The Health November 2023 | Page 23

NOVEMBER , 2023 | THE HEALTH

In the case of Type 2 , a known risk factor is obesity , which is on the rise in Malaysia . It is typically seen in the adolescent age group . Though there is a strong relationship between obesity and T2DM , there is an interplay of other factors , such as family history and ethnic background .

NAVIGATING THE RISKS

Along with a diagnosis of diabetes mellitus , be it T1DM or T2DM , comes the risk of developing complications , which include high blood pressure , abnormal cholesterol levels , non-alcoholic fatty liver disease and adverse effects on the kidneys , nerves and eyes . In both forms of childhood diabetes , doctors vigilantly monitor for complications and address them as and when they appear . However , optimising glucose control and ensuring compliance is the cornerstone of preventing complications .

In general , screening for such complications starts a few years after diagnosis , but it varies based on the type of diabetes and the age at diagnosis . For instance , T2DM requires complication screening from the time of diagnosis .

In T1DM , screening starts after a few years . In cases of T2DM , it is also important to screen for obesity-related complications ; these may include obstructive sleep apnea ( problems with snoring ), non-alcoholic fatty liver , and in girls , polycystic ovarian syndrome ( problems with menses ), which have to be managed in tandem .

MANAGING DIABETES

Managing childhood diabetes requires a partnership between the parents , the child and the healthcare team . The team usually comprises a doctor , diabetes nurse educator , dietitian and a psychologist and each of them has a critical role .

There is much to learn on the part of the family and much to impart on the part of the medical team . Cooperation and partnership are the glue that supports the child to achieve his or her potential .

The basic principle of managing T1DM is to mimic the functions of the pancreas . Hence , children and parents need to learn how to check glucose levels ( with a glucometer ) several times per day , understand what circumstances can make their glucose levels fluctuate and what action they need to take . They need to learn about the different insulins , how to inject them and how to count the carbohydrates in their meals .

Children with T1DM require insulin with all their meals and long-acting nighttime insulin too . This may vary according to the doctor ’ s advice , but a regime with multiple daily injections best mimics the pancreas . For children with T2DM , they would also have to understand about the oral hypoglycaemic medications which are prescribed .

SUPPORTING YOUR CHILD WITH DIABETES

Upon a diagnosis of T1DM , there are a lot of new tasks to be learnt and done for the child throughout his or her lifetime – and , understandably , the parent ’ s first instinct would be to take on all these tasks for their child .

However , as the child becomes older and independent in other aspects of life , it is important for parents to gradually hand over the responsibility of diabetes self-care to their kids while continuing to be their support at all times . This enables the child to become independent , responsible and confident in diabetes self-care .

Young children with diabetes can still be involved in their diabetes care by doing simple things like getting the items ready for a glucose check , which will progress to unsupervised glucose checks once the child is more independent .

School-going children will need to learn how to self-inject insulin , too . It ’ s about handing over responsibility slowly while ensuring you are there as a constant support .

DIABETES AND DIET

Having diabetes doesn ’ t mean a diet that is completely void of sweets and sugar . It ’ s all about moderation and following a healthy diet as any other child without diabetes should .

However , children with diabetes are required to count the carbohydrates in the sweets they eat and inject insulin for it . For the obese or overweight child with T2DM , there would be a greater emphasis on limiting calorie-dense food options .

Some parents may give their children “ carbohydrate-free ” foods to avoid administering insulin . However , this is not advisable , as the recommendation is that children with diabetes mellitus should consume a healthy , well-balanced diet . It is important to foster a good relationship with food and insulin for children with diabetes from the time of diagnosis .

Parents and patients may get exhausted with all the multiple tasks – glucose checks , counting carbohydrates and calculating insulin doses – and decisions that have to be made for any child with diabetes . However , it is important to remember that not every day will be a perfect series of glucose readings .

There will be readings that fluctuate , and achieving perfect glucose readings every hour of every day is not the main objective . Understanding the reasons for those fluctuations and rectifying those are more important .

THERE IS A SOLUTION

For a child diagnosed with diabetes mellitus , the road ahead will be marked with good days and challenging days . Patients and their families can get support from their doctors and work together to ensure a child with diabetes has an equally rich childhood as any other child . Awareness and education about childhood diabetes through reliable sources are critical .

Diabetes mellitus may be a chronic condition , but there is a solution . With the solution and teamwork , we can help children with diabetes to achieve their rightful potential .

Life with diabetes – is sweet . – The Health

Dr Meenal Mavinkurve is a Consultant Paediatric Endocrinologist at IMU Healthcare and Senior Lecturer in Paediatrics at the International Medical University .

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