RECOGNIZING DIABETES IN CHILDREN

Diabetes mellitus (DM) is a chronic disease whose incidence is increasing throughout the world, not only in adults but also in children.  According to the Indonesian Pediatrician Association (ID AI), the incidence of diabetes in children in Indonesia increased 70 times in 2023 compared to 2010, with a prevalence of 2 per 100,000 children.

DM is a metabolic disorder characterized by elevated blood sugar levels (hyperglycemia). This hyperglycemic condition will disrupt many other body functions if it is not treated, for example blood circulation function, kidney function, nerve function, and even disrupt the growth and development of children.

There are two types of DM in children, namely type 1 DM (DM 1) and type 2 DM (DM 2). In type 1 DM, blood insulin levels are less than normal due to decreased insulin production by the pancreas, while type 2 DM is due to the patient's body being resistant to insulin or insulin not functioning effectively even though the levels are normal.

The factors causing type 1 DM are genetic, immunological and environmental factors, while type 2 DM is caused by an unhealthy lifestyle and obesity. More children are found to suffer from type 1 DM than type 2 DM (around 5 -10%).

The initial symptoms of DM that often appear in children are:

1. Frequent urination
2. Drink a lot
3. Get thirsty quickly
4. Get hungry quickly
5. Feel tired quickly
6. Eat a lot but have difficulty gaining weight and even lose it quickly
7. Skin folds (armpits or around the genitals) often become itchy and infected with fungus

The above symptoms in older children will be reported to their parents, but in younger children they will be subtle or even unclear. If these symptoms are not immediately recognized by the parents, DM is not immediately diagnosed and treated, the child can experience an emergency condition known as diabetic ketoacidosis (DKA). Complaints that appear in children with DKA are usually abdominal pain, nausea/vomiting, frequent urination, shortness of breath, dehydration, and even decreased consciousness. Diabetes Mellitus cannot be cured, but DM sufferers can have an optimal quality of life with proper blood sugar and metabolic control appropriate.

The principles for managing type 1 DM sufferers in children consist of 5 pillars, namely:

1. Insulin injection
The use of insulin in type 1 DM is mandatory because the sufferer's body has very low insulin levels. Insulin administration is adjusted to the blood sugar level and number of calories the child needs.

2. Meal arrangements
Meal arrangements are provided without ignoring the calories that children need for growth, puberty and daily activities. Eating arrangements are made by calculating the daily amount of carbohydrates at around 50 – 60% of total calories, protein around 10 – 15% and fat around 30%. Carbohydrates have a big influence on blood sugar levels. Good carbohydrates are those that are high in fiber and have a low glycemic index, such as fruit, vegetables and cereals.

3. Physical activity and exercise
Can help lower blood sugar, create a "healthy" feeling and increase sensitivity to insulin so that it can reduce daily insulin requirements.

4. Independent blood sugar monitoring
The aim is that children with DM are able to manage this disease independently.

5. Education for children/families.
Handling of type 2 DM in children prioritizes lifestyle modifications such as managing food and physical activity.

Administration of medication and/or insulin, depending on symptoms, severity of hyperglycemia, and  whether or not there is ketoacidosis. Children with type 2 DM who are metabolically unstable require insulin injections, while those who are metabolically stable are given oral DM medication.

Children with DM require long-term attention to management and treatment. Support from family,  and  community  and  government  is  important  to  overcome problems such as drug availability, regularity of treatment, boredom, school absences, financial needs and psycho-social problems. Even though they require special treatment in everyday life, children with DM can live healthy, happy and successful lives. With good disease control, children avoid DM complications and can grow and develop optimally

Source :
1. dr. Ken Shinta, Sp.A
2. Indonesian Pediatrician Association (2015). National Consensus on Management of Type-2 Diabetes Mellitus in Children and Adolescents.
3. Healthy Children, American Academy of Pediatrics (2019). Diabetes in Children