What is diabetes mellitus?

• Diabetes mellitus (DM) is a disease in which there is too much glucose (sugar) in the blood due to too little or ineffective insulin.
• It is caused by lack of a hormone called insulin which is produced by an organ in our body called the pancreas.
• Insulin controls the balance of glucose in the body by helping glucose to move from the bloodstream into the body cells.
• If you have diabetes, glucose cannot enter the body cells and it remains in the blood giving rise to high blood glucose level.

What are the types of diabetes mellitus?

• There are 2 major types of DM:
  • Type 1 diabetes mellitus (type 1 DM).
  • Type 2 diabetes mellitus (type 2 DM).
• Type 1 DM is the most common form of diabetes in children and young adults, constituting >90% of all DM cases.

How common is it?

• Incidence of diabetes varies between countries and communities. In Malaysia it is estimated to be less than 1%.
• Adults usually get Type 2 DM but now with the epidemic of obesity worldwide, children also get this type of DM.

Child with obesity

What causes diabetes mellitus?

• The cause of childhood diabetes is not understood.
• It probably involves a combination of genes and environmental factors.
• Type 1 DM: Children and young people usually get type 1 DM. It is an autoimmune condition whereby the body’s immune system ‘attacks’ one of the body’s own tissues or organs.
• Type 2 DM: In children it is being reported more frequently in many countries in association with rising rates of obesity.
• Other causes include genetic defects of the function of the pancreas as maturity onset of diabetes in the young (MODY).

How does diabetes mellitus present?

Classic symptoms of type 1 DM usually present one or more weeks before children get really sick. Your child may have the following complaints:

• Frequent and excessive urination (day and night).
• Excessive thirst.
• Weight loss.
• Tiredness and lack of energy.

Note: Nocturnal enuresis (bedwetting) after a long period of adequate toilet training with dryness is called secondary enuresis. If your child develops this problem, diabetes should be suspected.

Additional symptoms typical for children are:

• Tummy pains with or without vomiting.
• Headaches.
• Behaviour problems.
• Tendency to get infection especially of the skin.

If the above symptoms are not recognized early, your child may develop a state of diabetic ketoacidosis (DKA).

What is diabetic ketoacidosis?

• It is an emergency situation whereby your child has a very high blood sugar level with rapid breathing and may be drowsy or comatose.
• In this situation, you should seek medical attention urgently. Your child needs to be hospitalised for insulin treatment and fluid therapy.

Type 2 DM occurs in older children at puberty or later than that. Parents may not know that their children have Type 2 DM because the symptoms are mild in comparison to type 1 DM.

What problems can Diabetes Mellitus cause?

The onset of complications depends on the duration and control of diabetes. These complications may only manifest later in life. Your doctor can tell you whether your child’s diabetes is well controlled or not when your child goes for his/her regular check-ups.

Good blood sugar control will decrease or delay the development of the following complications that involve various organs / system some of which may manifest only during adulthood.

• Kidney: kidney failure.
• Eyes: blindness.
• Heart: heart attack, stroke.
• Blood vessel: high blood pressure, increased lipid (fat) levels.
• Nervous system: sensory problems.
• Reproductive organ: impotence (as adults).
• Feet: diabetic foot (as adults).
• Skin: recurrent skin infections such as carbuncles, abscesses.

These complications can start after puberty. Your doctor will plan the necessary schedule for blood and urine tests to detect the complications

What is hypoglycaemia and how do you recognise it?

While your child is on treatment, be aware that your child can develop hypoglycaemia (low blood sugar level) whereby you can take sugary food or drinks to correct it.

Signs & symptoms of hypoglycaemia :

• Cold sweat/Excessive sweating.
• Tremors.
• Lethargy.
• Altered behaviour/loss of consciousness.
• Low blood sugar on home blood glucose monitoring.

How is diabetes mellitus in children managed?

• At any one time, your child will be seen by members of the hospital diabetes team which usually includes doctors, dieticians, physiotherapists, occupational therapists, orthopaedic surgeons, psychologists, diabetes educators and the social workers.
• If your child has type 1 DM your child will need life-long insulin injections.
• In type 2 DM, oral medication and insulin is given to lower the blood sugar level.
• In both types of DM, your child should be on an appropriate diet regimen and exercise.
• In order to know your child’s level of control you are required to do home blood glucose monitoring (HBGM) for your child using a machine called a glucometer.
• Do record the blood glucose level with the date and time of the test in a diary so that you can adapt your insulin dosage.
• A diabetic educator will teach you and your child all about diabetes.
• A dietician will see you and your child at the time of diagnosis and on regular basis thereafter for advice on appropriate diet in order to achieve a good sugar control.
• Your child will be advised to do regular exercise because it helps to reduce blood glucose level by assisting insulin to work more efficiently and helping in weight control.
• Depending on the nature of your child’s problems, you may need to see the other members of the diabetic team from time to time.
• Children with the diabetes needs regular follow up and monitoring by a doctor.

What else can be done for a child with diabetes mellitus?

Your child may have problems initially in understanding his condition and coming to terms with it. He/She may also have problems in accepting the treatment (especially the regular insulin injections). Counselling and psychological support in this aspect is very important for your child. Consult your doctor and psychologist for further advice.

Can diabetes mellitus be prevented?

• There is no clear preventive measure in type 1 DM.
• For type 2 DM, it is recommended that you lead a healthy lifestyle.

Rehabilitation

Children with diabetes especially if it is poorly controlled may develop serious complications in the long term.They would need a rehabilitation program involving the physiotherapist and the occupational therapist.

Support groups

1) Persatuan Diabetes Malaysia
No 2 Lorong 11/4 E
46200 Petaling Jaya,
Selangor Darul Ehsan, Malaysia
Tel +603-79574062
Fax +603-79557740

2) Diabetes Resource Centre of respective hospitals.