On Type 1 Diabetes In Children…Quid Est Veritas?

imageThose Misconceptions

“Children don’t have diabetes”….A myth that effectively belittles diabetes in children, especially those living in developing African and Asian countries. Children in these countries don’t eat sweets like they do in western countries, so how can they develop diabetes? The Reality: Reports from World Health Organisation (WHO) show that diabetes affects children globally. Type 1 affects 10% of diabetes patients and majority are young children and teenagers. Type 2 is rare in children. Many children die needlessly due to parents not recognising symptoms of diabetes. Worse still, in sub-Saharan Africa, symptoms are sometimes misdiagnosed as cerebral malaria or meningitis. In other cases, symptoms are given a repertoire of religious and traditional explanations.

Old Wives v Contemporary Folks

Interestingly, I believe that some old folks recognised the dangers of sugar in urine (a common symptom of diabetes), albeit confusingly. At least my grandma did. Any time I fell ill as a young child, she used to monitor my urine for about an hour before flushing the toilet. She said that she knew a child who died soon after ants started gathering around his urine. It didn’t make sense to me then. In fact, I don’t think she had answers to the causes of the child’s death. She just attributed ants around urine to some kind of bad omen signifying imminent death. Ironically, she was right, because mismanaged diabetes kills; which may have been the case with the child my grandma knew. Truly, sugar in urine attracts ants.

My grandma’s assessment was decades ago, so one should assume that most contemporary folks are aware of diabetes in children. Ha! The reverse is the case. In fact, my knowledge on diabetes in children was myopic until my nurse training days, when I wrote exams on the topic…twice (I failed the first time). Although I still reel from that experience, thankfully the knowledge I gained from it came in handy recently…well.

I rang my friend Carla in Ghana to discuss topics for my blog. During the conversation, she told me that Ghanian children don’t suffer from diabetes because they don’t eat as much sweets as children in western countries. I tried to sway her thoughts as well as show off my exam knowledge. She didn’t buy any of it. So in defiance, I thought to myself; “that’s Ghana, surely people are more aware of childhood diabetes in Nigeria”. To my utter shock, the first friend I asked about diabetes in children, told me that children in Nigeria don’t have diabetes because they are very active physically. Luckily I was sitting down during that call. My sister as well as other friends echoed Carla’s theory about children not having diabetes. Some added that if it occurs at all, the children must be morbidly obese. Oh gosh!!! A further check on the internet revealed a horrifying chasm in the recognition and diagnosis of type 1 diabetes in sub Saharan African and rural Asian communities. Thousands of children have died as a result.

Some science…the attack

Type 1 diabetes occurs when the body stops producing insulin. When we eat, glucose (sugar) and other nutrients are broken down and passed into our bloodstream. Insulin from the pancreas carry glucose into body cells, where it is converted to energy and some stored as fat. For people with type 1 diabetes, the immune system mistakes the insulin-making cells in the pancreas as harmful. The immune system then attacks these cells destroying them completely or damaging them enough to stop producing insulin. This usually occurs in children. There are no clear reasons why this happens, hence it is an Auto Immune Condition. It has nothing to do with sweets or geographical area. Some experts have linked this autoimmune reaction to viral infections, whilst others link it genetical factors. There are other theories, but there’s no proven reason why it happens.

Unfortunately, due to lack of awareness, parents may not recognise the core symptoms of type 1 diabetes; known as the 4Ts (toilet, thirsty, tired, thinness). Excessive sugar in the body draws water from the cells into the bloodstream. This then triggers the brain to signal the kidneys to flush excess fluids out; hence the frequent urination (toilet), and resultant compensatory thirst. Since there’s no insulin to take glucose into the cells, the person feels very tired due to lack of energy. Weight and muscle loss (thinness) are also expected as the body starts using up stored fat from the cells. Other symptoms include dry mouth, blurred vision and slow healing of cuts and wounds. Thrush (fungal yeast infection) in the genital, mouth and certain skin areas is also common. This is because yeast thrives in warm environment with high sugar levels.

Missing these symptoms can be fatal. It may lead to Diabetic Ketoacidosis (DKA). Sadly, most cases of type 1 diabetes are diagnosed at this stage. Due to lack of insulin, the body resorts to burning fatty acids and producing acidic ketone bodies. A high level of ketone bodies in the blood can cause severe illness and death. Symptoms of diabetic ketoacidosis include: vomiting, dehydration, fruity breath (likened to smell of nail varnish or pearl drops). Others are laboured breathing and rapid heartbeat. DKA also causes disorientation. Coma and death are the final consequences of untreated DKA.

There is no cure for type 1 diabetes, but the good news is that following diagnosis, it can be managed with insulin injections, or insulin using an insulin pump. Duration of insulin can vary from a short time, and some lasts for a long time.

My thoughts

This is the 21st century and lack of education shouldn’t lead to a child’s death. It is important to pay attention to presenting symptoms in children, and seek medical attention. Detecting sugar in urine is as easy as urinating in a pot. The health professional will do the rest. Sometimes blood tests are required. Self testing kits are also available in pharmacies. Please watch out for the 4Ts. Read up on children and Type 1 diabetes. Diabetic Ketoacidosis is a medical emergency. Any sign of it should be reviewed by a medical professional immediately. Knowing much saves many.

Info Sources:

World Health Organisation (2015). Diabetes Fact Sheet

Global status report on noncommunicable diseases 2014. Geneva, World Health Organization, 2012.
World Health Organization. Global Health Estimates: Deaths by Cause, Age, Sex and Country, 2000-2012. Geneva, WHO, 2014.
Mathers CD, Loncar D. Projections of global mortality and burden of disease from 2002 to 2030. PLoS Med, 2006, 3(11):e442.
Global status report on noncommunicable diseases 2010. Geneva, World Health Organization, 2011.
Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: Diagnosis and classification of diabetes mellitus. Geneva, World Health Organization, 1999 (WHO/NCD/NCS/99.2).
Morrish NJ, Wang SL, Stevens LK, Fuller JH, Keen H. Mortality and causes of death in the WHO Multinational Study of Vascular Disease in Diabetes. Diabetologia 2001, 44 Suppl 2:S14–S21.
Global data on visual impairments 2010. Geneva, World Health Organization, 2012.
Roglic G, Unwin N, Bennett PH, Mathers C, Tuomilehto J, Nag S et al. The burden of mortality attributable to diabetes: realistic estimates for the year 2000. Diabetes Care, 2005, 28(9):2130–2135.

5 thoughts

  1. I wish my mom will see this. My first son is chubby and he likes to eat well. My mom is always scared that he might be prone to diabetes and I tell her it doesn’t work that way. It isn’t about being fat or being slim. Thanks for this insight.

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