diabetes

he other diabetes

Your Health
DR GITA MATHAI

Diabetes, which affects eight to nine per cent of the urban population in India, is perceived to be a lifestyle disease of overweight, sedentary and middle-aged people. These patients do not require insulin injections. In this type of diabetes, the body either loses its sensitivity to insulin (the natural hormone needed to reduce blood sugar) or the pancreas (which produces insulin) fails to produce enough of the stuff. A judicious combination of restricted diet, exercise and tablets are usually enough to keep the sugar level in check and complications at bay.

Few people, however, realise that one per cent of newly diagnosed diabetics are thin and young. They have type 1 diabetes. The disease was previously called juvenile diabetes as sufferers were usually young but now the nomenclature has been changed to “insulin dependent diabetes”. In these patients, the pancreas fails to produce insulin. It can occur at any age, from infancy, childhood, and adolescence to adults, as both genetic factors and environmental triggers are involved. Once it has set in, it cannot be prevented, delayed or cured, it can only be treated.

Type 1 diabetes may be inherited or occur suddenly after an infection. The mumps, Epstein-Barr and coxsackie virus in particular have been implicated. The body itself may also produce antibodies to the islet cells (which produce insulin) in the pancreas, destroying them. A relative deficiency of vitamin D has been linked to an increased risk of type 1 diabetes. Drinking water contaminated with nitrates may also increase the risk. Early weaning (before the recommended 4-6 months) increases the risk. Exclusive breast feeding until the age of one reduces the risk.

Diagnosing insulin dependent diabetes in a child is difficult. There has to be a high index of suspicion on the part of the parent and the doctor. The typical symptoms of increased thirst, frequent urination, a relapse of bedwetting after successful toilet training, voracious appetite and overeating with loss of weight or fatigue may be accepted and dismissed as a “normal” part of childhood. Often the diagnosis is only made by accident or after uncontrolled infections or other complications set in.

Blood tests are needed to confirm the diagnosis. A random blood sugar level of 200 mg/dL (11.1 mmol/L) or higher, Glycated hemoglobin (A1C) of 6.5 per cent or more, a fasting blood sugar of 126 mg/dL indicates diabetes.

Treatment for insulin dependent diabetes requires a judicious combination of diet, exercise and insulin. The diet should be nutritious with plenty of fresh fruits and vegetables. The total calories required depends on the age and level of physical activity. Blood sugar levels should be checked three times a day (with a glucometer) before meals so that the quantity of food eaten can be adjusted. Some young people do well if food is split into six mini meals instead of three big ones. Control is often difficult for parents when the children are fussy eaters.

Unfortunately there is no oral medication or miracle drug as yet which can replace insulin. So insulin has to be given as injections — often several times a day — depending on blood sugar values and the quantity of food about to be eaten. It becomes difficult for parents when the child refuses to eat after the calculated dose of insulin has been given, or the child vomits. Flexibility in the diet and dosage of insulin has to be maintained.

Low blood sugar can be dangerous. It can cause sweating, shivering, hunger, giddiness, tiredness, headache, irritability, palpitations, tremors, sweating, convulsions and loss of consciousness. Some form of sugar should be given as soon as such symptoms occur. Affected children need to always carry sweets. Blood sugar can become low at night and cause sweating and morning headache.

In the absence of insulin, even when blood sugar levels are high, cells are unable to process the sugar and face starvation. The body begins to break down fat stores. This leads to a dangerous condition called ketoacidosis. There may be nausea, vomiting, abdominal pain, a fruity odour and eventually loss of consciousness or seizures.

Uncontrolled high blood sugar can over the years cause complications in the eyes, heart, kidney, skin, and nerves. Infections become difficult to control and wounds may not heal. In later life, dementia and Alzheimer’s can set in.

If the sugars are controlled with diet, exercise and insulin, patients can lead normal lives and have standard life expectancy.



Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in