BY DR MEENAL MAVINKURVE

WHEN your healthy , active child is diagnosed with diabetes , it can feel like the carpet has been pulled from under your feet . As a parent , it can be a confusing and overwhelming time .

Children with diabetes mellitus can achieve anything . I have encountered parents who experience feelings of shock , helplessness and hopelessness once their child is diagnosed with diabetes .

But the condition has a solution . It is very manageable , and teamwork between the family and the diabetes team opens all doors of opportunity to children with diabetes .

I want patients and parents to understand that a child with diabetes can do equally well , or even better , than any other child who does not have diabetes . No doubt it is a steep learning curve with its fair share of emotional rollercoasters and new routines , but teamwork will allow children with diabetes to have a sweet life as much as their peers . It is important to recognise this and focus on the solutions so that parents can better support their children with diabetes .

WHAT IS DIABETES MELLITUS ?

Diabetes mellitus centres around insulin , an important hormone made by an organ called the pancreas . Insulin is instrumental in getting glucose , a energy source , into our cells .

Diabetes mellitus is a condition where insulin is lacking ( insulin deficiency ) or the action of insulin is diminished ( insulin resistance ). Both insulin deficiency or insulin resistance leads to high glucose

Diabetes mellitus is a condition where insulin is lacking ( insulin deficiency ) or the action of insulin is diminished ( insulin resistance ). Both insulin deficiency or insulin resistance leads to high glucose levels in the bloodstream , which is diabetes mellitus .”

levels in the bloodstream , which is diabetes mellitus .

The most common forms of diabetes mellitus in children are Type 1 ( i . e . insulin deficiency or T1DM ) and Type 2 ( insulin resistance or T2DM ). T1DM is an autoimmune condition in which the body generates antibodies that destroy the beta cells in the pancreas . These are the cells responsible for producing insulin . In T2DM , the body can still make insulin , but the action of insulin is diminished .

SYMPTOMS AND SIGNS OF DIABETES

The most common symptoms are the 4Ts of the Diabetes UK campaign : Thirsty , Toilet , Thinner and Tired .

Excessive thirst , excessive urination , waking at night to pass urine or wetting the bed at night are important symptoms to be aware of in children , as it may indicate a diagnosis of diabetes . Some parents may report ants in the toilet because the ants are attracted to the “ sweet urine ” ( i . e . the glucose in the urine ).

Children can also experience infections ( fungal infections ), unexplained weight loss or a failure to gain weight despite being hungry . It ’ s important for parents to request their doctor to monitor their children ’ s weight and keep a record , irrespective of whether their child is ill or not . Growth is a good indicator of a child ’ s health .

Please see a doctor urgently if you notice these symptoms and signs . Parents should also enquire about the possibility of a diagnosis of diabetes and ask whether a test for glucose and ketones should be done .

IT STARTS WITH AWARENESS

One of the important steps that can lead to an earlier diagnosis of diabetes is the awareness that diabetes mellitus is a

disease that also affects children and that early recognition of the symptoms can lead to early diagnosis and treatment .

If the symptoms are not picked up early , it can progress to a more severe presentation of diabetes mellitus with symptoms of vomiting , lethargy , breathlessness and tummy pain . These are the symptoms of diabetic ketoacidosis ( DKA ), a severe presentation of diabetes . Even then , these same symptoms can sometimes be confused with other common paediatric conditions . A recent study by Mavinkurve et al , 2021 titled Is Misdiagnosis of Type 1 Diabetes Mellitus in Malaysian Children a Common Phenomenon ?, 2021 , demonstrated that the misdiagnosis rate in Malaysian children with T1DM was 38.7 per cent .

In this study , it was reported that children were commonly misdiagnosed with respiratory or gastrointestinal illnesses by healthcare professionals . Children younger than five years old had a higher risk of being misdiagnosed , presenting in DKA and being hospitalised in the intensive care unit . Overall , the study highlights that preventing misdiagnosis is an important factor in preventing DKA and a lengthy hospital stay .

THE NUMBERS KEEP RISING

In 2019 , the International Diabetes Federation Atlas ( IDF 9th ed , 2019 ) reported 977 cases of diabetes in children below the age of 18 in Malaysia . This was more than double the number of cases registered in 2008 under the Diabetes in Children and Adolescents Registry , Malaysia . This was reported in The Star , which stated that it “ suggests , on average , about 57 children are being diagnosed with diabetes each year .” Of the two types , Type 1 is the more common in children , accounting for more