Recently, a study conducted jointly by the University of North Carolina and the Chinese CDC showed that the incidence of diabetes among adolescents aged 7 to 17 in China is four times higher than that of adolescents of the same age in the United States, and the prediabetes rate is even higher at 14.9%. This is closely related to the dramatic changes in lifestyle and nutritional structure in recent decades and the increasing number of overweight adolescents.
So, how to detect diabetes in children early? What should adolescents with diabetes be aware of?
Juvenile diabetes mainly includes type 1 and type 2 diabetes. type 1 diabetes is an autoimmune disease, which is characterized by an absolute lack of insulin in the body and requires lifelong use of exogenous insulin to control blood glucose. type 2 diabetes is characterized by insulin resistance and insulin secretion defects caused by a combination of environmental and genetic factors, and family history of diabetes and obesity are important causes of the development of type 2 diabetes. Some patients with type 2 diabetes are treated with diet and exercise to keep their blood glucose in the ideal range, while those who cannot control their blood glucose well with diet and exercise can be treated with insulin and oral medication.
In the past, the onset of diabetes in adolescents was mainly type 1 diabetes, but in the past 30 years, the number of adolescents with type 2 diabetes has increased two to three times worldwide. The incidence of type 2 diabetes in adolescents may increase due to various factors such as high-fat diet, reduced physical activity, overnutrition and obesity.
Obese children: easy to develop and difficult to treat
Parents must understand the characteristics of diabetes in order to detect early whether their child has diabetes.
Typical type 1 diabetes has the following characteristics: younger age of onset, acute onset, “three more and one less” (more drinking, more eating, more urination, weight loss) symptoms are obvious, some patients start with ketoacidosis, other patients can be caused by infection and other stressful situations resulting in severe hyperglycemia or ketoacidosis, some patients are accompanied by thyroid Some patients also have hypothyroidism.
Type 2 diabetes includes the following important clinical features: obesity and overweight; most onset in adolescence, mostly in females; often accompanied by a family history of type 2 diabetes; the presence of insulin resistance-related diseases, such as polycystic ovary syndrome; and being born as a low-birth-weight or giant child. “Therefore, when children have the above conditions, parents should take them regularly to check fasting blood glucose, postprandial blood glucose and glycated hemoglobin, and do glucose tolerance tests if necessary, in order to detect early whether the child is diabetic or in the pre-diabetic stage and intervene in a timely manner.”
More than 85% of adolescents with type 2 diabetes are accompanied by obesity or overweight. The results of foreign studies show that the heavier the adolescent diabetic patient is, the more difficult it is to control his or her blood glucose, and we feel the same way in our clinical work. The reason why it is more difficult to control blood glucose in these adolescent patients is that the heavier they are, the more serious their insulin resistance is, and the more difficult it is to control their blood glucose.
Therefore, for obese adolescent patients, doctors will take into account the age, height, weight and blood glucose of the children and control their diet and exercise more strictly and individually to increase insulin sensitivity while losing weight, so that their blood glucose can be controlled more easily.
Strict dietary control may affect development
During clinical treatment, Chen found that many parents have a misconception that strict dietary control can lower their child’s blood sugar without realizing that it can affect their child’s growth and development.
In fact, “the treatment of juvenile diabetes is different from adult diabetes. Adolescents need adequate nutrition to meet the needs of growth and development, so in terms of dietary treatment, a diet plan should be developed according to the different conditions of each patient to achieve both blood glucose control and growth and development as much as possible.”
Moreover, it is not better to control blood sugar in adolescent patients as low as possible, and the obsessive pursuit of keeping blood sugar at a low level may cause hypoglycemia in affected children. It is important to know that hypoglycemia is not less harmful to the body than hyperglycemia. Once a child has a hypoglycemic reaction, he or she may have trembling limbs, pale face, panic and black eyes, or may be unconscious or even in a coma, and may have a life-threatening condition.
Adolescent diabetic patients, especially adolescent children have large blood sugar fluctuations, and blood sugar is difficult to control, while prone to hypoglycemia, which increases the difficulty of treatment. It is necessary to set up individualized blood sugar control goals according to the different conditions of patients, conduct close blood sugar monitoring, and implement timely adjustment of treatment measures. Parents should choose a blood glucose meter with simple and convenient operation and accurate results, try to pay attention to their children’s blood glucose monitoring and supervise it. They should not think that they do not need to monitor blood glucose after following the medication given by the doctor, or stop the medication by themselves after the blood glucose is well controlled and interrupt the treatment.
In addition to not strictly controlling the diet, parents should also pay attention to not allowing the child to blindly increase the amount of exercise, and should consider the patient’s physical condition, and choose the exercise time according to the patient’s eating time and insulin injection time, and appropriately reduce the amount of exercise when the child has diabetes complications.
The danger of complications cannot be ignored
Adolescents with type 1 diabetes are more prone to ketoacidosis than adults with type 2 diabetes because of their absolute insulin deficiency. Chronic complications such as retinopathy and diabetic nephropathy usually appear 3 to 5 years after the onset of diabetes. In order to avoid or delay the emergence of these complications, the following issues should be noted.
1. Lipid levels should be measured at the same time as diabetes is diagnosed, and if they are not normal, they should be monitored annually. If LDL cholesterol is <2.6 mmol/L, the lipid profile should be reviewed every 5 years.
2. Once the child reaches 10 years of age and the duration of diabetes has been 5 years, he or she should be screened annually for microalbuminuria. Urine samples should be taken at random time points and the albumin to inosine ratio (ACR) should be calculated.
3, Timely monitoring of blood pressure, if persistently higher than the 95th percentile of the same age, sex and height group or persistently >130/80 mmHg, should be treated with blood pressure lowering.
4, children ≥ 10 years old and have diabetes for 3 to 5 years should have an eye examination and be examined once a year.
Finally, to remind you that in the process of treatment, “because of the psychological and emotional changes of adolescents, it is very easy to have a sense of fear of the disease and thus generate negative emotions, can not cooperate with the treatment, so doctors and parents also need to pay more attention to the psychological response of children, more communication with children, on the one hand, to fully understand the dangers of the disease, but also to help them remove psychological barriers, establish confidence in overcoming the disease, so as to better cooperate with the treatment.”
Insulin pump – coping with the “dawn phenomenon” in children with diabetes
For juvenile diabetics, it has been a challenge to inject the exact dose of insulin.
Insulin pump therapy is an insulin treatment method that uses an artificial intelligence-controlled insulin input device to control hyperglycemia by simulating the physiological secretion pattern of insulin through continuous subcutaneous infusion of insulin. It can avoid the difference of injection dose caused by different sites, different techniques and different injection devices, which makes it easier to control blood sugar.
Due to the secretion characteristics of growth hormone and steroid hormone, adolescent diabetic patients are prone to dawn phenomenon (a state of early morning hyperglycemia caused by the unbalanced secretion of various hormones at dawn, i.e., 3-9 a.m., when diabetic patients’ blood glucose control is still stable and stable at night, i.e., no hypoglycemia). .
In recent years, more and more juvenile diabetic patients have started to apply insulin pump therapy, but it is still not widely used because of the high price and the need to wear it for a long time.