By Dr. Meenal Mavinkurve, Paediatric Endocrinologist consultant at IMU Healthcare and a Senior Lecturer in Paediatrics at the International Medical University
When your otherwise healthy, active child receives a diagnosis of diabetes, it can feel like the ground has been yanked from beneath your feet. As a parent, it’s a bewildering and overwhelming moment, according to Dr Meenal Mavikurve.
Children with diabetes mellitus can achieve anything,” she emphasized, highlighting the hope that this condition is manageable. With collaborative efforts between the family and the diabetes team, it opens doors of opportunity for children with diabetes.
“I really want patients and parents to understand that a child with diabetes can do just as well, or even better, than any child without diabetes. While it’s undoubtedly a steep learning curve with emotional ups and downs and new routines, teamwork can lead children with diabetes to a fulfilling life, just like their peers,” she emphasizes, underscoring the importance of recognizing this and focusing on solutions to better support these children.
What is Diabetes Mellitus
Let’s begin by delving into what diabetes mellitus entails. It centers around insulin, a crucial hormone produced by the pancreas. Insulin plays a vital role in transporting glucose, an energy source, into our cells. Diabetes mellitus occurs when insulin is deficient (insulin deficiency) or when insulin’s effectiveness is reduced (insulin resistance). Both situations result in elevated glucose levels in the bloodstream, which characterizes diabetes mellitus.
In children, the most common forms of diabetes mellitus are Type 1 (insulin deficiency, T1DM) and Type 2 (insulin resistance, T2DM). T1DM is an autoimmune condition in which the body produces antibodies that destroy the pancreas’s beta cells responsible for insulin production. In T2DM, the body can still produce insulin, but its actions are impaired.
Knowing the symptoms
The most common symptoms are encapsulated in the 4Ts of the Diabetes UK campaign: thirst, frequent urination, weight loss, and fatigue.
Excessive thirst, frequent urination, nighttime awakening for bathroom trips, or bedwetting can serve as critical indicators of diabetes in children.
Parents might even notice ants in the toilet, drawn to the “sweet urine” containing glucose. Children may also experience infections, unexplained weight loss, or failure to gain weight despite hunger. Dr. Meenal advises parents to track their children’s weight, whether the child is sick or not, as it is a reliable indicator of their health.
“If you observe any of these symptoms, consult a doctor urgently. Inquire about the possibility of a diabetes diagnosis and whether a glucose and ketone test should be conducted,” Dr. Meenal recommends.
Early awareness matters
One crucial step for early diabetes diagnosis is recognizing that it affects children as well. Early symptom recognition can lead to timely diagnosis and treatment.
“If symptoms aren’t caught early, they can progress to severe diabetes presentation with symptoms like vomiting, lethargy, breathlessness, and abdominal pain,” warns Dr. Meenal. These are signs of diabetic ketoacidosis (DKA), a severe form of diabetes.
A study by Mavinkurve et al. in 2021 highlighted that misdiagnosis of Type 1 Diabetes Mellitus (T1DM) in Malaysian children was prevalent, with a misdiagnosis rate of 38.7%. This emphasizes the importance of preventing misdiagnosis to avoid prolonged hospital stays.
Rising diabetes in Malaysia, worldwide
The International Diabetes Federation Atlas reported 977 cases of diabetes in children under 18 in Malaysia in 2019, more than double the number in 2008. This suggests an average of approximately 57 children are diagnosed with diabetes each year. Among the two types, Type 1 is more prevalent in children, accounting for over 90% of diabetes mellitus cases globally.
The rates of T1DM in children have been increasing worldwide, with diagnoses occurring at younger ages. In Malaysia, the average age of diagnosis is between seven to eight years. Type 2 diabetes is typically seen in adolescents, with obesity as a known risk factor. However, it’s influenced by other factors like family history and ethnic background.
The rates of T1DM in children have been increasing worldwide, with diagnoses occurring at younger ages. In Malaysia, the average age of diagnosis is between seven to eight years.
Managing diabetes, risks and complications
Managing childhood diabetes necessitates a partnership between parents, the child, and the healthcare team, including a doctor, diabetes nurse educator, dietitian, and psychologist. There’s much to learn for families and much to convey for the medical team. “Cooperation and partnership are the cornerstones of enabling the child to reach their potential,” says Dr. Meenal.
Managing T1DM primarily involves mimicking the pancreas’s function. Children and parents need to learn how to monitor glucose levels, understand factors affecting glucose fluctuations, and know how to administer insulin and count carbohydrates in meals. For children with T2DM, understanding the prescribed oral hypoglycemic medications is crucial.