In the past 25 years, the incidence of diabetes in childhood and adolescence has been steadily increasing. The reasons for this increase are not known.
98% of diabetes in this age group is due to destruction of the insulin producing beta cells in the pancreas by the body’s own immune system (Type 1 diabetes). These children are “insulin dependent” for survival. Only a very small percentage will have a family history of diabetes.
The remaining 2% of children suffer from other varieties of diabetes including Type 2, the variety seen more commonly in adults. Type 2 diabetes is largely genetic and is seen in obese, physically inactive children. The rising incidence of Type 2 diabetes in India is thanks to the junk food and media culture.
At present, diabetes is managed with insulin injections taken 2–5 times daily. Those who take insulin twice a day need to have constant meal timings with similar carbohydrate content for a given meal from day to day. Those opting for 3–5 shots daily have greater freedom with meal timings and content. Glass syringes and steel needles of the past have been replaced with disposable syringes with fine, painless silicone coated needles, disposable pens and refillable pens. Today most children above 7–8 years inject themselves. The older short acting and intermediate acting insulin have been joined by the ultra short acting (Aspart and Lispro) and ultra long acting (Lantus and Detemir) insulin analogs. These analog are expensive but give smoother control of blood glucose with less risk of hypoglycemia.
A major advance is the continuous subcutaneous insulin infusion (CSII) device, the so called “insulin pump.” This is not a magical device that guarantees excellent control of blood glucose without any input. Rather, it is an excellent weapon in the hands of those who count carbohydrate content of food, check blood glucose 4–5 times a day and know how to act on these observations. It is possible to have near-normal blood glucose with CSII, and those who can afford the extra cost (Rs. 1,50,000 initial investment and a running cost of Rs. 4,000–5,000 per month) should opt for it.
Do remember that one can feel very fit and healthy despite blood glucose in the range of 200–300 mg%, but over the years those with this level of control are likely to develop slow damage to the eyes, nerves, kidneys, heart and blood vessels. A good control with average blood glucose below 160 mg% (this is judged by a test called the HbA1c) reduces the risk of the long-term complications of diabetes several fold.
Today blood glucose can be easily and painlessly tested at home with the help of a variety of meters that are available at a very reasonable price. Patients should check blood glucose 2–5 times a day and use the results to make intelligent adjustments in their insulin dose from time to time. This data can also be used to study the influence of various foods and activities on blood glucose and to study the correlation between how one feels and the blood glucose. A continuous blood glucose measuring system (CGMS) is also available which displays your tissue glucose level every 5 minutes for a period of 72 hours at a time. This device is very expensive but can be a real boon when used in short spells to control brittle diabetes.
Soon we hope to have a pump that is connected to the CGMS and that releases insulin as per the prevailing blood glucose without any manual inputs.
The insulin inhaler does not replace injections totally but it can be used as a substitute for short acting insulin only. It has not yet been approved for use in children below the age of eighteen years.
Oral insulin has been threatening to burst on the scene for quite some time now, but it may still take a long time to materialize.
Islet cell transplantation presents two problems: 1) getting sufficient number of islet cells and 2) preventing rejection of the transplanted islets by the immune system. Stem cell transplant is experimental.
While scientists work hard to find a cure for diabetes you should strive hard to keep your blood glucose as close to normal as possible. When a cure is available would you not like to be in perfect health with intact eyes, kidneys, nerves, heart, blood vessels?