07/03/03
According
to the American Diabetes Association, 17 millions Americans have diabetes
today, which accounts for 6.2% of the population. Children (those under the age of 20) account for 151,000 of
people with diabetes. Although Type I
(also known as Juvenile or Insulin Dependent Diabetes Mellitus) has typically
been associated with children, Type II (also known as Non-insulin Dependent
Diabetes Mellitus) is becoming more prevalent in children, especially in Native
American, African American, Hispanic, and Latino populations. Gestational diabetes (GD), or diabetes in
pregnancy, also plays a role in childhood diabetes because uncontrolled or
unmanaged GD can lead to a greater risk for Type II diabetes for the child.
In
a person not afflicted with diabetes, elevated blood glucose causes release of
insulin from beta cells on the Islets of Langerhans in the pancreas. Insulin stimulates cells to take in glucose
(which is nutrition) and the blood sugar level is lowered accordingly. Insulin also stimulates muscle and liver
cells to store glucose as glycogen, which is the storage form of glucose; this
too lowers blood glucose levels.
Oppositely, when blood sugar levels are low, glucagons is released from
the alpha cells of the Islets of Langerhans and new glucose is formed from
amino acids and fats, which raises the blood glucose levels.
When
someone has diabetes, their body is unable to regulate their blood glucose
levels either through a lack of or inability to produce insulin. Glucose is necessary in the body for energy
but only in specific levels, because, too much or too little can greatly affect
a person’s health. An influx of glucose
(or sugar) in the blood can lead to heart disease, blindness, kidney failure,
and amputation of the lower-extremities.
Diabetes is a life-long or chronic disease. It is the seventh leading cause of death in the United States,
and although this statistic is reflective of adult rates, many of them died of
complication from diabetes beginning in childhood.
People
with Type I diabetes account for 5% of the diabetes population and is the most
common disease found in children. Type
I diabetes is an autoimmune disease, specifically due to the pancreas’
inability to produce insulin.
Autoimmune diseases are classified as the body attacking it’s own organs
and tissues and the process of such begins a lot sooner than the results
present themselves. The direct cause of
Type I diabetes is unknown, but it is surmised that the environment and
hereditary factors play a role.
Symptoms include (but are not limited to): frequent urination, excessive
thirst, loss of appetite and weight, excessive tiredness, and yeast infections
of the skin around the mouth.
Type
II Diabetes accounts for 90-95% of the diabetic population and although
formally known as Adult-onset diabetes, it is becoming more and more frequent
in children due to eating and lifestyle habits. People with Type II either do not produce enough insulin or their
body is unable to process the insulin in such a manner to break down the
glucose. According to a Yale University
study, because 25% of children are glucose intolerant (as young as age 4), the
incidence of children diagnosed with type II continues to rise. Children who develop type II usually present
with very few symptoms, if any. The
major risk factors are children who are overweight, not physically active,
having a family history of the disease, African-American, Hispanic,
Asian-American, Pacific Islander, or Native-American, female, or having a
mother who had gestational diabetes.
Type II diabetes in children is frequently associated with high
cholesterol, high blood pressure, polycystic ovary syndrome, and a skin condition
called acanthosis nigricans.
Another
subset of Type II diabetes is something called “pre-diabetes.” Pre-diabetes is diagnosed when a child has
higher blood glucose levels than normal, but have not been diagnosed with
diabetes as of yet. An estimated 16 million people in the United States have
pre-diabetes now and are unaware of it.
The fact about pre-diabetes is that the person afflicted will typically
be diagnosed with Type II in the next ten years if they do not lose 5-7% of
their body weight and change their lifestyle accordingly. People with pre-diabetes are also at a risk
for developing heart disease.
There
are many components of treatments for Type I and Type II. Due to the fact that Type I is caused by
lack of insulin production, the treatment options are more regimented. Type I is treated by strict dietary control,
planned physical activity, home blood glucose testing (several times a day),
and home insulin injections (also several times a day). Treatment for Type II includes diet control,
exercise, home blood glucose testing, and with some people, oral insulin or
insulin injections.
Gestational
Diabetes affects about 4% of all pregnant women and is diagnosed the 28th
week of pregnancy in women who have never had diabetes before. The direct cause is unknown, however, the
placenta, which helps the developing fetus grow, secretes hormones that block
the effects of insulin in the mother’s body.
This process, known as insulin resistance, makes it hard for the mother
to break down glucose, which leads it to increase in the body to unhealthy
amounts. Untreated, or poorly treated
GD causes the developing baby’s pancreas to produce large amount of insulin to
get rid of the excess glucose, however, the baby has enough energy and
nutrients from the mother as s/he develops and the excess insulin is stored as
fat. This can lead to “fat” baby
syndrome, or macrosomia and the baby is born with dangerously low blood sugar,
due to the overproduction of insulin by their pancreas and increases the
likelihood that the child will suffer from obesity. Obesity in children is one of the leading factors in type II
diabetes in children.
Treatment
of GD usually only requires dietary changes, however in sever cases,
supplemental insulin is required.
Looking into the future, women who have had GD should watch their weight
gain, make healthy food choices, and exercise regularly.
In
1994, it was estimated by the New Jersey Department of Health and Senior
Services that 5,888 children (or 2.8% of the total population) under the age of
20 had diabetes (whether diagnosed or undiagnosed) in New Jersey. In the United States however, the National
prevalence of people under the age of 20 afflicted with diabetes is 0.16%. Therefore, the cases of children afflicted
with diabetes in the state of New Jersey in 1994 were 5.71 times as high as the
national average. The possibilities for
such differences are healthcare accessibility, increased childhood obesity, and
the trend towards a sedentary lifestyle.
In
order to remedy the trend towards childhood diabetes (especially type II), a
magnitude of people must be involved.
Children should be taught healthy eating habits and how to make wise
choices of foods. Such habits must be
taught at home, the doctor’s office, and reinforced in school. Adequate physical activity should be a
factor of every child’s life as well.
If a child has been diagnosed with diabetes, it is even more important
to eat healthy and exercise, in addition to managing glucose and insulin levels
so that their quality of life can be extended and as normalized as possible.