Diabetes Mellitus in Children
Blood sugar levels are abnormally high as the body doesn’t produce enough insulin or the body fails to respond normally to the insulin produced. Weight loss is experienced despite adequate or increased food consumption.
Common Causes of Diabetes Mellitus
The causes vary depending on genetic makeup, family history, ethnicity, health and environmental factors. The causes of diabetes are undefined as the causes vary depending on the individual and the type.
Insulin
A hormone that’s released by the pancreas; it allows glucose to move from the blood stream into individual cells. Glucose does not move into the cells and builds up in the blood without a proper amount of insulin. Glucose begins to appear in the urine as glucose levels in the blood increase.
Common Types of Diabetes in Children
Prediabetes
Condition
The blood glucose levels are too high to be considered normal. However, it’s not high enough to be considered diabetes. This is common among obese adolescent.
Treatment
Children with prediabetes are advised to make lifestyle changes. Generally, medication isn’t recommended for children with prediabetes.
Type 1 Diabetes
Condition
This occurs when the pancreas produces too little or no insulin. This is the most common type among children. It’s also as one of the most chronic childhood disease. This may develop any time during childhood or even during birth.
Treatment
Children with type 1 diabetes take injections of insulin to control blood glucose. Children are usually hospitalized when type 1 diabetes is first diagnosed. They are given fluids (to treat dehydration) and insulin. Since nothing else is effective, they’ll always require insulin.
Type 2 Diabetes
Condition
The cells in the body don’t respond adequately to insulin. The pancreas can still make insulin but not enough to overcome insulin resistance.
Treatment
Generally untreated in the hospital unless the diabetes is severe. Severe diabetes may require hospitalization to start insulin treatment.
Common Complication of Diabetes
Diabetic Ketoacidosis
This is common among children with type 1 diabetes; it is one of the most serious immediate complications that can occur. It is present at the time of diagnosis in about one third of children with type 1 diabetes. It also develops in about 1 to 10% of children every year. It is usually because these children have not taken their insulin or are facing problems with insulin delivery.
Diagnosis of Diabetes
A diagnosis often follows a person seeking medical advice after experiencing symptoms like:
- Feeling thirsty
- Frequent urination
- Fatigue
- Unexpected weight loss
A blood and urine tests may be ordered to check for high glucose levels to indicate diabetes.
The Importance of Normal Glucose Levels for Young Children With Diabetes
Normal glucose levels range between 4 -7.7 mmol/L or 72-138 mg/dL. The level of blood sugar should always be persistently high as it reflects the body’s inability to use glucose for its various needs.
Thyroid
Common Kinds of Thyroid Disorder
Hypothyroidism
Thyroid problems are common in overweight children. Hypothyroidism most commonly occurs when the thyroid gland isn’t producing enough thyroid hormone. This could be due to the fact that it won’t produce enough or because it isn’t being stimulated properly.
Children affected are easily spotted because:
- Presence of a goitre
- Grown slower than usual
- Their parents feel they are struggling with a new learning disability
Symptoms
- Heart rate is slow
- Tiredness or lethargy
- Inability to tolerate cold
- Dry skin and hair
- Constipation
- Puffiness in the face (especially around the eyes)
- Impaired memory and difficulty in thinking
- Poor performance at school
- Depression
Treatment
Synthetic thyroxine (Levothyroxine) is given to augment the low levels of thyroid hormone (T4). Children who have had longstanding thyroid problem will receive replacement dose slowly over weeks to months in order to avoid unwanted side effects such as:
- Short attention spans
- Hyperactivity
- Insomnia
- Behaviour difficulties
Hyperthyroidism
When the thyroid is too active and releases too much thyroid hormone into the blood stream.
Symptoms
- Issues swallowing
- Prominent eyes
- Weight loss (despite an increase in appetite)
- Sudden growth spurt
- Increase in scalp hair loss
- Rapid pulse
- Raised blood pressure
- Nervousness, shakiness, tremors, an inability to sit still, swinging feet
- Tiredness
- Poor performance at school
- Increased sweating
Treatment
Anti-thyroid drugs are normally given at the start. They have a positive effect after 6 to 8 weeks. There is a much lower likelihood of entering into remission after a course of ATDs than in adults. Radioactive iodine can be used in children in further treatments (especially those aged over 10 years), especially for those whose hyperthyroidism is difficult to control.
Graves Disease
An immune-mediated disorder; the thyroid gland overproduces thyroid hormone (hyperthyroidism). It is the most common cause of hyperthyroidism.
Symptoms
- Anxiety
- Bulging Eyes
- Pain in chest
- Difficulty Sleeping
- Insomnia
- Elevated Blood Pressure
- Fatigue
- Hand Tremors
- Increased Sweating
- Irregular Menstrual Periods
- Irritability
- Nervousness
- More Frequent Stools
- Diarrhea
- Muscle Weakness
- Rapid Or Irregular Heartbeat
Treatment
Based on the symptoms, age and general health of the child; treatment may be done with:
- Antithyroid Medicine: To block the production of thyroid hormone; your child may be given methimazole or propylthiouracil (not often used first due to the risk of side effects).
- Radioactive Iodine: If your child has a serious reaction to antit-hyroid medicines or if the medicine doesn’t help stop symptoms. It works to destroy part or all of the thyroid gland. This medication blocks the production of thyroid hormone.
- Thyroidectomy: Surgery to remove all or part of the thyroid. It may be done in children who have not reacted well to anti-thyroid medicines or radioactive iodine. Your child will likely need to take thyroid hormones to avoid low thyroid hormone (hypothyroidism) symptoms after surgery.
Neonatal Thyrotoxicosis
A rare condition that is associated with a high mortality rate of approximately 20%.
Neonates may suffer from thyrotoxicosis secondary to transplacental transfer of stimulating maternal antibodies. The mothers of these children may either have a history of Graves or they are unaware that they have Graves.
This condition is transient as the maternal antibodies are cleared from the baby’s system by 12 weeks. Even though this is a rare condition, babies with neonatal thyrotoxicosis may have:
- Low birth weight
- Microcephaly
- Craniosynostosis
Typically, a few days after birth, the babies experience irritability, sweating, vomiting, diarrhoea, tachycardia, poor feeding or hyperthermia and associated hepatomegaly, jaundice or signs of cardiac failure.
This life-threatening condition is managed similarly to the treatment of a thyroid storm. The aims of treatment are to:
- Decrease thyroid hormone production
- Reduce peripheral conversion of T4 to active T3
These are achieved with a combination of anti-thyroid medication, iodine, steroids and beta-blockers.