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Diabetes mellitus in children is becoming more common. Treating diabetes is difficult for a child because it requires discipline. How to care for children with diabetes is advised by dr hab. n. med. Piotr Fichna.

The number of people with diabetes is growing in the world. A particularly disturbing phenomenon is the increasing prevalence ofdiabetes in childrenand adolescents. Until recentlytype 2 diabeteswas almost exclusively an affliction of aging people. Today, cases of insulin resistance are not uncommon in the very young.

  • Diabetes mellitus in children appears more and more often. Is it true?

In the early 1990s, the incidence of diabetes in Poland was around 4.5 per 100,000. minors under the age of 15. Slowly, but constantly rising, and after a dozen or so years, it almost tripled! This phenomenon is also observed in other countries. The incidence of both type 1 (insulin-dependent) diabetes and type 2 diabetes is increasing.Type 1 diabetes , if it is clinically revealed, cannot be overlooked. There are symptoms that must worry parents, guardians, family doctor - excessive thirst, drowsiness, weakness, weight loss. You can see that something is wrong with the baby. Unfortunately, it is difficult to recognize the disease in its earliest, secret stage. When symptoms are noticeable, the disease is advanced. The destruction of the pancreatic islet cells takes place "silently" and only when it reaches 85% of the total, diabetes appears.

  • Diabetes in children: what can we do to prevent this from happening?

Not much. We know how this process works, but we don't know what starts it or how to stop it.

  • Type 2 diabetes in children? Until now, it was considered an adult disease. But now it also affects children.

Indeed, type 2 diabetes is very common among adults, but for the past 10 years or so, the number of children affected by this disease has been increasing rapidly worldwide. And in our clinic, after examining several hundred overweight and obese children, it turned out that in this group, 2/3 of patients have very serious metabolic disorders. Increased levels of inspin (inspin resistance) have been noted, and many of them also have elevated blood sugar levels.

  • What's thisdoes?

Nothing less, nothing more than the fact that these children have upset the mechanisms regulating their metabolism and in the near future they are certainly at risk of type 2 diabetes. Hence the alarming conclusion: obesity is a serious leaven of developing type 2 diabetes!

  • Can pharmacotherapy help fight overweight?

Diet and exercise play a decisive role in obesity-related type 2 diabetes. Sometimes, when the lifestyle does not seem to improve at all, pills are administered. We do it very carefully, adjusting the therapy to a specific child, and we monitor each action. However, education provided by a doctor or properly trained nurses is essential. It is also necessary to work well with specialists in movement and physical activity.

  • Diabetes in children: what are the consequences of a late diagnosis or poor conduct?

Complications are severe, their appearance progresses imperceptibly and initially imperceptibly. Over time, the blood vessels are damaged, and thus the eyesight, nervous system and kidneys are disturbed. And so much so that dialysis, and even a kidney transplant, becomes necessary. Other types of complications and the resulting dangers are associated with the states of hypoglycaemia. The complications listed here occur in children and adolescents suffering from type 1 diabetes, with many years of poor metabolic control, which must be emphasized so as not to confuse the various types of this disease with each other. Type 2 diabetes, if it occurs in adolescence, and even obesity “only”, has other complications. These are, for example, lipid disorders, arterial hypertension, fatty liver, often skeletal overload, maturation disorders, but the worst of them seems to be the progressive deterioration of resistance to the effect of inspin and dysfunction of the cells secreting inspin - this will eventually lead to such complications in adulthood, as in poorly controlled type 1 diabetes.

  • Diabetes in children: what are the risks of them?

In the most severe case, damage to the central nervous system, which results from "hypoglycaemia" of the brain. People who have had such an episode are able to notice and properly interpret the symptoms that precede them: sweating, nervousness, lack of concentration, feeling hungry, and sometimes psychotic symptoms. Unfortunately, they do not always appear and then, without warning, deep disturbances of consciousness, loss of consciousness, convulsions occur.

  • These are all things that children with diabetes have to learn. There is a long way ahead of them, which they have to endure with illness.

The child does not have such a sense of responsibility that would guard the proper therapy, which would last 24 hours a day. That is why he needs support, someone who watches over him and teaches him to make decisions in only seemingly trivial matters: when to eat, when to give and when to increase the dose of inspina. It is necessary to cooperate with the school and to communicate quickly with the home.

  • Type 1 diabetes presents difficult tasks to educate both children and caregivers.

Diabetes affects both small children, one-year-olds and preschoolers, schoolchildren and rebellious teenagers. You have to reach everyone in a different form, look for motivation in a different way. And it is not easy, especially since the child, unable to cope with it, starts to run away from reality. There are lies and deceptions in reading the results and taking meals. They do not result from the bad nature of young patients, but are a manifestation of their helplessness in the face of the demands of this difficult disease. Education must be continuous, repeatable, "tailored" to the patient and his abilities.

  • How to reconcile this with the severe rigors imposed by the disease on diabetics? To what extent does modern therapy help to bear this burden?

The progress in the treatment of diabetes is huge. Research is focused on finding ever better clinical and pharmacological solutions in an attempt to mimic the physiological release of inspin. The production of highly purified human insins and the development of modern methods of their administration - pumps and pens, are milestones in the improvement of treatment methods. Another very significant achievement was the introduction of human inspina analogs.

  • What are inspin analogues and how do they differ from other inspin?

They are products very similar to poultry, obtained through biotechnology. They differ from human inspin in one or more amino acids. This changed the properties related mainly to their absorption from the subcutaneous tissue into the blood. The consequence of this is the acceleration of action (fast-acting analogs) or its uniform extension (long-acting analogues), while their effect on the body's cells, once they reach there, is practically the same as in human.

  • What are the benefits for the patient, especially the diabetic child?

Analogues, by generally better ensuring diabetes control, significantly improve the quality of life as they allow you to reduce or change the number of meals. It becomes possible to eliminate additional snacks to protect the sick child fromyou experience hypoglycaemia (a severe and severe drop in blood glucose levels), and eating anything you want, sometimes even cookies. There is a possibility of additionally administering several units of the fast-acting analogue of inspin, which is important especially for children. Fast-acting analogues are absorbed after a few or several minutes, so they can be administered immediately before a meal (it is not necessary, as in the case of human inspina, to keep a 30-45-minute break between the injection and the beginning of the meal). You can also modify the doses on an ad hoc basis, as needed.

  • People with diabetes hope for a breakthrough in its treatment. Where can it come from? In genetics, biotechnology, stem cells?

All these directions are promising. Research is conducted in all of these fields. It is difficult to say which of these paths will lead to the expected breakthrough the fastest. Regardless, one thing is certain: those waiting for pharmacological news are not exempt from the daily, tedious performance of doctors' recommendations. And in many ways. Because diabetes therapy is like a chair based on four legs: medication, diet, exercise and education. And none of them can be missing.

Diabetes is an increasingly common disease among children. Prophylaxis should be started in the prenatal period


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