Juvenile diabetes requires proper management

Immune mediated diabetes mellitus or Type 1 diabetes mellitus was previously called Juvenile Diabetes, explains Dr. K. Chaitanya Murthy, Consultant, Dr Mohan’s Diabetes Specialities Centre, Bangalore

It is a form of diabetes where the β cells in the pancreas (which produce insulin) are destroyed resulting in abysmal insulin production so that the particular child developing diabetes becomes completely dependent on Insulin. Immune mediated diabetes (type 1 diabetes) can be diagnosed only by measuring antibodies (which destroy the β cells) and C-peptide (which quantifies insulin levels in the body). Type 1 diabetes is the most common form of diabetes in children. Apart from Immune mediated diabetes, other forms of diabetes can be seen in this particular age group. Genetic forms of diabetes and the more common Type 2 diabetes can also be seen in this particular age group, diagnostic and treatment strategies completely differ when compared to Type 1 diabetes. Type 2 diabetes is seen in 6-12 % of individuals below the age of 20 in India. Genetic forms of diabetes can be seen from day 1 of life in the form of neonatal diabetes. The monogenic forms of diabetes, MODY(maturity onset of diabetes) will usually present in three or more generations of family history. Many patients with MODY are wrongly diagnosed as Type 1 and started on lifelong insulin whereas most MODY do require insulin.

 How is juvenile diabetes treated?

Insulin remains the main stay of treatment in case of Type 1.

But in case of Type 2 and genetic forms of diabetes, oral drugs is the mainstayof treatment with adequate emphasis on diet/lifestyle.

 Is there a cure for juvenile diabetes?

 In case of Immune mediated Type 1 diabetes, the destruction of β-cells is permanent and irreparable and at present there is no cure.

In case of type 2 diabetes presenting at very young age, early identification during the stage of pre-diabetes followed by proper modification of lifestyle and diet could play a role in reversing the diabetes.

 What complications can arise as a result of having juvenile diabetes?

Two types of complications can be seen.

A) Acute

Hypoglycaemia (low sugar) because of insulin therapy.

Diabetic Keto acidosis(DKA), it is a state of high sugars resulting from inadvertent insulin therapy. It is a medical emergency and needs to be addressed immediately.

DKA usually results from a co-existing ailment like pneumonia(respiratory tract infection) or urinary tract infection. The child will be sick, dehydrated(due to vomiting) and due to inadequate food intake parents tend to skip the dose of insulin which can result in high sugars.

Each and every patient of a child with type 1 diabetes should be educated about SICK DAY RULE.

 B) Chronic 

Apart from the classical chronic micro or macrovascular complications including the eye, kidney and nerve disease few other complications like growth retardation are specific to childhood diabetes.

 What are symptoms or early signs of juvenile diabetes we should be aware of?

 Classical type 1 will have signs and symptoms of high sugar in the form of polyuria(increased frequency of urine),poydypsia(thirst) and polyphagia(hunger).

If a child is presenting with any of these symptoms with or without weight loss, parents should immediately seek medical attention.

Atleast 30-60% of children with type 1 diabetes will be initially admitted in a hospital with some other ailment like pneumonia and at the time of evaluation during the stay in the hospital type 1 diabetes will be diagnosed.

Type 2 diabetes is more common in obese children/adolescents and they have signs of insulin resistance. Many of them are usually diagnosed during routine medical evaluation.

It is prudent on the side of parents to seek appropriate medical advice if a child is becoming obese.