Juvenile Diabetes
Definition
Juvenile diabetes mellitus is now more commonly called Type 1 diabetes. It is a syndrome with disordered metabolism and inappropriately high blood glucose levels due to a deficiency of insulin secretion in the pancreas.
Description
After a meal, a portion of the food a person eats is broken down into sugar (glucose). The sugar then passes into the bloodstream and into the body's cells via a hormone called insulin. Insulin is produced by the pancreas. Normally, the pancreas produces the right amount of insulin to accommodate the quantity of sugar. However, if the person has diabetes either the pancreas produces little or no insulin, or the cells do not respond normally to the insulin. Sugar builds up in the blood, overflows into the urine and passes from the body unused. Diabetes can be associated with major complications involving many organs including the heart, eyes, kidneys, and nerves, especially if the blood sugar is poorly controlled over the years. Types Of Diabetes Diabetes mellitus is a chronic disease caused by the inability of the pancreas to produce insulin or by the body to appropriately use the insulin it does produce. There are two main types of diabetes, Type 1 and Type 2.
Type 1 diabetes(also called insulin-dependent diabetes or juvenile diabetes) is caused by autoimmune destruction of the B cells of the pancreas which normally secrete insulin. Those patients require insulin injections for survival. Type 2 diabetes(or non-insulin-dependent diabetes) is much more common and results from insulin resistance, mainly due to obesity, with inadequate additional production of insulin by the body. In other words, the pancreas produces a reduced amount of insulin or the cells do not respond to the insulin, or both.
Complications of Diabetes If juvenile diabetes is left unmanaged, damage can occur to:
- Eyes - leading to diabetic retinopathy and possible blindness
- Blood vessels - increasing risk of heart attack, stroke and peripheral artery obstruction
- Nerves - leading to foot ulcers, impotence, and digestive problems
- Kidneys - leading to kidney failure
Causes
An estimated 17 million people in the U.S. have diabetes, of which about 1.4 million have Type 1 diabetes. The highest prevalence of Type 1 diabetes is in Scandinavia, where it comprises up to 20 percent of the total number of patients with diabetes. The prevalence of Type 1 diabetes is about 5-10 percent of the total number of diabetes patients in the U.S., while in Japan and China, less than 1 percent of patients with diabetes have Type 1. Approximately 35 American children are diagnosed with juvenile diabetes every day. The exact cause of Type 1 diabetes (juvenile diabetes) is still unclear. However, it is believed that Type 1 diabetes results from an infectious or toxic insult to persons whose immune system is genetically predisposed to develop an aggressive autoimmune response either against altered pancreatic B antigens (proteins) or against molecules of the B cell resembling a viral protein (called molecular mimicry). It is not caused by obesity or by eating excessive sugar. The risk of juvenile diabetes is higher than virtually all other severe chronic diseases of childhood. Juvenile diabetes tends to run in families. Brothers and sisters of a child with juvenile diabetes have at least 100 times the risk of developing juvenile diabetes as a child in an unaffected family.
Symptoms
The symptoms of Type 1 diabetes (juvenile diabetes) may occur suddenly, and include:
- Frequent urination
- Increased thirst
- Extreme hunger
- Unexplained weight loss
- Extreme weakness and fatigue
- Urinating at night (nocturnal enuresis)
- Blurred vision
- Numbness or tingling in the hands or feet
- Heavy or labored breathing
- Drowsiness or lethargy
- Fruity odor on the breath
Diagnosis
A child with the above symptoms must be seen by a physician as soon as possible. Besides a complete history and physical examination, the doctors will do a battery of laboratory tests. There are numerous tests available to diagnose diabetes such as urine test, blood test, glucose-tolerance test, fasting blood sugar and the glycohemoglobin (HbA1c) test. A urine sample will be tested for glucose and ketones (acids that collect in the blood and urine when the body uses fat instead of glucose for energy). A blood test is used to measure the amount of glucose in the bloodstream. A glucose-tolerance test checks the body's ability to process glucose. During this test, sugar levels in the blood and urine are monitored for 3 hours after drinking a large dose of sugar solution. The fasting blood sugar test involves fasting overnight and blood being drawn the next morning. The glycohemoglobin test reflects the cumulative effects of high blood glucose (and measures the degree of control over blood glucose after treatment begins).
Treatment
Treatment of Type 1 diabetes involves:
- Diet
- Insulin
- Self-monitoring of blood glucose
- Exercise
Questions
Does the child have Type 1 diabetes? How can this best be managed? What is diabetic ketoacidosis? What changes in diet will be required? Is there a specific meal plan? What type of insulin should be used - what is the frequency and dosage? How can exercise help the child - how much, and what type? At what age should the child self-administer insulin? What restrictions and limitations will be placed upon the child's life? Should the child's teacher or school nurse be alerted to the situation? Are there any support groups or organizations regarding the care of a child with diabetes? What is the prognosis?
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