Managing Childhood Diabetes: Expert Tips and Strategies for Parents

We often think of diabetes as a health condition that adults have. Children too, can be diabetic, for various reasons. In this article, we are privileged to have Dr Rashdan Zaki Bin Mohamed, a paediatric endocrinologist with Kementerian Kesihatan Malaysia, to share his expert advice and knowledge about childhood diabetes. From symptoms to look out for, to ways to care for diabetic children, Dr Rashdan Zaki covers these important points and more, for parents to take note of. Let’s begin, and understand more about diabetes in children and how to manage it. Q1: How common is it in Malaysia for babies to be born diabetic? This is not common. In fact, it is very rare! First and foremost, dear readers and parents need to understand that there are few types of diabetes amongst children, namely Type 1 diabetes (T1D), Type 2 diabetes (T2D) and genetic (monogenic) type. T1D is an autoimmune condition whereby there is a gradual destruction of pancreatic beta-cell function leading to diabetes. T2D is associated with obesity and insulin resistance. Whilst neonatal diabetes (NDM) is related to certain genetic mutation. NDM is very rare with estimated prevalence of 1 in 90,000 to 400,000 live births. We need to suspect NDM if the onset of diabetes occurred before the age of 6 month. Q2: What are the chances of babies having diabetes due to the mother’s diet while being pregnant? Image credit: Canva Pertaining to NDM, it has no relation at all as it is a genetic monogenic condition. But having said that, all pregnant mothers need to really take care of themselves, eat a balanced diet, exercise regularly, and lead a healthy lifestyle. There is a phenomenon called “epigenetics and foetal programming” where pregnant mothers with obesity and diabetes issues not only put themselves at risk, but the subsequent two generations as well—the baby and the future grandchildren, to some metabolic diseases, namely obesity, diabetes, and metabolic syndrome. So, all pregnant mothers, please look after yourselves well! Q3: If one or both of the parents have a history of diabetes, will the child develop this condition, too? If yes, at what age do they usually start having diabetes? Oh, this is rather a difficult question. Yes, if one or both parents are diagnosed with diabetes, there is a risk of the children developing diabetes as well. It is of higher risk than the normal population. This depends on many factors as well, for example, types of diabetes, associated genetic factors, and environmental factors. For instance, we found that in T2D, with obese and diabetic parents and children, it could be partly due to genetic inheritance, or it could be “obesogenic” environment—eating unhealthily, not exercising, sedentary lifestyle that lead to obesity and later on, diabetes. In T2D, the onset of diabetes occurs much later, usually during adolescent. Q4: What are the early signs that parents can detect at home if their child is diabetic? Very good question! To make it very simple for our dear readers and parents, remember the “5 Ts”: Thirsty – drinking a lot of water Toilet – passing a lot of urine Tired – easily getting tired Thinner – sudden unexplained loss of weight is a sign of diabetes Test – when we do blood glucose (sugar) testing and find that it is high (more than 7 mmol/L in fasting sample, and above 11 mmol/L in random sample.) Q5: What are the risks of having diabetes from an early age? Again, it depends on the types of diabetes:- NDM – onset before 6 months of age T1D – can occur in early childhood, as young as 1 year-old T2D – usually in adolescent age group (usually above 10 years old but we have as young as 8 years old having T2D due to obesity) Q6: Can diabetes be cured or controlled if caught early? Certain types of diabetes, for example NDM, can be a transient type or it can be a permanent type of NDM. T1D is usually life-long, with no curative therapy, but “controllable” with insulin injections and nutritional therapy. Image credit: Canva Whilst T2D sometimes need oral medications, some requiring insulin injection, most of time it can be controlled with good dietary and lifestyle modifications. Q7: How common is it in Malaysia for kids to be needing assistance from insulins? Image credit: Canva In T1D (autoimmune-condition and requiring life-long insulin injections)—which is the most common type of diabetes in children and adolescent, the incidence is relatively low in Asia. It affects approximately 2 to 5 per 100,000 population. However, I don’t have any confirmed data in Malaysian children. As for NDM, usually we (Paediatric Endocrinologists) will be initiating insulin therapy in this group of infants to control the blood sugar. If confirmed genetically, we try to manage some to transition to oral medications. For those with transient type, we may manage to even stop treatment and observe the condition. In T2D, those with uncontrolled diabetes (elevated blood glucose during monitoring, high HbA1C or those with metabolic decompensation), they need insulin injections to stabilise blood glucose. The key in T2D management is a healthy diet and lifestyle. Some may need oral medications, whilst others may require insulin therapy (in uncontrolled T2D). Q8: What are the long-term effects of having diabetes at an early age? The complications of having uncontrolled diabetes include kidney problem (nephropathy), eyes (retinopathy), nerves (neuropathy), related to blood vessel (microvascular and macrovascular) that may affect the heart, brains, and other organs. Other complications also include abnormal cholesterol, hypertension, and joints involvement. We have patients requiring dialysis due to diabetic nephropathy, or become blind because of retinopathy. Hence, once diagnosed with diabetes, one needs to really control it to avoid long-term complications. Q9: In your opinion, what is the most crucial thing a diabetic child’s parent should be alert on? The most feared acute complication in diabetes is a condition called “Diabetic Ketoacidosis” or simply, DKA. DKA is life-threatening condition (58.3% of patients, first diagnosed with diabetes, usually T1D, presented with DKA) that usually requires ICU (Intensive care unit) admission. The child typically will become breathless, experience recurring vomiting, tummy-ache (abdominal pain), is dehydrated, and looks very ill because of elevated blood acid, ketones, and high blood glucose. So, parents with diabetic children need to aware of these DKA signs and bring the child to a hospital immediately. Another condition is called “hypoglycaemia” or low blood glucose level (less than 4 mmol/l), in which the child may experience hunger, sweatiness, shakiness, tremors, palpitations or even worse, have a seizure! This is due to excessive insulin or skipping meals. Image credit: Canva Parents will usually be advised to give the child sweet drinks (or other measures) and to repeat blood glucose to ensure that it returns to normal. In general, once diagnosed with diabetes, the doctors will counsel and educate the parents regarding type of diabetes, the signs, and symptoms to watch for, insulin therapy (types, doses, and injection technique), other medications, diet and nutrition therapy, blood glucose monitoring, hypoglycaemia, sick days treatment, exercise, and long-term complications of diabetes. Q10: Do you think parents should bring their diabetic children to see a nutritionist to plan out their meals? Definitely! In fact, we have dietician (nutritionist) as part of our team, to care for a child with diabetes. The dietician helps in ensuring optimum nutrition for growth, development, health, and bodily functions. These are tailored individually for the diabetic patient, including insulin therapy and daily activities. My team here in Kota Bharu consists of myself as paediatric endocrinologist, sports medicine specialist, diabetic nurse and educator, dietician (nutritionist), physiotherapist, pharmacist, and a support group. We are all dedicated in caring for diabetic children, regardless of whether they are T1D, T2D, or other types, including NDM. We even care for cases like a Thalassaemic adolescent with iron overload complicated with diabetes, a 2-month-old baby with NDM, an adolescent with monogenic type of diabetes called MODY, and a few other rare conditions cases that are associated with diabetes. Our team is committed to care for these groups of diabetic patients, ensuring their best of health and living a normal life as children and adolescents. Live and Maintain a Healthy Lifestyle We hope the insightful sharing above provides mummies with better understanding of childhood diabetes. Let's all stay healthy by choosing to live and maintain a healthy way of life, for our own as well as our children's health. And like the doctor says, ill health can go beyond generations! So, let's make healthier life choices for the sake of our future generations, too. Source: Dr Rashdan Zaki Bin Mohamed, Paediatric Endocrinologist with Kementerian Kesihatan Malaysia Disclaimer: The information provided in this article is for informational purposes only and should not be considered as medical advice from Motherhood. For any health-related concerns, it is advisable to consult with a qualified healthcare professional or medical practitioner. 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