Diabetes in Children

For reasons that are not clear, the incidence of childhood diabetes has been rising in recent years, not only in the UK but in many other countries as well. In the UK alone, about 20,000 children have diabetes with around 2,000 new cases being diagnosed each year. In almost all cases, the type involved is autoimmune Type 1 diabetes requiring insulin treatment. However, the high and rising incidence of obesity among Western children has meant that cases of Type 2 diabetes are now occurring, even among this young age group. Much more rarely, the type of diabetes known as MODY (Maturity Onset Diabetes Of The Young) may affect children, and this possibility has to be kept in mind at the time of diagnosis.

In children, symptoms are usually clear-cut and arise quickly in a matter of weeks or even days. About 25 per cent of children present with diabetic ketoacidosis (DKA) and in any event suspicion or diagnosis of diabetes in a child necessitates hospital admission. Often, a short stay in hospital is all that is necessary to initiate insulin therapy. However, the child and his or her family may require a great deal of help and support to overcome the shock of diagnosis, to answer their questions and address their worries and generally to begin to learn about diabetes. If the child is veryyoung, it is often the parents who require the greatest degree of support. Feelings of guilt and anxiety for the child's future health are common and entirely understandable. Parents may also worry that diabetes may occur in their other children or in any future offspring. hypoglycaemia is a particular cause for concern and is common in insulin-treated children. Sometimes, especially in young children, the symptoms can be hard to recognize and repeated severe episodes can cause neuropsychological damage. Obviously, this is a considerable potential source of worry for parents, who can suddenly find themselves in the position of being the people mainly responsible for the recognition and treatment of hypoglycaemia. Clear instructions about what to do are vital and it is important to convince parents that an occasional attack, even if severe, will not cause lasting harm to their child.

Very young children require adult assistance to administer insulin. However, older children usually quickly learn to take charge of their own treatment, with support from their parents. Many children are able to take diabetes in their stride and carry on with life in the same way as before. It is very important that they should be encouraged to do this and that diabetes is not seen as a barrier to any normal activity, either at school or in the social environment. The child's teachers need to be informed about the diabetes and the possibility of hypos. Most schools and teachers now have a much better understanding of the condition than in the past.

It is in the teenage years that diabetes may cause the greatest number of problems. Hormonal changes at puberty with their accompanying spurts of growth can disrupt glycaemic control and increase insulin requirements. The young person may have more frequent hypos, which may happen at school, and may be subject to teasing, just at the time when he or she most desperately needs to feel the same as everyone else. Even when understanding and empathy is good, diabetes can be a cause of depression in the teenage years. Like others in their age group, young people with diabetes are not exempt from more serious psychological problems such as eating disorders, which pose a particular danger to their health and wellbeing. In diabetes, a manifestation of this can be missing out insulin doses as a perceived means of losing weight. This maybe attempted particularly by teenage girls and is a problem that is now beginning to be more widely recognized. Fortunately, diabetic complications as such are rare among children and young people.

It is considered to be ideal if children and young people can attend clinics that are specially geared to their own age group, although this is not possible in all areas. However, clinical care staff recognize that it is the affected child who must be listened to and whose opinions must be taken into account in discussions about treatment or problems connected with diabetes. They endeavour to treat each child with sympathy, tact and discretion and to respect confidences, so that a relationship of trust is built up. In this way, it is hoped that the older child or teenager will feel able to discuss problems with the diabetes clinical care team, even if he or she is not confiding in parents or teachers.

• Diabetes and pregnancy
• Diabetes in children
• Diabetes in elders
• Diabetes in minority group people