With the improvement of living standards and lifestyle changes, type 2 diabetes is no longer the exclusive preserve of adults. Nowadays, there are more and more naive and young faces among the middle-aged and elderly-oriented type 2 diabetes team. Survey data from Beijing and Shanghai show that the prevalence of type 2 diabetes among adolescents is about 0.48‰ to 0.60‰. This “younger” trend of diabetes is closely related to the poor lifestyle of adolescents, especially the long-term consumption of high-calorie and high-fat foods. Diabetes not only seriously damages the physical and mental health of adolescents, but also imposes a heavy economic burden on families and society. In order to protect the future of our country, we must vigorously advocate a healthy lifestyle, starting with children and early intervention.
I. Diabetes in children, type 2 is becoming the main character
With the improvement of living standards and lifestyle changes, the diabetes army is growing at an unprecedented and alarming rate. According to the latest statistics, the prevalence of diabetes among adults in China is 11.6%, and the prediabetes rate is 50.1%, according to this estimate, there are about 113.9 million diabetics and nearly 500 million prediabetics in China. In recent years, due to the increase of obese children, there are more and more naive and young faces among the middle-aged and elderly-oriented type 2 diabetes team. For a long time, it has been believed that diabetes in children is mostly type 1, while type 2 diabetes is the preserve of adults. At present, it seems that this view really needs to be revisited and revised. The International Diabetes Federation predicts that within the next decade, the proportion of type 2 diabetes in children will fully exceed that of type 1 diabetes. In fact, in Japan, Europe and the United States, type 2 diabetes in children already accounts for 80% of the total number of children with diabetes, much higher than type 1 diabetes. There is a lack of statistical information on this in China, but it is an indisputable fact that type 2 diabetes is increasing in children in clinical practice.
Second, children become “little sugar man”, are obesity caused by the trouble
Type 2 diabetes is not only related to heredity, but also closely related to poor lifestyle. Dietary structure is not reasonable (high fat, high calorie diet), exercise is seriously insufficient, resulting in calorie intake than consumption, resulting in a sharp increase in the number of obese children, which is the main cause of type 2 diabetes in children. Survey data shows that 12% of children in China are overweight and 8% are obese.
Why are obese people prone to type 2 diabetes? This is because obesity (especially abdominal obesity) can make the body produce insulin resistance, in order to maintain normal blood sugar, the body must compensate for the secretion of more insulin to meet the metabolic needs, over time, the pancreatic islet cells are overwhelmed, impaired function, and eventually lose compensation, resulting in increased blood sugar and diabetes. The younger the age of obesity and the longer the history of the disease, the greater the risk of diabetes.
The significantly earlier age of onset of type 2 diabetes not only makes the diabetes cohort even larger, but also has more serious consequences in the long run. Imagine being with diabetes at a young age, which will inevitably have many effects on your child’s future life, school, work, marriage, and psychology. Once poorly controlled, it will not only affect the growth and development of the child, but also various terrible complications, such as kidney failure, blindness, cardiovascular and cerebrovascular diseases, which will unfortunately accompany the child with diabetes for the rest of his or her life, and the economic burden and mental pressure on the child and his or her family will be immeasurable, which cannot but cause concern and vigilance of the whole society.
3. High-risk children, key screening
Children with type 1 diabetes usually have an acute onset, and the symptoms of “three more and one less” (i.e., excessive urination, excessive drinking, excessive eating, and weight loss) are very obvious, and in severe cases, vomiting, abdominal pain, diarrhea and other gastrointestinal symptoms are often the first manifestation.
Unlike type 1 diabetes, most children with type 2 diabetes have an insidious onset, and the symptoms are mild and often atypical when they first appear. Therefore, for obese children, especially those with a family history of diabetes, type 2 diabetes should be highly suspected once the following signs appear.
1. the appearance of obvious symptoms of thirst, excessive drinking, polyuria and polyphagia.
2. recent significant increase in food intake but weight loss instead of gain.
3, unexplained weakness and drowsiness.
4. “Acanthosis nigricans” appears in the folds of the neck, armpits, elbows, groin, etc. (meaning that the skin in the folds is dark and rough, with a velvety feeling when touched, which is the result of high insulin stimulation and reflects the existence of insulin resistance in the body).
5, obesity accompanied by hypertension, dyslipidemia, fatty liver, sleep apnea syndrome, polycystic ovary syndrome.
6. Wounds that do not heal easily, old skin boils or girls who often feel itchy vulva, etc.
Parents should pay extra attention to such children and should go to the hospital regularly (every six months) for blood glucose tests, not only for fasting blood glucose, but also for 2 hours after meals, the latter being more significant for early detection of diabetes. The diagnostic criteria for diabetes in children and adolescents are the same as those for adults, i.e. fasting blood glucose ≥7.0mmol/L or 2 hours after meal blood glucose ≥11.1mmol/L; if the patient has “three more and one less” diabetes symptoms, only one blood glucose result can be diagnosed, if there are no diabetes symptoms, two blood glucose tests must be performed. If the patient has “three more and one less” diabetic symptoms, only one blood glucose result can be diagnosed.
Clinical treatment, not to copy adult diabetes
The treatment principles for children with type 2 diabetes are basically the same as those for adults with type 2 diabetes, but there are some special features.
Diet: It is important to control the total caloric intake without being too restrictive, but also to pay attention to balanced nutrition. Because children are growing and developing, the basic needs for growth and development must be ensured. The formula for calculating the daily calorie requirement for normal children is: 1000 + age x 80 (kcal). The formula for calculating the standard weight of teenage children (7~14 years old) is: standard weight (kg) = age × 2+8. For patients who are obese (more than 20% over the standard weight), the calorie requirement is 65%~80% of that for healthy children of the same age, and for patients who are overweight (10%~20% over the standard weight), the calorie requirement is 90% of that for healthy children of the same age. In addition, it is best to mix coarse and fine staple foods, and eat more fresh fruits and vegetables, lean meat, fish and other foods, while trying to avoid high-calorie, high-fat foods, such as candy, chocolate, cream, foreign fast food and so on. The practice of “excessive dieting” or “replacing side dishes with staple foods” is not advisable, as this is prone to starvation ketosis, and because side dishes contain more fats and oils, eating too much will lead to blood lipid disorders and increase obesity.
Exercise: The importance of exercise for children with type 2 diabetes is self-evident. Adhering to long-term regular aerobic exercise not only reduces weight, but also helps reduce insulin resistance and assists in lowering blood sugar. It is recommended that patients should do about 1 hour of moderate intensity exercise (such as jogging, swimming, cycling, etc.) every day, but avoid strenuous exercise. Drink plenty of water before exercise and carry sugar cubes for emergency use.
Medication: Human insulin and insulin analogues are the main drugs used to treat diabetes in children. Besides insulin, metformin is the only oral hypoglycemic drug currently approved by the U.S. Food and Drug Administration (FDA) for use in children, which can safely lower sugar and control weight, and is especially suitable for obese children with type 2 diabetes. As for other glucose-lowering drugs medications (such as sulfonylurea and glargine insulin stimulants, alpha-glucosidase inhibitors, and thiazolidinedione insulin sensitizers) have not been officially approved for use in children with diabetes to date.
Usually, diet and exercise are preferred for children with type 2 diabetes who have mildly elevated blood glucose, and then glucose-lowering medications (e.g., metformin) are initiated if blood glucose control is poor. For children with high blood glucose or ketoacidosis at the time of initial diagnosis, insulin therapy can be initiated to eliminate the damage to pancreatic islet B cells caused by high blood glucose and to reverse and repair the function of pancreatic islet β cells. After the blood sugar is controlled, glucose-lowering drugs are added and insulin is gradually reduced to discontinued. Children with diabetes have the characteristics of activity and irregular eating, so they need to use more flexible and effective insulin therapy.
V. Psychological problems, can not be ignored
Children and adolescents are not yet mature physically, and their psychological state is relatively fragile. A survey shows that 30% of children with diabetes have low self-esteem, depression and other psychological problems. If these problems are not solved properly, they will definitely affect the smooth clinical treatment. Therefore, for children with diabetes, we should not only pay attention to the problem of blood sugar control, but also pay attention to their psychological problems, and help them understand and treat the disease correctly, enhance their self-confidence and courage, and get rid of the negative emotions through psychological guidance and various kinds of education. Of course, these need the cooperation and support of parents, schools and the whole society.
Sixth, blood sugar control, should not be too strict
Long-term hyperglycemia can lead to retinopathy, nephropathy, peripheral neuropathy, hypertension, dyslipidemia and other comorbidities, which seriously endanger the health and normal growth of the children, therefore, good blood sugar control is very important for the children. However, attention should also be paid to avoid hypoglycemia, the latter is also not to be underestimated, hypoglycemia can lead to serious brain damage, so that the child’s language and memory ability is significantly reduced, and severe hypoglycemia can even cause death if not rescued in time.
Compared with adults, children with diabetes have their own characteristics: they are young and need longer night sleep; their behavior and eating habits are unpredictable; they have poorer perception of hypoglycemia and have higher insulin sensitivity. These characteristics make the children themselves vulnerable to hypoglycemia, and the risk of hypoglycemia is even higher if glycemic control is too tight. In view of this, the glycemic control standards for children with diabetes are relatively more lenient than those for adults, with pre-meal glucose control of 4-8 mmoI/L, 2-hour post-meal glucose ≤10 mmol/L, and glycated hemoglobin (HbAIc) below 7.5%. control goals, as shown in the following table.
Glycemic control targets for children with diabetes
VII. Control obesity to prevent problems before they occur
Obesity is not only easy to make children have low self-esteem, which will have adverse effects on their future mental health, personality shaping and interpersonal communication, but also sow the seeds of hypertension, coronary heart disease, hyperlipidemia and diabetes in the future. Studies show that for every 1 kg increase in body weight based on standard weight, the risk of diabetes will increase by at least 5%; more than 85% of children with type 2 diabetes are obese.
Over-eating and under-activity are the two main causes of obesity, so the key to controlling obesity is to “keep your mouth shut and your legs open”. The best love parents can give to their children is not to blindly satisfy their appetite, but to help them establish a healthy life concept from childhood and develop good eating and exercise habits. Let children eat less greasy food, eat more vegetables and fruits and mixed grains, pay attention to dietary balance, avoid long hours on the Internet or watching TV, strengthen physical exercise, in addition, pay attention to the combination of work and rest, to ensure good sleep, to avoid long-term high mental tension is also very necessary, a healthy lifestyle helps to lose weight and can largely avoid the occurrence of diabetes.
Children with diabetes should not use diet pills. To date, no clinical reports have been seen on diet pills that can both lose weight and be used safely and harmlessly in children. Advertised diet pills of all shapes and sizes should not be used for the treatment of childhood obesity.