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T1DM occurs when the body does not produce insulin, T1DM mostly has sudden onset in children and adolescents and the symptoms can be easily identified. It can strike at any age varying from less than a year of birth, up to 40 years of age. T1DM accounts for 5 to 10 percent of all diagnosed cases of diabetes and is the leading cause of diabetes in children and adolescents. In those less than 10 years of age, type 1 is the only from of diabetes.
At a younger age the symptoms are more dramatic and hence easily identifiable whereas as age advances the chances of developing T2DM are higher. Early symptoms, include increased thirst and urination, constant hunger, weight loss and blurred vision. Children may also feel very tired and weak. Children with T1DM are at risk for long-term complications (damage to the cardiovascular system, kidneys, eyes, nerves, blood vessels, skin, gums, and teeth). In T1DM since the pancreas can no longer produce insulin the patients are required to take insulin daily, either by injection or via an insulin pump. A diabetes management plan for young people apart from insulin therapy includes self-monitoring of blood glucose,healthy eating,and physical activity.
Risk Factors: A combination of genetic and environmental factors put people at increased risk for type 1 diabetes.
Type 2 Diabetes (T2DM)
The first stage in the development of T2DM is often insulin resistance, requiring increasing amounts of insulin to be produces by the pancreas to control blood glucose levels. Initially, the pancreas responds by producing more insulin, but after several years, insulin production may decrease and diabetes develops. T2DM used to occur mainly in adults who were overweight and older than 40 years. Now, as more children and adolescents all over the world become overweight, obese and inactive, type 2 diabetes in occurring more often in young people. T2DM is rare in children younger than 10 years of age, regardless of race or ethnicity.
Type 2 diabetes usually develops slowly and steadily in children symptoms may be similar to those of type 1 diabetes. A child or teen can feel very tired, thirsty, or nauseated and have to urinate often. Other symptoms may include weight loss, blurred vision, frequent infection, and slow healing of wounds or sores.
The main stays for managing early onset T2DM is nutrition management, increased physical activity and regular blood glucose levels, glucose-lowering medication and/ or insulin therapy are used as well.
Risk factor for early onset T2DM Being overweight (BMI >23),
*Strong family history of type 2 diabetes, especially if one parent or both parents have diabetes.
*Black velvety skin (known as acanthosis nigricans) specifically at the nape of the neck or axilla region.
*Early menarche / puberty
*Sedentary behavior with very little physical activity.
REMEMBER
*All children and adolescents with diabetes NEED NOT ALWAYS HAVE type 1 diabetes. *Accurate clinical history, detailed pedigree chart, few biochemical tests and simple clinical signs can help to classify diabetes in children and adolescents to give the appropriate treatment. *Childhood onset type 2 diabetes is preventable- Ensure that your child looks healthy (not obese) and is involved in games and sports. *Fatness is NOT Fitness
The harmful consequence of holding urine in school
When a child habituates holding urine in school for an abnormally long period of time the muscles which provide both control to both urine and stool, become spastic and painful. Since all the urine is never expelled there is always a residue with becomes the seed for bacteria to grow. When a kidney ultrasound is done the urinary bladder a thick walled because it has been working hard to overcome a resistance. This creates an increased pressure, which transmits back to the kidneys affecting the filtration of urine. The stage is set for chronic renal disease. Overtime the bladder becomes exhausted and fails to work. In these children it becomes necessary to empty the urine by passing a tube into the bladder at regular intervals.
A few simple rules can overcome this problem very easily. All parents should ensure that the child passes stool (and completely) before leaving for school in the morning. In school the child should drink sufficient quantities of water and void at least twice during the breaks. At home TV, video games or the internet should never be allowed to take priority over going to the toilet. If the parents sees the child suppressing the urge to pass urine or stool, the TV or computer should be shut down and child firmly reprimanded.
For their part schools should ensure that there are adequate toilets on their premise. For every 30 student one toilet should be provided. While in the case of boys, urinals are often enough for girls especially over 8 years of age enough oilets should be ‘top priority’, Once the girls attain puberty unless privacy is provided changing soiled napkins in school becomes a problem. Teachers should be sensitized to this issue and staggered breaks provided so that all students do not rush to the toilets at the same time. During class hours any child wanting to go should be allowed provided this does not become a habit.
Once established, the habit of urine and stool postponement is very hard to overcome. Unless concerted action is taken, this problem is poised to become an epidemic and will ultimately result in a large number of adults with “Lower Urinary Tract Symptoms’’ needing life long treatment.
Foot fundas
It is important for all diabetic patients to undergo “2 vital tests’’ annually to identity the development of “2 bad markers’’ of diabetic foot. 1.Bilthesimetry –t o identify the first “bad maker’’ “Neuropathy’’ – a nerve disorder which leads to numbness with subsequent development of painless ulcers.
2.Arterial Doppler with ABI –to identify the second “bad marker’’ - “peripheral Vascular Disease’’ – a state of low blood flow in the which leads to ulcers and gangrene.
Take the first step
Foot complication are among the most serious and expensive complications of diabetes mellitus. Amputation of all or part of a lower extremity is usually preceded by a foot ulcer. A strategy which includes prevention, patient and staff education, multi – disciplinary treatment of foot ulcers, and close monitoring can reduce amputation rates close to 70%.
State of the are technology advancements that can be used to prevent amputations: Arterial revascularization procedures; Bone curettage; Anodyne Therapy; Charcot Foot Reconstruction; use of cell based tissue technologies. i.e., Skin Replacement like Dermagraft & Apligraf; use of advanced wound dressing agents such as hydrocolloids, alginates, collagen based; use of extracellular matrix products; use of epidermal growth factors; hydroscalpels to deride infected tissue; Negative Pressure Wound Therapy; Bioengineered Skin Tissue Grafts; Advanced Techniques for Wound Closure; Stem cell treatment).
By using a combination of these advances therapeutic options, we can definitely make an effort in saving a limb. Our advice; take care of your feet as you would like to take care of your face.