signs of a complication.

What are the complications of childhood diabetes?

More than 30% of children who are hospitalized for diabetes already have a significant complication of the disease, ketoacidosis. The long-term complications of diabetes are numerous:

• visual disturbances,
• neuropathies,
• kidney disease…

They aggravate diabetes and reduce life expectancy. Severe complications of childhood diabetes may require emergency hospitalization. They must be identified as early as possible in order to treat them quickly. and prevent their aggravation. Chronic complications occur most of the time in the small vessels of the eyes, kidneys or nerves, thus causing a retinopathy, nephropathy or neuropathy. “Diabetic retinopathy, disease of the retina, is one of the main complications of diabetes. It can even make you blind“, specifies the specialist. Indeed, diabetes is the leading cause of blindness in the western world. There diabetic nephropathy, it is due to lesions of the small vessels of the kidney. The presence of protein in the urine most often allows the diagnosis of nephropathy when no other manifestation is detected. There neuropathy, it is an attack of the nervous affections. There are other complications, such as lipodystrophies, morning hyperglycaemia or growth disorders.

The child with type 1 diabetes should take lifelong treatment. “This obviously requires learning and adaptation. In fact, the disease leads to risk of hypoglycaemia and malaise, so it is necessary to adapt especially for sports activitiesrecalls the professor. But many advances have been made in monitoring children. Young people with type 1 diabetes have an easier life compared to those before. And we can expect, in the future, new therapeutic innovations, for example, we are talking about artificial pancreas which will avoid insulin injections, or improved insulin pump“. For the parents : Once the diagnosis has been made, the daily lives of families are “turned upside down” and require an adjustment period, during which the role of parents is decisive. The family and the child must acquire new reflexes, both from a hygiene and dietary point of view and self-monitoring of blood sugar (reading and understanding of results, etc.) or treatment. The demands of diabetes and its management must be understood and accepted : for example, the use of an injection can be perceived as a “wickedness”. It is therefore essential that the child understands that this gesture is benevolent. For that, you have to explain it to him and reassure him.

You can eat a bit of everything, without depriving yourself, but without excess

What diet for diabetic children?

► You must limit fast sugarss,”no more than one sugary drink or fruit juice per day“.

► You must limit excess starch : “slow sugars are also sugars: it is therefore necessary to favor wholemeal breads or cereal breads which have a lower glycemic index than white breads, and divide them into small portions“.

It is thus necessary to play on the glycemic index of foods, without depriving yourself, as the diabetologist reminds us: “you can eat a bit of everything, without depriving yourself, but without excess. The most important thing is to pay attention to the quantity. No need to totally deprive yourself of sweets, once in a while to avoid frustration, it does not matter. I have patients who have deprived themselves all their lives and who feel that diabetes has ruined their life, but you can live well with diabetes today as long as you don’t overdo it. A pie once in a while, it’s not a big excess“.

Thanks to Professor Fabrice Bonnet, diabetologist and endocrinologist in Paris.